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Inspection on 05/10/05 for The Mews Nursing Home

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

This inspection was carried out on 5th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Staff are committed to providing a caring environment for people living at the home and try to support them sensitively. A typical comment from a relative was, "I am happy with the care here". The home uses all of it`s communal space and gardens for the benefit of service users and service users are able to spend their time in areas of their own choosing. The quality of meals is good and service users have a choice that extends further than the written menu choice. Some service users have detailed social assessments in their care plan. The home has a sheltered, and pleasantly planted, garden area that is used by service users and their relatives.

What has improved since the last inspection?

There are now photographs, to help identify service users, on medication charts. There are fewer bedroom doors held open with wedges. The home has a permanent manager in post.

What the care home could do better:

The home should replace the black carpet that is in all corridors and in some rooms with something that looks less industrial and more in keeping with the idea of homeliness. The plastic mugs and "canteen" type tea-trolley should be replaced with more domestic style equipment. The light levels in bathrooms must be improved. It is advisable that stock balances should be kept, of some drugs that could be abused. Several aspects of care planning could be improved, particularly in relation to the accurate assessment of service users needs. There are still some bedroom doors held open with wedges rather than automatic closure devices. There is still odour emanating from sluice machines.

CARE HOMES FOR OLDER PEOPLE The Mews Nursing Home Southburn Terrace New Herrington Houghton Le Spring Tyne & Wear DH4 7AW Lead Inspector Mr Tom Moody Unannounced Inspection 5th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Mews Nursing Home DS0000018210.V274900.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. The Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Mews Nursing Home Address Southburn Terrace New Herrington Houghton Le Spring Tyne & Wear DH4 7AW 0191 512 0097 0191 512 0959 the.mews@fshc.co.uk www.fshc.co.uk Tamaris Healthcare (England) Ltd (wholly owned subsidiary of Four Seasons Health Care Limited) 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) Care Home 50 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (50), Physical of places disability over 65 years of age (40), Terminally ill (5) The Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 5 places for palliative care 17 years and over Date of last inspection 9th February 2005 Brief Description of the Service: This home provides 50 places for elderly persons. This includes 5 respite places for persons requiring palliative care. The home is purpose built and the internal space is generous. There is a variety of lounge and dining areas. The bathrooms and WC’s have handrails and appropriate equipment for disabled service users. The home is constructed in a traditional style incorporating brick and a tiled roof. It has two floors with passenger lift access to the upper floor. Ground floor access is level. The home stands in grounds shared with another care home. The garden area is well maintained and there is adequate parking. There is a secure patio area for service users. The home is located in a village, in a suburban area. There are local facilities close to the home including shops. The Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day in October 2005 and was carried out by a single inspector. Records were examined and a tour of the premises took place. Discussion took place with the manager, who has only recently taken up his post. The midday meal was observed and inspectors also spoke to service users, staff, and visitors throughout the inspection period. The feedback from service users and relatives was generally positive. The home is reasonably well equipped with aids and adaptations suited to the client group’s age and lifestyle preferences. The home has plenty of space in all areas. It is popular with service users and their families. What the service does well: Staff are committed to providing a caring environment for people living at the home and try to support them sensitively. A typical comment from a relative was, “I am happy with the care here”. The home uses all of it’s communal space and gardens for the benefit of service users and service users are able to spend their time in areas of their own choosing. The quality of meals is good and service users have a choice that extends further than the written menu choice. Some service users have detailed social assessments in their care plan. The home has a sheltered, and pleasantly planted, garden area that is used by service users and their relatives. The Mews Nursing Home DS0000018210.V274900.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. The Mews Nursing Home DS0000018210.V274900.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 The Mews Nursing Home DS0000018210.V274900.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, 5 Not all service users have a comprehensive assessment of need undertaken before admission and following admission to the home. Service users and their families are able to visit the home and are given enough information to judge if it can meet their needs. EVIDENCE: All care plans contain assessments including some useful information about the person’s life, like’s and dislike’s, health needs. Some care plans were found to have significant omissions, such as service users on opiate medication having no assessment of pain control. Service users relatives confirmed that they were able to visit the home and had made a positive choice to place their relative there. Staff confirm this and spoke of relative continued involvement in the home. The Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 9 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, 9, 10 Although some care plans had useful information there were some significant omissions in relation to healthcare needs. The care plans cannot fully demonstrate that the home is meeting all of service user’s healthcare needs. The homes medication systems are being adhered to and service users are protected by as safe system of medication that is properly operated by staff. Staff generally respect service user’s privacy and the care practice that was seen support this. The Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 10 EVIDENCE: Although some care plans had much useful information including risk assessments, there were some worrying omissions. Examples of this included one service user who was deaf had not had this acknowledged in their assessment; evidence that some pressure damage prevention scores had been underestimated, and one person, who it was noted preferred to be in their own room, had the plan of placing them in the lounge to “prevent boredom”. There was evidence that primary care teams were involved in service user’s care and the home involved clinical specialists when this was necessary. The medication storage and administration systems were well ordered and recorded. It is recommended that drugs that have the potential for abuse, such as Temazepam, have stock balances recorded. Staff were aware of service users needs for privacy, and staff knocked at bedroom doors before entering. Service users views and preferences on privacy, and issues such as gender of carers, were noted in their care plans. Staff stated that consultation with health and social care professionals takes place in private, within service user’s bedrooms. The Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 11 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, 13, 14, 15 The service users can make full use of all of the homes facilities and show signs of having their own interests and possessions. There is evidence of much visitor involvement and of service users using community facilities. All of this indicates their needs and preferences are being met by the home and that they have choice and control over many areas of their lives. Service users enjoy an appetizing selection of meals in well decorated and pleasant surroundings but the blanket use of plastic cups tends to detract from this aspect of their care. EVIDENCE: Several service users had their own selection of videos, books or music in their own rooms. The staff are aware of service user’s preferences and patterns of activity throughout the day. Service users were able to use all of the communal space and were seen enjoying the garden area. One service user had bird feeding stations outside their room and relatives were observed replenishing the seed in them. Visitors were present throughout the day and staff observed that one service user was taken out of the home on outings “every day” by their family. Visiting relatives spoke positively about the home stating that, “The care is good here”. The Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 12 The manager spoke of regular visits from ministers of religion. Service users made positive comments about the quality of meals as did their visitors. They also indicated that a choice of alternatives was available if the menu was not to their liking. A mealtime was observed and any assistance required by service users was provided discreetly and sensitively. Unfortunately the drinks were dispensed from a “canteen” type trolley and milk was in it’s original, plastic cartons. This was at odds with the rest of the décor in the dining room. Drinks were provided in plastic mugs and this also seemed out of character. Ordinary cups could have been provided for the majority of service users. The kitchen carried a good stock of food and ingredients. The Mews Nursing Home DS0000018210.V274900.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 Service users and relatives are comfortable about raising issues with staff and the manager. They are sure that issues will be dealt with appropriately. Staff have had training and have a good awareness of protection issues. The local authorities approach, and the company’s policy should combine to protect service users from abuse. EVIDENCE: There were no recent recordings of any representations and the manager believes that most issues are dealt with before they escalate to the level of complaints. Service users relatives spoke of their satisfaction with the care provided and confirmed that they would feel comfortable raising issues with staff members or the manager. The home has appropriate adult protection policies, but the Four Seasons whistle blowing policy does not encourage disclosure by staff. The injunction to make disclosures “in writing” and “to the Manager” is not appropriate and may discourage some staff from making disclosures of bad practice. Staff are aware of protection issues and have received training in the local authority procedures on protecting vulnerable adults. The Mews Nursing Home DS0000018210.V274900.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, 22, 23, 24, 25, 26 The environment is generally safe and the home is well maintained. The continued use of door wedges may negate fire precautions and in this respect the home may not provide a completely safe environment. Rooms are well furnished with service user’s possessions and are generally suited to their needs apart from unpleasant carpeting. The home has aids and adaptations to meet most service users needs but there is little adaptation for those with sensory loss. The home is clean, tidy and is generally kept in a hygienic condition. The Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 15 EVIDENCE: There is a variety of different environments in the home including quiet rooms and a smoking lounge. The dining area has pleasant wood-effect flooring. Although a number of door guards have been installed, several room doors were still being held open with wedges. It must be pointed out that this practice could potentially place service users and staff at risk. The use of a rather “institutional” black carpet fitted in all corridors, and some bedrooms, tend to spoil the homely aspect of the rest of the décor. The home has suitable grab rails fitted in toilets and bathrooms. Handrails are available throughout the building to assist service user mobility. Hoists are available in several areas and there is level access to showers. It was noted that light levels were low in bathrooms and showers. This could be a problem for those with defective vision. There is no loop system in the home to help those with hearing loss. The home is clean and tidy in all areas occupied by service users but the problem of odour persists in the sluices. This is linked to the lack of proper overflows to sanitary fittings. The Mews Nursing Home DS0000018210.V274900.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): 27, 28 The number of staff on duty was sufficient to meet service users needs. EVIDENCE: The home now has a permanent manager. The staff on duty were busy, but service users did not have to wait for attention. Call buzzers were answered promptly. Comments were positive from relatives but some indicated that higher staffing levels would be preferred. The Mews Nursing Home DS0000018210.V274900.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, 33 The home is well managed and staff morale has been maintained under the latest manager. This ensures that the service users are cared for in a safe environment by staff who act in their best interests. EVIDENCE: The home has a new manager in post. She is an experienced registered nurse who has experience of managing other care homes. She is currently applying for registration as the manager of The Mews. The manager feels she is well supported by the senior management team of Four Seasons. Staff, service users and relatives confirmed that they found the manager, and her deputy, to be approachable and would not hesitate to contact her if they had any areas of concern they wished to discuss. The Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 18 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 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 X 2 3 2 2 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X X X The Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 19 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 2 Standard OP3 OP7OP8 Regulation 14, 15 14, 15 Requirement A full assessments of service user’s needs must be carried out and accurately recorded The service user’s plan of care must be based on a comprehensive and accurate assessment of needs. Dining room equipment and crockery must be suitable for service users needs. The manager must ensure that fire precautions are observed by staff. Adequate light levels must be maintained in all areas used by service users and equipment must be provided for those with sensory deficits. Suitable carpeting must be provided in rooms and doors must not be held open with wedges. Timescale for action 30/11/05 30/11/05 3 4 5 OP15 OP19 OP22 16 23 16, 23 30/11/05 30/11/05 30/11/05 6 OP24OP25 16 30/11/05 The Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 20 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 OP25 Good Practice Recommendations Adequate overflows should be fitted to sluice machines to avoid the entry of foul air into the home. The Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Mews Nursing Home DS0000018210.V274900.R01.S.doc Version 5.1 Page 22 - 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!