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Inspection on 19/02/08 for Myford House Nursing And Residential Home

Also see our care home review for Myford House Nursing And Residential Home for more information

This inspection was carried out on 19th February 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

Improvements have been made to the upgrading of the kitchen (there are plans for further improvements), and some communal and private areas have been decorated and refurbished. Amendments have been made to the recruitment procedures ensuring that people are fully suitable to work with vulnerable adults.

What the care home could do better:

The service user guide should be reviewed at regular intervals to ensure that the information included in the document is correct and up to date. When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. A full review of meals, mealtimes and dining arrangements is urgently required to ensure that people are well nourished, and are offered meals (and drinks) at appropriate times. The wardrobes provided by the home should be securely fixed to ensure the safety of people living, working and visiting the home. Staffing levels and skill mix should be determined by the assessed needs of the people living at the home, to ensure that care needs are fully met and that outcomes for people are improved. The registered manager should continue and complete the Registered Managers Award and continue to develop skills and competencies through additional management training.

CARE HOMES FOR OLDER PEOPLE Myford House Nursing And Residential Home Woodlands Lane Horsehay Telford Shropshire TF4 3QF Lead Inspector Joy Hoelzel Unannounced Inspection 19th February 2008 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 Myford House Nursing And Residential Home DS0000022260.V358543.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. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Myford House Nursing And Residential Home Address Woodlands Lane Horsehay Telford Shropshire TF4 3QF 01952 503286 01952 504966 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) Redwood Care Homes Ltd Mrs Alison Hubbard Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may accommodate 30 persons requiring Nursing Care. The home must comply with the Staffing Notice issued by the Shropshire Area Health Authority dated 31 May 2000, in respect of the nursing care beds. 3rd October 2006 Date of last inspection Brief Description of the Service: Myford House is a care home for older people, registered to provide both personal and nursing care for up to 40 Service Users, and offers both single and double bedroom accommodation. All three floors are accessible via a passenger lift. The home is situated in the Horsehay area of Telford and is a large detached property set in its own grounds. Information of the home and the provision of the service are available in a service user guide, which incorporates the statement of purpose. The booklet is available on request at the home. The service user guide does not include information on the current level of fees for the service. The reader may wish to obtain more up to date information from the care service. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place over six and a half hours on Tuesday 19th February 2008. Twenty three of the thirty eight National Minimum Standards for Care Homes for Older People were inspected as they are viewed as key standards for services. Thirty two people are currently living at the home and during the inspection were observed to be accessing all areas of the home. A registered nurse was in charge of the home, supported by four care staff and ancillary personnel. A look around the home took place, which included a number of bedrooms as well as communal areas. The care documents of a number of people using the service were viewed including care plans, daily records and risk assessments. Other documents seen included medication records, service records, some policies and procedures and staffing records. Discussions were held with people living, visiting and working at the home. Prior to this inspection an Annual Quality Assurance Assessment (AQAA) document was posted to the home for completion. The AQAA is a selfassessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service and is an opportunity for providers to share with us areas that they believe they are doing well. It is a legal requirement that the AQAA is completed and returned to us within a given timescale. The registered manager completed this document and returned it to us. Comments from the AQAA are included within this inspection report. What the service does well: The accommodation provided is of a good standard with the premises being warm, comfortable and homely. People living, working and visiting the home commented – Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 6 ‘ The management and staff are always approachable and check with us if everything is ok, it is always easy to find someone to talk to if necessary’ ‘My relative has improved and is comfortable, clean and as well as can be expected under difficult circumstances, the staff have shown great affection over the past months’. What has improved since the last inspection? What they could do better: The service user guide should be reviewed at regular intervals to ensure that the information included in the document is correct and up to date. When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative. More attention should be given to increasing the variety, frequency and range of social and leisure activities to meet the needs and personal preferences of all the people living at the home. A full review of meals, mealtimes and dining arrangements is urgently required to ensure that people are well nourished, and are offered meals (and drinks) at appropriate times. The wardrobes provided by the home should be securely fixed to ensure the safety of people living, working and visiting the home. Staffing levels and skill mix should be determined by the assessed needs of the people living at the home, to ensure that care needs are fully met and that outcomes for people are improved. The registered manager should continue and complete the Registered Managers Award and continue to develop skills and competencies through additional management training. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 7 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. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 8 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 Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 9 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): OP 1,3,6, Quality in this outcome area is good. Admissions are not made to the home until a needs assessment has been undertaken by a senior member of the staff team, this ensures that the home is confident that all assessed care needs of the individual can be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of the service provision are available in a service user guide that incorporates the statement of purpose. The booklet is available on request and was last reviewed in November 2006. This booklet was not inspected in depth on this occasion but on general observation the service user guide does not detail the current level of fees for the service although there is a section on Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 10 what is included in the fees. To comply with the regulations the service user guide must include information about the current level of weekly fees. The case file of the person who recently moved into the home was looked at to see if information had been sought regarding this persons needs prior to moving into the home. A letter is on file from the local hospital detailing the individual requirements, in addition an assessment was completed by a member of staff at the home. This person stated that they were very pleased to be at the home following a very long hospital stay and that it was comfortable and ‘not a bad place to live’. Other case files looked at included social worker reviews; assessments from Primary Care Trusts and community care services. The Annual Quality Assurance Assessment (AQAA) completed by the manager of the home specifies that – ‘We do not accept residents unless we are satisfied we can meet their assessed needs’. The service user guide explains the admission policies and procedures in detail, offering a full overview of what can be expected. The home does not provide an intermediate care service. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 11 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): OP 7,8,9,10 Quality in this outcome area is adequate. Each individual has a care plan but the practice of involving people in the development and review of the plan is variable. The plan includes basic information necessary to deliver the person’s care but does not consistently reflect the care being delivered. The current practice of administering medication has the potential of putting people who use the service at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home have a plan of care that is based on the information gained prior to admission; the plan is then reviewed on a regular basis. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 12 Core care plans are used to record an assessment of individual persons needs using a tick list approach. Four case files were selected for inspection and generally contained the information required to ensure staff have the specific details for successfully meeting a persons needs. However there appeared to be omissions of information and some discrepancies when discussing care needs with individuals and observing staff working practice. One case file included on assessment of a person ‘not requiring bedrails whilst in bed’. On observation this person would most definitely have fallen out of bed if the rails had not been in place as they were leaning heavily against the rail whilst in bed waiting for staff to assist with washing and dressing. Another person spoke of a specific treatment the GP had prescribed recently and for which she required the assistance from staff. Observation of the care plan did not specify the treatment or the action needed to be taken by staff. One case file looked at documented the contact with other healthcare professionals when a problem and concern had been identified. There was no evidence in the case files selected to suggest that people or their representatives were being fully involved with the care planning process. One person stated that they were not aware of a ‘care plan’ and as such had no involvement in planning their care. Comments in the AQAA indicates that they could do better by ‘ Engaging residents in care planning and record same’. It is acknowledged that some people may not wish to or are unable to contribute to the process but efforts should be made to ensure that the plan of care is discussed and agreed with the individual. The home operates a twenty eight day prescribing regime for the administration of medication using a monitored dosage system with the additional use of boxes and bottles of medicines. The registered nurses administer the medications, the Medication Administration Record appears to be fully completed, and no gaps in the recording sheet were seen in the selection viewed. During the morning of this inspection the registered nurse was endeavouring to complete the morning medication round but was continually being called away to attend to other things. This and the general working practice did not guarantee that medications were being administered at the prescribed times. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 13 On person living at the home confirmed that on regular occasions medication prescribed for a specific medical condition is not being administered at the correct and stated times. The nurse discussed the difficulties with the limited space in the medication trolleys and the practice of sharing prescribed medicines between residents was taking place. A locked room is used for storing surplus medications and the trolleys when they are not in use. Insulin that is in use is being stored in the fridge contrary to the manufacturers instructions. This was discussed with the registered nurse and the quality manager at the time and an alternative storage procedure was implemented. A check was made of the storage and recording of the controlled drugs and was found to be satisfactory. The care staff were generally observed to be addressing people in an appropriate manner and it appeared that good relationships had been developed. People living at the home in the main commented that the ‘staff were very good’. Observation of the shared rooms during the tour of the premises evidenced that some privacy curtains were either missing or needed repair. In one bedroom there were no privacy curtains around the wash hand basin, thereby compromising a persons privacy and dignity when being supported with personal care. Myford House Nursing And Residential Home DS0000022260.V358543.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): OP 12,13,14,15 Quality in this outcome area is poor. Generally staff are aware of the need to support residents with daily life and social activities but are very limited by workload and time constraints. The working practices and routines adopted have the potential of placing people at risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One existing member of staff has the additional responsibility of organising and arranging social and leisure activities with staff stating that an additional six hours per week is soon to be allocated. This person was busy all morning serving breakfast to people. During the day there appeared to be very little structured activity as staff were extremely busy with attending to the personal care needs of people and assisting with their preparations for the day. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 15 People were generally sitting in the lounge and dining areas, the television was on, some people were asleep in the armchairs, and others were waiting for staff to help them. Information gained by the ‘Have your Say’ surveys completed by relatives on behalf of residents indicates that leisure activities are somewhat lacking with two people indicating that only sometimes suitable activities are arranged with one person stating that there is never anything arranged. The AQAA completed by the manager includes comments that they – ‘Provide activity in an informal and relaxed way, and have arranged outings’ But goes on to state that they could do better by – ‘Structure an activity programme more positively and record who engages/declines’. Visitors to the home commented that they were able to visit at times suitable for them and felt welcome when visiting the home. Generally they were satisfied with the care provided but stated that in their opinion there ‘was never enough staff on duty’. Meals are served in the dining room or lounge areas, observation of the midday meal in the dining room indicated that it was a very functional occasion with little opportunity for the meal to be a social or pleasing experience. Staff appeared to be very rushed with little preparation and attention to detail. The dining tables did not have any table linen, the cutlery and paper serviette were placed directly on the table, and there were insufficient condiments available with tables sharing the salt and pepper pots. Observation of staff working practice and discussion with staff and residents evidenced that breakfast is only served to people in their bedroom if they are poorly other people have to wait until staff help them to get up and dressed and then go to the lounge/dining room for breakfast. This means that some people were not having breakfast until 11:30. Staff confirmed that the last meal offered was the previous evening meal, which is served from 17:30- 18:30, indicating that some people are not being offered diet or fluids for in excess of twelve hours. One person received a bowl of cereal at 11:40 but was not offered a hot drink, they confirmed that they had a cup of tea ‘when the day staff came on duty’ but had been offered nothing else. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 16 Another person went to the dining room at 11:10 and requested egg and bacon but was told that they were vegetarian and as such did not eat meat and was given egg on toast. People that were up at breakfast time confirmed that they had had sufficient to eat but it was observed that no further hot drinks were offered or available midmorning. Lunch was then served to everyone at 13:30. The service user guide indicates that – • • • • Breakfast is served 07:30 onwards-flexible finish time Lunch 12:30-14:00 Evening meal 17:30-18:30 Tea, coffee and snacks will be served throughout the day. Myford House Nursing And Residential Home DS0000022260.V358543.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): OP 16,18 Quality in this outcome area is good. The complaints procedure is supplied to people living at the home and is displayed in a number of areas within the service. Residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Details of how to make a complaint are included in the service user guide and a copy of the procedures is displayed at the entrance to the home. The ‘Have Your Say’ surveys completed all indicated that people know how and to whom to make a complaint – ‘This has been explained to me and my family’. Since the last inspection in October 2006 we have received three complaints regarding the service directly and there has been one referral to the safeguarding adults team for investigation. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 18 Two of the complaints raised concerns with the staffing levels and people having to wait for assistance from the staff, mainly to help wash and dress in the mornings and then for assistance to go to the toilet. These two complaints were forwarded to the manager to consider using the homes own procedures and a reply was received. The most recent complaint again commented on the insufficient staffing levels and that people had to wait for assistance. These issues were looked at during this inspection and confirmed that people have to wait for unacceptable periods of time for staff to assist them with daily living. The findings were discussed with the quality manager and the person in charge during and at the end of the inspection and an assurance was given that any shortfalls in the staffing levels would be filled with agency staff until suitable recruitment take place. We will be carefully monitoring the situation. The referral to the safeguarding adults team was investigated through the procedures and reached a satisfactory conclusion. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. Myford House Nursing And Residential Home DS0000022260.V358543.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): OP 19, 24,26 Quality in this outcome area is good. The home provides a physical environment that generally meets the specific needs of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was warm and cosy with all areas being clean and hygienic. Some areas of the home have benefited from redecoration and refurbishment and there is an ongoing plan for further improvements. Most people spoken with stated that they were satisfied with their accommodation, one person, however, although reluctant to move to a larger Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 20 room, spoke of the difficulties with not having enough space for a suitable arm chair to sit in when they are out of bed. They have to sit in a wheelchair all the time. Many bedrooms were seen to have lots of personal possessions and treasured items that people had brought into the home with them. Some of the wardrobes provided by the home had not been secured to the wall to prevent them from toppling over and causing injury. Not all bedroom doors have been fitted with a suitable locking facility. The person in charge stated that locks are fitted if the resident requests this. A requirement was made following the last key inspection in October 2006 that ‘All radiators in areas accessible to residents must have appropriate guards in situ’. The quality manager stated that three radiators are still requiring covers but these are in areas of low risk to residents. The Environmental Health Officer has recently visited the home; staff confirmed that action has been taken to ensure the recommendations are complied with. Comments included in the ’Have Your Say’ surveys completed indicated a satisfaction with the accommodation and – ‘The home is always fresh and clean’. Hand wash facilities have been provided in all communal areas and at the point of the delivery of care for general hygiene purposes and to ensure effective infection control. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30 Quality in this outcome area is poor. Staffing levels are not meeting the needs of the people using the service, with their health and welfare being adversely affected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A duty rota is maintained on a weekly basis to identify the people in the home at any one time. Staffing at the time of this inspection consisted of 1 registered nurse, 4 care staff, domestic and catering staff. The person in charge stated that there are currently 32 people living at the home of which eight people are having a re- assessment of their care needs following deterioration in their health. General observations and discussion with staff confirmed that staffing numbers were not sufficient to successfully meet the care needs of the people living at the home. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 22 As discussed earlier there are many delays with staff availability to assist people to wash and dress and subsequently there is a delay in people receiving adequate nutrition. Other people stated that they had to wait over an hour to get assistance to go to the toilet and on occasions this had caused some embarrassment. Other people stated that they did not receive their medication at the correct time resulting in potentially causing deterioration in their physical condition. During the morning the nurse was administering the medications from the trolleys in the main lounge but was continually being called away to assist in other areas. People appeared to be disengaging due to the lack of social stimulus and activities. This was discussed with quality manager and person in charge during and at the end of this inspection with an assurance given that immediate attention would be given to ensure that there are staff on duty in sufficient numbers to meet the needs of people living at the home. We will be closely monitoring the situation. Comments included in the ‘Have Your Say’ surveys indicated a satisfaction with the care provided by staff but discussed difficulties with‘Main concern is that staff tend to take their breaks at the same time it is often difficult to find someone at times’. ‘Mother’s needs are usually met, only when they are understaffed are there problems waiting for attention’. A recommendation was made following the last key inspection in October 2006 for consideration be given to having two nurses on duty at peak periods, and from the observations made at this inspection it is again strongly recommended that this is considered. The Annual Quality Assurance Assessment completed by the manager documents that of the 15 permanent care staff nine have been accredited with National Vocational Qualification level 2 or above with two people working towards it. Three staff personnel files were selected for inspection and indicated that suitable recruitment procedures are in place. Each file contained references, criminal record bureau disclosures and confirmation of identity. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 23 The quality manager assured that a training matrix has been developed to identify the training needs of each member of staff but could not locate the document. The quality manager confirmed that training in the core topics and specialist areas were in the process of being organised throughout the coming year. All new staff receive an induction programme that meets the specifications of ‘Skills for Care’. One staff member on duty at the time of this inspection was currently working through the programme. Myford House Nursing And Residential Home DS0000022260.V358543.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): OP 31,33,35,38 Quality in this outcome area is adequate. The management team have a knowledge of the service and the needs of people living at the home but appear to have difficulty in translating this theory into practice for ensuring that positive outcomes for residents using the service are achieved This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mrs Alison Hubbard the registered manager was not at the home for the duration of this inspection. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 25 Mrs Ann Walton, the company’s quality manager and Mrs Dawn Kirby, registered nurse and in charge of the premises were both at the home and offered their fullest cooperation during the inspection day. Both were very knowledgeable regarding the aims and objectives of the service and the care needs of the people living at the home. The manager completed all sections of the AQAA and the information gives a reasonable picture of the current situation within the service. The AQAA gives us some limited detail about the areas where they still need to improve. The ways that they are planning to achieve this are briefly explained. The information indicates that the manager should complete the management award and to continue with management training. Quality assurance and monitoring of the service continues with weekly, monthly and annual audits conducted with the findings actioned. Satisfaction surveys are distributed to people living, visiting and working at the home on a regular basis to obtain an overview on how the service is operating. The home offers a facility for residents to deposit personal monies for safekeeping; records relating to this have been maintained and fully receipted. Weekly, monthly and annual testing of the equipment and premises are conducted with records kept and available for inspection. The fire risk assessment for the premises is due for review in June 2008. Myford House Nursing And Residential Home DS0000022260.V358543.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 2 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 2 3 STAFFING Standard No Score 27 1 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 Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13(2) Requirement All medications must be administered at the correct time to ensure that people are not adversely affected or at risk of harm. Hot and cold drinks, snacks and meals must be available at regular times and the interval between the evening meal and breakfast the following day is no more that 12 hours. This will ensure that people are not at risk from malnutrition. Sufficient numbers of staff must be on the premises at all times to ensure that the care needs and requirements of all people living at the home are fully met. Timescale for action 29/02/08 2 OP15 16(2)(i) 29/02/08 3 OP27 18(1)(a) 29/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000022260.V358543.R01.S.doc Version 5.2 Page 28 Myford House Nursing And Residential Home 1. Standard OP1 2 3 4 5 6 7 8 9 10 11 12 OP7 OP7 OP9 OP9 OP10 OP12 OP14 OP24 OP25 OP27 OP31 The statement of purpose and service user guide should be reviewed and updated to contain current and accurate information of the service provision, so people can make informed choices about the home’s service and understand what is offered. The service user guide should include information on the current level of fees. Information in the care plan should accurately reflect the care that is being offered and provided. When ever possible care plans should be developed, agreed and reviewed with the individual person and/or representative Medication should be administered and used only for the person for whom it is prescribed. All medications should be stored as to the manufacturers instructions to ensure the integrity of the medicines in upheld. To maintain a person’s privacy and dignity at all times privacy curtains should be provided in all shared bedrooms. All people should be offered opportunities to engage in leisure and recreational activities to suit their personal preferences. People should be supported and helped to exercise choice in daily living to ensure that whenever possible they are in control of their own lives. Doors to service users private accommodation should be fitted with locks suited to service users capabilities. All radiators in areas accessible to residents should have appropriate guards in situ. It is recommended that consideration be given to having two nurses on duty at peak periods. The registered manager should aim to complete the registered mangers award in a timely way and to access further training in management to ensure her skills and competencies are developed. Myford House Nursing And Residential Home DS0000022260.V358543.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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