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Inspection on 06/05/08 for The Malvern Nursing Home

Also see our care home review for The Malvern Nursing Home for more information

This inspection was carried out on 6th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

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

Two health professionals from the Community Mental Health Team made positive comments about the home: `Listens to concerns from the support team and family. Make themselves available for reviews. Monitor ongoing health situations within the unit.``They make sure people are reviewed regularly.` Before a person moves into the Malvern, staff visit them and carry out a assessment of their needs, following this they are encouraged to visit, this helps to make sure The Malvern is the right choice of home for them.

What has improved since the last inspection?

The registered manager has commenced a formal management qualification to complement her existing skills when managing a complex and diverse service. Improvements have been made to how staff are trained. Staff are now provided with induction training and some have been provided with training on how to manage people who are displaying challenging behaviour. Trained staff help to make sure people are properly looked after.

What the care home could do better:

People must be provided with a plan of their care which they or their family have contributed to and made choices about, this plan should be written in a form which they can understand and contain their personal preferences. This and the assessments of any risks involved must be reviewed, as people`s needs change. More must be done to provide people with the opportunity to carry out meaningful activities during the day and to take part in the local community if they wish. More attention must be paid to meal times. The menu needs to be varied, balanced and nutritious, with a number of choices including a healthy option and include a variety of dishes that encourage people to try new and unfamiliar foods and meet with their cultural needs. More must be done to monitor and maintain people`s personal care and physical health needs. There must be a complaints procedure, which is easy to follow and people, are offered support to use. Any complaints should be recorded and any patterns identified so lessons can be learnt about how to improve the home. To protect people from being abused more must be done so staff are trained to follow the protection of vulnerable adult policy and are fully aware of what constitutes abuse. More must be done to improve the environment to provide people with a comfortable, clean and safe place to live.

CARE HOME ADULTS 18-65 The Malvern Nursing Home 425 Toller Lane Heaton Bradford West Yorkshire BD9 5NN Lead Inspector Caroline Long Key Unannounced Inspection 6th May 2008 10:00 The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 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 The Malvern Nursing Home DS0000019899.V364800.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 Adults 18-65. 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. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Malvern Nursing Home Address 425 Toller Lane Heaton Bradford West Yorkshire BD9 5NN 01274 492643 01274 499557 rachel@malvernuk.com 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) Mrs Rachel Halsall Mrs Rachel Halsall Care Home 28 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (28), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (28) The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th May 2007 Brief Description of the Service: The Malvern is a 28-bedded care home with nursing, specialising in the care of adults with mental illness. The home takes both males and females and was established 20 years ago. The house is a late 19th century detached residential building situated on a main road approximately 3 miles from the centre of Bradford, served by a good bus route. There is a parking area to the side of the building and a small patio area situated on the other side of the building. Access to the home is gained through the conservatory at the front and a ramp is provided for people with mobility difficulties. There are 16 single bedrooms and 6 double rooms on two floors, accessible for those with mobility difficulties by a stair lift to the first floor. The home is owned and managed by Mrs Rachel Halsall, RMN. On the 2nd June 2008 the fees were from approximately £410 to £440 per week. There are additional charges are made for newspapers, hairdressing and toiletries The Malvern Nursing Home DS0000019899.V364800.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 0 star. This means the people who use this service experience poor quality outcomes. This is what we used to write this report: • • • We looked at information we have received about the home since the last key inspection. We sent surveys to and talked to health professionals. Two inspectors visited the home unannounced. This visit lasted over six hours and included talking to the staff and the deputy manager about their work and the training they have completed. And checking some of the records, policies and procedures the home has to keep. We spent time talking with people who live in the home. We looked at four people’s care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people living in the home, as well as matters that were raised at the last inspection. As part of this inspection we carried out a thematic probe about how vulnerable adults are protected from abuse, this is where we look at additional information on a particular theme. This information is taken from all the homes visited in the country between May 6th and May 16th. The findings of this thematic probe will be used as part of a wider investigation that we are doing, about the quality of care that people experience. This report will be published in 2008. Further information on this, and thematic inspections can be found on our website www.csci.org.uk • • • • What the service does well: Two health professionals from the Community Mental Health Team made positive comments about the home: ‘Listens to concerns from the support team and family. Make themselves available for reviews. Monitor ongoing health situations within the unit.’ The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 6 ‘They make sure people are reviewed regularly.’ Before a person moves into the Malvern, staff visit them and carry out a assessment of their needs, following this they are encouraged to visit, this helps to make sure The Malvern is the right choice of home for them. What has improved since the last inspection? What they could do better: People must be provided with a plan of their care which they or their family have contributed to and made choices about, this plan should be written in a form which they can understand and contain their personal preferences. This and the assessments of any risks involved must be reviewed, as people’s needs change. More must be done to provide people with the opportunity to carry out meaningful activities during the day and to take part in the local community if they wish. More attention must be paid to meal times. The menu needs to be varied, balanced and nutritious, with a number of choices including a healthy option and include a variety of dishes that encourage people to try new and unfamiliar foods and meet with their cultural needs. More must be done to monitor and maintain people’s personal care and physical health needs. There must be a complaints procedure, which is easy to follow and people, are offered support to use. Any complaints should be recorded and any patterns identified so lessons can be learnt about how to improve the home. To protect people from being abused more must be done so staff are trained to follow the protection of vulnerable adult policy and are fully aware of what constitutes abuse. More must be done to improve the environment to provide people with a comfortable, clean and safe place to live. The Malvern Nursing Home DS0000019899.V364800.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. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 only. People who use this service experience good quality outcomes in this area. People are assessed before admission to the home to make sure the Malvern is the right place for them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The clinical nurse manager visits people before they move in, to carry out an assessment of people’s needs and aspirations including social, physical, personal, and behaviour. The deputy manager said following this they are encouraged to visit before they make a decision to move in. The assessment and the visit help to make sure The Malvern has the equipment and staff necessary to care for them properly and that they are compatible with the other people living at the home. We looked at two assessments and both contained enough information to enable the staff to make a decision about whether or not they would have the necessary skills and equipment to provide a person with the support they need. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 10 The home has produced written information about services they provide and this was looked at the previous inspection in May 2007 and found to be clear and easy to read and would help people decide if they wish to live at the home. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. People who use this service experience adequate quality outcomes in this area. For some of the people who live at the Malvern the opportunity to make choices about their lives is limited. We have made this judgement using a range of evidence, including a visit to this service EVIDENCE: Overall the plan of care was detailed and contained good information about how a person would have preferred their care and support to be given, it was accompanied by assessments of risk, which would have protected the person from harm. However although these were signed as reviewed monthly, there were incidences where they had not always been updated, when people’s care needs had changed. For instance, where a person was displaying inappropriate behaviour or had considerable weight loss neither of these were reflected in the care plan or the risk assessment. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 12 Following the initial plan there was also limited information to show that people were being encouraged to be involved in developing and maintaining their care plan. There were two sets of daily records one in people’s files and a day record sheet in a folder, some people did not have both, therefore it was confusing which one staff are completing and following. When we visited people appeared to have limited ability to make choices, or be involved in making choices. Examples were: • A health professional commented about one person ‘The door to a person’s room is generally kept locked, therefore does not always have access to a private space.’ People living in the home were given a daily amount of ‘pocket money’ and daily ration of ‘cigarettes’ however there was nothing to show how these amounts had been agreed. We saw people were not given choices about daily living activities. Such as what they preferred for lunch or what TV channel they liked or whether their chosen activity. • • However people were seen leaving the home and one person who wanted to go out everyday for all day was enabled to do so, and this was risk assessed and described in their care plan. Records showed us people living in the home have meetings to make their views known about living together and the service they receive. These have been held in July 07 and April 08 where issues were raised by people about their pocket money and not been given enough and how swearing by some people was upsetting others. However there was nothing to show how issues raised in these meetings had been dealt with. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15, 16 and 17. People who use this service experience poor quality outcomes in this area. People’s choice of activities and the support they receive to develop their life skills and access the community is limited. People are not always receiving a balanced nutritional meal of their choice. This judgement has been made using available evidence including a visit to this service EVIDENCE: When we visited many of the people living in the home were in the lounge/dining area in the morning, many remained in the room throughout the day. Except when they left for a short while to smoke a cigarette. The room had a large TV on the wall that would have been easily visible by all, however there did not appear to be any choice about what channel it remained on. The other activity was bingo; this was played with two or three people who lived in the home. There were no daily newspapers or magazines and people wandered aimlessly around. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 14 There were no activity sheets displayed or a programme of activities. The activities organiser left in January. For the people whose records we reviewed the record of daily activities was completed only up to twenty-first of January, when the activities organiser left. Before she left the deputy manager told us the activity co-ordinator had got everyone a leisure card but these hadn’t been used. The numbers of staff on duty also restricted the amount of people who could be offered a social activity of their choice. There was one nurse and three care staff on duty. Three people living in the home needed their actions to be monitored throughout the day. A health care professional commented on a survey: - ‘Health care needs are generally met within the unit although staff are not always available to maintain support for maintaining attendance at organised day activities such as gardening group, art group etc. I feel that external social contact is essential for my client’s continued well being.’ However the deputy manager did say they hope to recruit an activities organiser soon and people who did not need support were seen coming and going from the home as they choose. To prevent people from smoking in them some bedrooms were locked. One person when asked said their room was locked and they did not have a key but would like one. People’s cultural needs were not met, for instance admission records stated a person is a practising Muslim and the review notes said “feels free to practice their religion and respect for their diet and prayers is respected”. However there was nothing in care records to show how their cultural or religious needs are met. When the kitchen assistants were asked about providing people with halal meat they said the meat was provided on special occasions such as Christmas, however should a person buy their own they would cook it. Lunch was served mainly in the dining room, the dining tables were basic and some of the chairs were rusty. People were not offered a choice of menu, the kitchen assistants explained they are offered one choice and if they don’t want it they may then be offered something else. The tables were not set, there were no tablecloths or napkins or condiments. Several people were given cloth bibs to wear. On the day we visited there was chicken in a white sauce with rice followed by sponge and custard or peaches in juice however people were not receiving a choice of a well balanced diet. Examples were: • One person who was a diabetic was having soup, followed by peaches; they were having difficulty with the bits in the soup and they was observed DS0000019899.V364800.R01.S.doc Version 5.2 Page 15 The Malvern Nursing Home sieving them out with their teeth to remove them. The peaches were removed before they had chance to sample them. • • A person who needed a soft/liquidised diet was given a bowl of liquidised rice and chicken followed by liquidised custard and sponge. When we arrived we saw one person had fallen asleep over their breakfast. They remained asleep in the chair until lunchtime when they ate very little lunch. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 18, 19 and 20. People who use this service experience adequate quality outcomes in this area. People have access to health services to enable them to remain in good mental health, however their physical needs are not always monitored or met. The administration and storage of medication needs to be improved to make sure mistakes are not made. This judgement has been made using available evidence including a visit to this service EVIDENCE: Two health professionals from the Community Mental Health Team both said the clients they work with receive the mental health care they need. One described how the staff at the Malvern actively sought their advice and made sure their client’s care was reviewed regularly. The records we looked at also showed people accessed opticians, chiropodists, general practitioners and consultant psychiatrists. However there was information to show people’s physical health care needs were not always recognised or responded to. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 17 A person who is an insulin dependent diabetic was seen at the diabetic clinic in February 08 where it is recorded they had a significant weight loss; the advice was for them to eat and take walks. There was an entry in the records stating ‘weight being monitored’, however the risk assessment and dietary plan had not been updated since April 2006 and the weight chart showed it was last recorded in October 2007. The charts to monitor what the person had eaten were not always completed and the deputy manager told us the scales had been broken since just before Christmas. For two other people behavioural charts had not been completed, this means staff would have been unable to see if there were any triggers or patterns to people’s behaviour. People generally looked unkempt, although it could be argued that this was their choice, most people had either ill fitting or dirty clothes on and they did not look as if they had been to the hairdresser or had help with their hair. Many had old cigarette burns on their clothes. We looked at the medication and not all of the medication was locked away in the cabinets or cupboards, and the nurse could not find the fridge temperatures taken to make sure the fridge was cold enough to keep the medication in. When we looked at a sample of medication charts, one of the medications was signed for indicating the person had taken it but it was still in the packet. It was also unclear whether the nurses had updated their medication training recently. Good practice states medication must be stored in a suitable, safe and clean place and given at the times it is prescribed. This is to prevent mistakes and to make sure people get the medication they need to maintain their health. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. People who use this service experience poor quality outcomes in this area. People using the service are not provided with the support and information they need to raise their concerns fully. People cannot be confident they will have their rights protected or be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a complaints policy displayed, which was dated April 2004 but didn’t give any details of the procedure just says complaint will be dealt with within 28 days. The deputy manager explained that the home had changed the way it recorded complaints and he was unable to find the new records. However he had received a complaint in February 2008 and had attached this to the old records. We were therefore unable to look at all the complaints since our last inspection in May 2008. The complaint in February was from a person who lived at the Malvern and involved a safeguarding issue. This had not been referred to the adult protection team at Bradford Social Services, but had been investigated by the home itself. To protect vulnerable people from abuse the staff must promote the sharing of these incidents with the Bradford Adult Protection Team. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 19 The information we had to look at as part of the thematic probe, showed us the Adult Protection policy is not up to date and does not follow Bradford Adult Protection Team’s guidelines. Also the whistle blowing policy, which is to give reassurance to staff that issues will be managed fairly and properly if they report a fellow member of staff or management being abusive, did not say who to contact if the issues are about the manager or owner. We were told that some staff have not been provided with regular training about protecting people from abuse. The nurses in charge were not clear about the procedure should they be alerted to any abuse in the home. Incident forms were being completed but there was no evidence that these were being reviewed for any possible patterns or had been referred to Bradford Adult Protection. Also they stated physical restraint had been used but there were no details of the type of restraint in the report or the care plan. We were unable to look at people’s personal money. The deputy manager told us the registered manager is the only person who has access to people’s money and she was not available when we visited. We will therefore be going back to the home to look at these in more detail. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 People who use this service experience poor quality outcomes in this area. People do not live in a clean, well-maintained environment. This judgement has been made using available evidence including a visit to this service EVIDENCE: When we visited we looked at all the environment and we found it to have a poor standard of cleanliness, with unpleasant odours. For example: • Upstairs corridor had a dirty carpet. • Upstairs bathroom had cobwebs in the corner of the room and old toothpaste on the side. • In the bedrooms we found dirty carpets and lino, faeces on the bed linen and on the carpet. • Many of the toilets, en-suites, communal bathrooms and toilets did not have soap or paper towels. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 21 There are two communal lounges and a dining room where people can smoke. When we visited this was being intensely used and we noticed the build up of smoke in the adjoining lounge. Although much of the furniture is used to minimise the risk of fire should a lighted cigarette be dropped, there are many areas of the home that need to be refurbished or maintained. Examples were: • • • • • • • The lounge/conservatory had rusty dining chairs. Some of the bedrooms had curtains falling down. The upstairs bathroom had a broken towel rail, no paper towels or soap dispenser. One bedroom had a toilet seat broken and a piece of skirting board missing off the wall. Some rooms had no light bulbs in the lights above the beds In the front porch area the seating was torn and there was a small hole in the roof. One room had a tear in the carpet and the ceiling was marked where there had been a leak. Outside there is a small enclosed seating area, where people smoke, which had chairs and tables. When we visited there was a lack of soap and paper towels. To prevent the spread of infections within the home, dispensed soap and paper towels must be provided in all bathrooms, toilets and any areas where personal care is carried out. However people’s bedrooms had some of their possessions, which reflected their personal interests and tastes. Also both of the lounges had large flat screen TVs that would have been easily visible by everyone using these rooms. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35. People who use the service experience adequate quality outcomes in this area. Staff are not always consistently trained or available in sufficient numbers to fully support the needs of everyone living in the home. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: When we visited there were twenty-three people living in the home. The staff on duty were the deputy manager and a nurse through out the day and three support workers. The staff rotas showed that these are the usual staffing levels. However a nurse explained that to protect people in the home three people’s actions were being monitored throughout the day. Due to the levels of help people need, the staffing levels should be reviewed as this may not be enough to meet everyone’s needs fully. When we visited in May 2007 a requirement was made for the process for recruiting staff to be more robust, to ensure staff are safe to work with The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 23 vulnerable people. At a further visit in December we found that the management team was carrying out robust recruitment practices. During our visit we looked at three of the staff records we found: • All three did not have a start date therefore it was difficult to make sure all the correct checks had been carried out before they started work. • All three had a protection of vulnerable adults check and criminal record check completed. • Two had two references, however one only had one and this was not from the previous employer. The home therefore needs to be continually vigilant when recruiting staff to make sure only suitable people are employed. A requirement was made at the last visit that the home must introduce a detailed staff induction training programme based on the Skills for Care guidance. A newly recruited support worker told us they had received induction from the deputy manager and the clinical manager for two days. The deputy manager explained the operational manager carries out a lot of the training. However no staff training records were available for us to see. Two support staff records had training certificates for fire safety, safeguarding, health and safety, basic life support, infection control, and principles of care. However talking to the nursing staff did not give us any indication of how they reviewed and updated their practices and there was no overall training plan to identify who had completed training. A training plan helps to identify what training staff need and when it needs updating. As part of the thematic probe staff were asked about their training and understanding of protection of vulnerable adults, they said they had not received training. A requirement was made at the last inspection, that staff must be trained to specifically understand challenging behaviour and dementia. The deputy manager confirmed staff have received challenging behaviour training from the operational manager, however because there has been a lot of new staff, this course now needs to be carried out again. The deputy manager confirmed over half of the care staff have completed their National Qualification level two or above in care, this qualification helps to make sure staff are properly trained to carry out the work. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39, and 42. People who use the service experience adequate quality outcomes in this area. The home is not always managed in the best interests of people who live there. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The owner /registered manager is a registered mental health nurse, with vast experience of caring for people with enduring mental health illness. At the last inspection she was asked to commence a formal management course, the deputy manager was able to confirm that she has now commenced a management course. The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 25 However the outcomes in this report show the home is not always managed in the best interests of those who live there or that the quality assurance and quality monitoring systems are proving to be effective. A previous requirement asked for the updating of all policies and procedures in the home to continue, to ensure all staff are working in a consistent safe manner. Looking at the protection of vulnerable adult policy and complaints policy shows this has not yet been completed. A sample of the maintenance certificates were looked at and found to be up to date, the deputy manager explained an external company have now been taken on for health and safety and are producing a manual and will be giving training. The fire alarm certificate, fire extinguishers and emergency lighting were up to date, however the fire risk assessment was last carried out in February 2007. The fire logbook shows the last fire drill was in February 2007 and the fire training was for staff in January 2007. The Malvern Nursing Home DS0000019899.V364800.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 Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 X LIFESTYLES Standard No Score 11 1 12 1 13 2 14 1 15 3 16 1 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 1 X 2 1 X 1 X 2 X The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement Timescale for action 01/07/08 2 YA9 13(4) (b) and (c) Everyone living in the home must have an up to date written plan that includes all his or her personal and health care needs and their goals and aspirations. • The plan must include clear guidance to staff about the support that they have to provide to meet people’s needs. • People living in the home or their representatives must be involved in the development of, and agree with, the plan. • The plan must be kept under regular review and people living in the home or their representative made aware of any revisions. This is to make sure people are provided with a consistently good standard of care in the way they prefer. Where areas of risk are identified 01/07/08 a risk assessment must be completed. The risk assessment should be reviewed and agreed with the people living in the DS0000019899.V364800.R01.S.doc Version 5.2 The Malvern Nursing Home Page 28 home or their representatives. 3 YA12 16 All people must be provided with a choice of fulfilling activities and supported to enjoy the full range of opportunities and activities in the community. To make sure people have a healthy diet. People must be provided with a choice of meal, in comfortable surroundings. You must promote and maintain people’s health and make sure they have access health care services. • You must make sure people are promptly referred to the appropriate health care professional if needed. • Any equipment used for the monitoring of peoples health must be maintained and provided. (Weighing Scales) To make sure people can be confident their concerns will be taken seriously and acted on there must be: • A complaints procedure that is clearly set out so that people can easily understand it. It must be made available to people living in the home, their relatives, friends and advocate. • All complaints must be fully investigated and the complainant must be informed of the outcome. All complaints must be fully recorded and these records must be available for inspection. Version 5.2 Page 29 01/07/08 4 YA15 16 (2) (i) 01/07/08 5 YA19 12 (1) (a) 01/06/08 6 YA22 22 01/06/08 • The Malvern Nursing Home DS0000019899.V364800.R01.S.doc 7 YA23 13 (6) 8 YA23 13 (6), (7) and (8) 9 YA24 23 10 YA30 16 (j) & (k) 23 (2) (d) To protect people from abuse • All staff must be trained in Safeguarding Adults so they are aware of and follow the Bradford Adult Protection Procedures • The home must have an up to date policy and procedure for the staff to follow about protection of vulnerable adults. When the interventions of staff restrict a person, this must be the only practicable means of securing their welfare and it must be only in exceptional circumstances and meet the guidelines issued by the department of health and the Mental Capacity Act. There must be a programme of refurbishment and records for the routine maintenance of premises and facilities. The CSCI must be provided with a copy of the refurbishment programme. The home must be kept clean and free from offensive odours. This is to protect people’s dignity, protect them from infections. The updating of all policies and procedures in the home must continue, to ensure all staff are working in a consistent safe manner. (Previous timescale not met. 07/12/07) All training and procedures must be kept up to date. 01/07/08 01/06/08 01/07/08 01/06/08 11. YA40 17 01/07/08 12 YA42 23 (4) 01/06/08 The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 30 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 Refer to Standard YA20 Good Practice Recommendations Good practice states medication should be stored in a suitable, safe and clean place and given at the times it is prescribed. This is to prevent mistakes and to make sure people get the medication they need to maintain their health. There should be a training and development programme, which identifies staff training needs so they have the skills 2 YA35 The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. Extracts may not be used or reproduced without the express permission of CSCI The Malvern Nursing Home DS0000019899.V364800.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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