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Inspection on 10/10/05 for The Maypole Nursing Centre

Also see our care home review for The Maypole Nursing Centre for more information

This inspection was carried out on 10th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

The ownership of the home has recently changed and the management and staff have ensured that there was little disruption to the home. Residents and visitors are positive about life in the home. Visitors are encouraged, there are various activities available for the residents and they receive good meals.

What has improved since the last inspection?

The Maypole has maintained a good level of care provision, residents, their visitors and staff are happy with the provision of care and the services available.

What the care home could do better:

The home should continue to improve; the changes that will occur with new ownership should ensure that the Maypole continues to do well

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE The Maypole Nursing Centre Lower Northam Road Hedge End Southampton Hampshire SO30 4FS Lead Inspector Pat Griffiths Unannounced Inspection 10th October 2005 10:00 X10029.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 The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 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 and 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 Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Maypole Nursing Centre Address Lower Northam Road Hedge End Southampton Hampshire SO30 4FS 01489 782698 01489 781937 nikki.simpson@anspic.co.uk 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) ANS Homes Limited Nichola Claire Simpson Care Home 68 Category(ies) of Old age, not falling within any other category registration, with number (68), Physical disability (68), Physical disability of places over 65 years of age (68), Terminally ill (68), Terminally ill over 65 years of age (68) The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd February 2005 Brief Description of the Service: The Maypole Nursing Centre is a purpose built care centre providing nursing care and accommodation for up to 68 people who are over 19 years of age. The residents require nursing care for physical disabilities, terminal illness or old age. The home has recently been acquired by BUPA, which has not affected the smooth running of the home. Mrs Simpson, a registered nurse, is the Registered Manager. The Maypole is located in Hedge End, on the outskirts of Southampton, with easy links to all community facilities and public transport systems. All of the bedrooms are single and have en-suite facilities. There are three lounges and two dining rooms. A passenger lift links the two floors. The home has been adapted to meet the needs of service users with physical disabilities. There are raised flowerbeds in the courtyard garden in the centre of the home and the building is surrounded by landscaped gardens, which include car-parking areas. The home is inspected as a ‘Mixed Category’ home because of the age range of the residents; the report includes the National Minimum Standards (NMS) for Older People (OP) and Care Homes for Younger Adults [18 – 65] (YA). The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first of two unannounced inspections for the inspection year 2005/06. The registered manager was on duty and supported the inspector during the visit. The inspector had a tour of the home and courtyard garden, looking at some bedrooms and all of the communal areas. The inspector also read some staff files and care files, observed the daily routine of the home and spoke to staff, residents and visitors. What the service does well: What has improved since the last inspection? What they could do better: The home should continue to improve; the changes that will occur with new ownership should ensure that the Maypole continues to do well. The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 6 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 Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 & 6 (OP) Standard 2 (YA) The assessment of residents prior to their move into the home ensures that their needs can be met Standard 6 does not apply to this service EVIDENCE: Service users and staff prefer to use the term residents instead of service users. The inspector looked at three care files and was able to see that pre-admission assessments had been completed and that relatives had also been involved in planning admissions to the home. The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 9 The matron undertakes all pre-admission assessments; information obtained included medical history, personal care needs, nutritional needs, social activities and general likes and dislikes. Talks with some of the residents indicated that they had been seen in hospital and other care homes for assessment prior to their admission to The Maypole. The Maypole does not provide intermediate care. The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 & 8 (OP) Standards 6, 7 & 8 (YA) The resident’s needs are identified and set out in a care plan, ensuring that these needs are fully met EVIDENCE: The inspector saw several care plans, which showed that all sections of the plans were completed and reviewed and updated as appropriate. The plans included information about the activities the residents were involved with, such as college courses; the likes and dislikes of the residents, what time they liked to go to bed and how they wished to be addressed by the staff. The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 11 Staff that spoke with the inspector were familiar with the care plans and felt that the home provided good care for the residents, meeting all their needs. Residents and their visitors were happy to chat with the inspector. They were very positive about the care they received. The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14, &15 (OP) Standards 13,14,16, &17 (YA) Residents experience a varied and stimulating life at the home, their visitors are encouraged, and they receive good meals. EVIDENCE: Several residents get out and about, with friends and families and as part of the group outings organised by the Maypole staff. There are also community groups, such as the Brownies and a local school, that visit the home. During The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 13 the summer, students that were undertaking the Duke of Edinburgh’s Award scheme organised an outing to Marwell Zoo for the residents. The inspector looked at several care plans, which clearly indicated what times the residents like to get up in the morning and go to bed at night. Residents spoken to said that staff respected their ‘do not disturb’ signs, so they could have a lie-in if they wanted to. The chef has worked at the Maypole for several years and is familiar with the likes and dislikes of the residents. The menus are varied and offer choices to cover all tastes. The kitchen was clean and all food stored appropriately. Snacks are available and residents can choose to have their meals in their rooms or in the dining room. Residents spoken to said that they liked the food that is provided and were always able to choose what they had for their meals. The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 (OP) Standards 22 & 23 (YA) Arrangements ensure that complaints are taken seriously and acted upon. Arrangements for the training of staff in adult protection protect the service users. EVIDENCE: Staff and residents spoken to by the inspector are aware of the complaints policy in the home. The home has a complaints log that is stored securely to maintain the confidentiality of any complaints made. The work of the commission was discussed with staff and residents, who were keen to know more about the role of the inspector. Staff that spoke with the inspector were aware of the need to protect residents from abuse and what to do should they suspect that it is happening in the home. One of the trained nurses in the home has undertaken a ‘Train the Trainers’ course and now provides training in adult protection in-house; it is included in induction training for new staff and is available every six months for all staff. The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 (OP) Standards 24 & 30 (YA) The nursing centre is clean, safe and well maintained. EVIDENCE: The Maypole is purpose built to meet the individual and group needs of the residents in the centre. The front door is wide, with easy wheelchair access, and opens automatically when approached during the day; it is locked at night. There is a central courtyard garden with level access and raised flowerbeds as well as a lawn, this area is ‘managed’ by one of the residents who enjoys The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 16 gardening. There are three sitting rooms and other, small, quiet areas in the centre. On the day of the visit the inspector was able to tour the centre; seeing several bedrooms, the sitting rooms, the kitchen and both dining rooms. All were clean, pleasant and free from odour. The manager advised that the centre has cleaning staff on duty every day, including weekends. One of the trained nurses has undertaken a ‘Train the Trainers’ course in Infection control, and the staff training is now provided ‘in-house’. The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 28 (OP) Arrangements ensure that residents are in safe hands at all times EVIDENCE: The Maypole Nursing Centre provides nursing and personal care to a group of residents with mixed needs and differing age groups. The staff skill mix includes sixteen registered nurses; fifty-two carers, seventeen who have NVQ qualifications; and twenty-five ancillary staff for catering, cleaning and laundry services. All staff have undertaken statutory training, which includes manual handling, fire safety and adult protection. The trained nurses have done ‘Train the Trainer’ courses, each in a different subject, so that most training is now done in-house and is up-to-date. The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33 & 38 (OP) Standards 37, 38, 39 & 42 (YA) Arrangements ensure that the home is well run and in the best interest of the residents. Arrangements are in place to ensure that the health, safety and welfare of the residents and staff is protected. The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 19 EVIDENCE: The registered manager is a registered nurse, who has been in post for the last three years, and is currently undertaking her Registered Managers Award. The resident’s personal care plans are reviewed and updated regularly and they or their nominated representatives are involved during this process if they wish. The residents have regular meetings to which the manager is invited. The inspector was advised that the activities organiser gathers opinions and agenda items and assists the residents with the meetings. The inspector was able to able to see the service contracts for services such as the boilers, the fire safety equipment and the lift. The record of the weekly fire alarm tests was also examined and found to be up-to-date. The manager advised that later this year it is planned for all bedroom doors to have ‘automatic closers’ fitted that will be connected to the fire alarm system. The manager advised that there is a policy in place to ensure that the home is locked and secure at night and all external door are connected to an alarm system. The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 ENVIRONMENT Standard No Score 19 3 20 X 21 X 22 X 23 X 24 X 25 X 26 3 STAFFING Standard No Score 27 X 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 X 36 X 37 X 38 3 The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 21 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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 Maypole Nursing Centre DS0000011451.V257852.R01.S.doc Version 5.0 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!