CARE HOMES FOR OLDER PEOPLE
Myford House Nursing And Residential Home Woodlands Lane Horsehay Telford Shropshire TF4 3QF Lead Inspector
Janet Adams Unannounced Inspection 12:45p 9 March 2006
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 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) Roborough Limited Christina Williams 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.V266769.R01.S.doc Version 5.1 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. 27th July 2005 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. The Registered Provider is Redwood Health Care (Roborough Limited), with the responsible individual being Mr. H. James. The Registered Manager is Christina Williams. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and commenced at 12.45pm lasting five and a half hours. It included observing activity within the home, inspecting the premises, an ‘in depth look’ at records for residents and staff, observing, talking and listening to the 30 people living there, a few visitors and the staff on duty during the time of the inspection. Discussions with people were carried out in private on a one to one basis, or together in groups. Everyone was welcoming and happy to share comments, which are explored and reflected in the main body of the report. The management team member in charge of the home at the start of the inspection was most helpful and professional. She was later joined by the Registered Manager and newly appointed Deputy Manager as the inspection progressed. They had been out at the local hospital assessing potential residents for the home. Myford House has a history of meeting and exceeding national minimum standards and providing a good service for people, consequently, on this occasion only those certain ‘key’ standards have been inspected. A total of 22 out of a possible 38 National Minimum Standards for Older People were assessed. What the service does well:
Myford House provides a clean, and homely place to live at for individuals who need to be supported and cared for. It is impressive that the home more than meets National Minimum Standards for several parts of the service and support it provides for its residents. The home excels at identifying and meeting the care needs of individual residents in a flexible and effective manner. The excellent systems the home has in place to manage its wound care reflects the successful high standards of nursing care which have a favourable impact on people’s well being. Unanimous comments from residents living at the home as well as their relatives confirmed people appreciated living and being looked after at Myford House. One relative commented that the way the home had improved the quality of her mothers life has resulted in her being ‘the best she has ever been for a long time.’ Knowledgeable staff appeared enthusiastic and happy in their roles. The records they keep to account for the care delivered to the residents reflected the good standards of ‘hands on’ care observed and overheard. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Myford House have in depth pre- admission procedures, which excel to assure individuals that the home will meet their needs. Professional systems and the ongoing efforts of the home’s team make sure people living at Myford House are looked after in the way they need and prefer to be. EVIDENCE: Inspection findings were of similar high standards when they were seen at the announced inspection in July 2005 when it was reported, ‘Observations and discussions with residents, staff, and home management team indicated that the home meets the individual needs of the elderly people living at Myford House in a desirable manner’. On the day of the inspection, the newly appointed deputy manager had accompanied the registered manager to assess potential new residents for the home as part of her induction to the ‘Myford House Lifestyle’. This means that this important aspect of the service can continue in the absence of the manager, as her deputy gains the competency to carry this out. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 9 Records seen, and discussions with residents, their visitors and staff confirmed that, the quality of life for several people in need of a lot of nursing care had in fact improved since they had been admitted to the home. One person commented that although her mother had only lived at the home for a short time she is more than happy with they way she is looked after, and said that the nursing care her mother has received has resulted in a ‘great improvement in her.’ Many relatives and visitors to the home were seen being welcomed by a friendly care team who knew them and the people they had come to see. People were overheard being informed and kept up to date with any changes in their family members condition. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 10 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, & 10 There is a good, consistent care planning system in place, which confirms residents get the care they need and expect, by staff that meet the individual needs of each resident in a professional and sensitive manner. EVIDENCE: Several observations made whilst at the home confirm the management of health and nursing care is most desirable. A pleasant, professional atmosphere was seen to prevail throughout the home during the course of the inspection. Residents looked relaxed, comfortable and were at ease when the personal care they received was seen being respectfully carried out. The care plans of three residents looked at in depth were found to be most satisfactory as they contained many relevant details for the people concerned, and reflect the similar high standards seen in records at the last inspection. Examples of good practice include: • Excellent wound management systems at the home ensures any person admitted to Myford House needing this type of care get the attention they need so they fully recover in as short a time as possible. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 11 • The records of a person recently admitted to the home had a very detailed risk assessment for the staff to follow to make sure everything has been done to prevent her from having a fall. It is noteworthy the home encourage the family to participate in their relatives care if they wish to. Discussion of this with a relative of a lady whose records were looked at in depth showed this works very well. In addition to the above findings, the home has a good communication network with the health care specialists in the local community. They regularly involve them in the care of their residents to make sure people get suitably looked after. On the day of the inspection the speech and language therapist called at the home, and telephone calls overheard with an infection control nurse demonstrated this. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 12 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 & 14 Full involvement of individuals living, visiting and working at the home promotes choice and control over residents lives wherever possible within a stimulating, homely atmosphere. EVIDENCE: Observations of staff on duty confirmed they were very knowledgeable about many of the residents’ personal interests and preferences in how they choose to pass their leisure time in the home. Many of the people living there took advantage of watching the entertainer who arrived to hold a sing a long session during the afternoon of the inspection. Another resident presented the inspector with a collection of poems she had written. Many people were seen to be involved in their own chosen pastimes, and spoke in appreciation of the forthcoming activities planned. One of the relatives spoken to confirmed that one of the main strengths the home has is that it creates a homely feeling which encourages the individuals ‘to be themselves’. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The home has systems in place to make sure concerns and complaints are dealt with promptly and professionally and thus enhance the effective procedures and practices in place to protect individuals from abuse. EVIDENCE: The home has not received any complaints since the last inspection. The paperwork looked at shows the home has excellent systems in place to make sure such an issue is managed professionally should the need arise. It was favourable to be informed that any comments compliments and complaints are raised as an agenda item at residents and relatives meetings, to make sure people know that the home welcomes any feedback to improve the home. A suggestions box is also located in the reception area so people can make anonymous suggestions or complaints if they wish. No such comments have been made. The ongoing training programme for staff means that by the end of March 2006, all members of the home team will have attended the Adult Protection training being hosted by Telford and Wrekin Social Care services. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 14 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): 19,20,21,22,24, 25 & 26 Although in general, Myford House is a homely, comfortable place to live, and has had some new equipment provided, slow progress with necessary improvements identified at the last inspection mean that some parts of the home continue to show signs of wear and tear, challenging service delivery at the home. EVIDENCE: Many parts of the home were seen to be spotlessly clean without any unpleasant odours. On the morning of the inspection, staff confirmed that the manager had carried a ‘walk about’ at 8am to spot check and monitor how clean and tidy the home was. This is carried out regularly as part of the ongoing measures to make sure the home is kept safe, clean and tidy. Although some parts of the home are showing signs of wear and tear, especially carpets seen in both communal and bedroom areas, it is noteworthy to comment that the home has been subject to some financial expenditure. Fifteen new commodes and three new pressure relieving mattresses have been bought since the last inspection, and an inventory of works seen shows that
Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 15 thirteen radiator guards have been ordered and are due for delivery and installation. All hot water valves have been replaced in order to meet a requirement made at the last inspection to keep the hot water temperatures stable. Shared facilities in the home have also been improved following the provision of a relatives’ rest room. However, some shortfalls reported at the last inspection need to be put right: • A resident’s specialist feeding pump was again seen in need of cleaning. In addition to this, the bedside table it was positioned on was worn, exposing a rough wooden surface, which poses a cleaning challenge. Some spillage of the liquid feed was also seen to have soiled the carpet. It was seen that some of the baths were showing signs of wear and tear, and the chipped enamel on some needed attention to make sure they could be easily cleaned between use. • For the first time ever in February 2006, the home has had an external audit by the Health Protection Agency to look at its standards for infection control. The home was not aware this was to be carried out, and the overall scoring of 84 confirmed the home has indeed high standards for this matter. Following on from the audit, the home have already made changes to their practices to make sure the already good standards are now even better. This has included the introduction of a specialist type of hard surface cleaner, and the introduction of hand disinfectors and hand cream for staff. More importantly, the findings of the audit did confirm that the deterioration of the general condition of the main kitchen posed challenges with regard to food hygiene. Although it was anticipated this work was to be given priority at the last inspection, this has not yet been confirmed by the Registered Providers, Redwood Care. Priority must be made for remedial work to be carried out to ensure this food preparation area can be effectively cleaned. As the home was only audited a fortnight before the inspection, the issues raised by the report from the Health Protection Agency will be looked at in depth at the next inspection. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 16 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): 29 & 30 A well trained and committed staff group meet the needs of each individual in a sensitive and professional manner at Myford House. The recruitment systems in the home need improvement to show staff are thoroughly screened before they start work at the home. EVIDENCE: Comments from residents, relatives and the staff themselves all confirmed they felt the home employs staff in sufficient numbers to meet the needs of residents. As the staff team has been stable with the same personnel for some time, the efforts of the nursing team have resulted in a training programme being developed for the staff to further improve their knowledge and skills. On the afternoon of the inspection a training session on Parkinson’s Disease was being held. This in house training also covers aspects of health and safety as well as medical conditions some of the people living at the home need care for. When the records for three staff members who have been recently employed at the home were looked at, two files did not have the necessary information to show they have made sure the person is fit to do the job expected of them before starting work at the home. This was discussed with the manager at the time of the inspection and is in the process of being rectified. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 17 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): 31,32,35, & 38 The home has a competent provider who ensures the staff team have been effectively managed. The health, safety and welfare for residents, staff and visitors continue to be maintained, improved and adjusted to make sure safe working systems already in place meet any changing needs as they arise. EVIDENCE: The open welcoming manner in which the registered manager and staff responded to this inspection indicated that a good management approach is in place and that staff are committed to ongoing improvements, achieving best practice and to developing equal opportunities. Once more it is noteworthy to report that there have again been very little changes to the staff team – only two people have left their employment with the home during the past year. The way in which the induction for the newly appointed deputy manager has been carried out shows that the person is being adequately supported to take
Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 18 on the responsibilities of her new role to maximise the smooth running of the home. Myford House continues to have a consistent and sensible approach to all health safety and well-being matters. Records kept for accidents show they are suitably acted upon to prevent the chance of them happening again to a minimum. The home is well on its way to ensure attention to risk assessments and maintenance checks for bedrails are in place. The home has obtained the appropriate information in order for this important matter to be fully addressed. Efforts to improve the safety standards within the home have resulted in the installation of key pad security locks. Although the home has many good record keeping systems set up, the way valuables are held by the home on behalf of residents needs to be further enhanced. This matter was discussed at the time of the inspection. Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 19 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 4 4 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 X 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 2 3 2 2 X 2 2 X STAFFING Standard No Score 27 X 28 X 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 X X 2 X X 3 Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes- four 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 2 Standard OP19 OP19 Regulation 23 (2)(b) Requirement Timescale for action 23/06/06 23/06/06 3 OP21 4 OP22 5 OP24 6 OP25 All flooring in the home must be clean, in good repair and free from trip risks. 23 (2)(b) The main kitchen must be 13 (3,4) refurbished to provide a food preparation area, which can be effectively cleaned and decontaminated, to meet food hygiene regulations. 16 (1), 23 All baths must have readily (2)(j) cleanable surfaces. (Immediate effect timescale of July 2005 not met) 16 There must be a home policy (1),(2)(j) implemented to ensure all PEG feeding equipment is kept clean at all times. (Previous timescale of 23/01/06 not met) 23 (2) ( c) All furniture in residents bedrooms including bedside cabinets must be kept in good repair. 23 (2)(p) All radiators in areas accessible to residents must have appropriate guards insitu. (Previous timescale of 23/01/06 not met) 23/05/06 23/04/06 23/04/06 23/04/06 Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 21 7 OP29 19, Sch 2, Sch 4.6 8 OP35 Schedule 4.9 All staff files must contain all relevant recruitment details as per Schedule 2 at commencement of employment by the home. (Previous timescale of 23/01/06 not met) The home must devise and implement a system to ensure the safekeeping and return of valuables for service users. 23/04/06 23/04/06 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 Standard Good Practice Recommendations Myford House Nursing And Residential Home DS0000022260.V266769.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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