Inspection on 05/06/08 for WCC Mayfield

This inspection was carried out on 5th June 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 but made no statutory requirements on the home.

Other inspections for this house

WCC Mayfield 19/12/08

WCC Mayfield 20/12/07

WCC Mayfield 12/10/06

WCC Mayfield 30/01/06

WCC Mayfield 02/08/05

WCC Mayfield 08/03/05

WCC Mayfield 01/06/04

WCC Mayfield 11/12/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE WCC Mayfield Mayfield Close Bedworth CV12 8ES Lead Inspector Lesley Beadsworth Unannounced Inspection 5th June 2008 10:20a 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 WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service WCC Mayfield Address Mayfield Close Bedworth CV12 8ES 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) 02476 313600 02476 315376 Warwickshire County Council, Social Services Department Manager post vacant Care Home 35 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (1), Old age, not falling within any of places other category (35) WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th December 2007 Brief Description of the Service: Mayfield is a Local Authority home for older people, with thirty-five beds. It provides permanent care, phased care (which means that people come in for regular, planned periods) short stay and day care. Four assessment beds are also available for rehabilitation. The home is situated on a housing estate, within easy walking distance of Bedworth town centre. The town is a small but busy community, with a variety of shops, a local market and a civic centre. These are all in a pedestrian zone. The home is close to local bus routes as well as being provided with services from Coventry and Nuneaton. It is also close to the M6 motorway. There is car parking to the front and rear of the home. Mayfield was refurbished in 1995 and provides accommodation on two floors. There are three lounges and a main dining area. There is a day care area with its own lounge with kitchenette, which does not have to be registered and therefore was not inspected. All bedrooms have en-suite toilets and washbasin, and on each floor there are bathrooms and toilets suitable for people who need assistance. The main kitchen, laundry and staff offices are on the ground floor. Access to the upper floors is via either of the two staircases or the passenger lift. The home’s fees were not published in the Service User Guide although the items not covered by the fee were listed. These were hairdressing, chiropody, day trips, toiletries and entrance fees whilst on outings. WCC Mayfield DS0000034958.V365649.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. The inspection included a visit to Mayfield. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Information contained within this, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place between 10:20am and 8pm. What the service does well: Pre admission assessments are carried out to ensure that the home can meet the needs of the prospective resident. Meals provided on the day of the inspection were well presented and tasty. Meals were taken in attractive surroundings. Condiments and sauces were available for residents to help themselves, and appropriate tableware was provided. The bedrooms seen that belonged to permanent residents were personalised with their own small pieces of furniture, ornaments, plants, pictures and photos, and looked comfortable and homely. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 7 Care plans did not always reflect the needs identified in assessments and did not contain updated information or sufficient detail that would inform staff of what care to provide for each resident. Risk assessments did not always include all presenting hazards. Action needed as identified in risk assessments was not always added to care plans and created the potential for needs not being met and risks not being minimised. The pharmacist inspector found that the medicine management was poor. It must be improved to safeguard the health and well being of the residents who live in the home. There are insufficient care staff available to meet the social, emotional and physical needs of the people living at the home and insufficient ancillary staff to prevent care staff from being taken away from time with residents. Activities and occupation are not always available to meet the social and emotional needs of the people living at the home. There continues to be no homely remedy policy, which means that minor ailments, such as headaches, cannot be safely treated without a GP being consulted. The lighting in communal areas remains unchanged from the previous visit and is not sufficiently bright enough for people to see clearly in some areas. Staff supervision was not provided at the required six times a year. This is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. Areas of the home continued to be in need of redecorating and some furniture and fittings needed replacing in order to offer the residents comfortable surroundings. 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. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 Quality in this outcome area is adequate. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. Some effort is made to meet specialist, cultural and religious needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All referrals to Mayfield are made via the Social Services Department. The social work team provides an assessment of need and a care plan when making a referral. These documents were present in each of the care files looked at. Following the referral a senior member of staff visits the prospective resident in their current location in order to assess that they are able to meet their needs at Mayfield. This would ensure that the individual’s needs are met. Observations made and discussion with residents and staff indicated that assessments were relevant and up to date. Three care files were looked at as part of the case tracking process. Preadmission assessments were carried out using a format that includes all the WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 10 necessary headings and sufficient detail to decide if the home could meet the person’s needs or not. Following admission to the home an allocated worker continues the assessment process. Prospective residents were informed in writing of the outcome of the pre admission assessment. The care plan of a resident with specific cultural needs showed that some attempt had been made to meet these needs by contacting a relevant social group. A training matrix of training undertaken by staff in the current year was provided. Training was the responsibility of the deputy manager. The records showed that staff had undertaken training related to dementia, stroke awareness and DVD training related to Parkinson’s disease. This would give staff the skills and knowledge to meet these specialist needs. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. There are shortfalls in care plans that carry the risk of residents’ needs not being met. There are concerns around the medication process that could mean risks to residents’ well being. Residents have access to health care professionals and are cared for in a respectful manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new format had been devised by the Local Authority and implemented at the home. This was easier for staff to extract information than the previous version. Parts of the care plan were written in the first person, for example, “I like the bathroom door left open to show the light through the window.” This implies that these are the words used by the person and can be patronising if this was not the case. Some of the instructions for care continued to be in the ‘strengths/needs/problems’ column, for example, “I require three pillows”, as WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 12 well as, or instead of, the ‘care instructions’ column, “ensure has three pillows”. This could be misleading. Some areas did not have sufficient detail, for example one care plan advised that the person wore a hearing aid but there was no mention of how this needed to be cared for, or used. One resident had reference to the use of a Glyceryl Trinitrate tablets stating that it was for stomach pains, whereas it is for angina (heart/chest pains). This could cause major problems for the resident if the medication was not given when the relevant symptoms were experienced. A further care plan of a person with diabetes did not refer to the diet that the person needed to be taking. A pre-admission assessment of a resident with an alcohol related dementia diagnosis had no care instructions to their mental health concerns or to their alcohol related behaviour completed by the social worker did not relate to the home’s care plan. These concerns therefore relied on word of mouth between staff. These shortfalls could result in this person’s needs not being met. One person had recently been prescribed sedation following a close bereavement but the care plan did not give any care instructions regarding how staff could support this person in their grief. Daily records had made only one brief reference to the loss and the resident’s grief. This omission could result in the resident’s emotional needs not being met. A third care plan contained sympathetic instructions on how to manage the moving and handling of a person in a severe pain when moved. These had been confirmed with the Health and Support Officer to be safe for both the resident and the staff, and showed a person centred approach to the resident’s needs. There was evidence to show that care plans had been ‘reviewed’ at monthly intervals but they had not always been brought up to date. There was evidence identified, in the care files looked at, of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse being. This indicated that residents’ health care needs were being addressed. Records for falls, pressure areas and weight were in place within the files looked at. Completed risk assessments for nutritional risk screening and a manual handling risk assessment were also in place. These should help to minimise any risk, however one person’s risk assessment regarding falls showed a low risk but it had not taken into account that this person had a history of frequent falls when suffering from the effects of alcohol. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 13 The pharmacist inspector also found that care plans had not been updated and information recorded not acted upon. It was noted that one resident had lost 5kg in two months and was below her recommended weight range but no action had been recorded as taken. Preventative measures such as pressure relieving mattresses and cushions were in use for those residents assessed as being at risk of developing pressure sores. The meeting of some care needs relied on staff reading risk assessments as well as the plans in order to acquire the information regarding some care needs. One resident had an in depth assessment about the risk of choking due to Parkinson’s disease. The action required/care needed had not been included in the care plan and therefore there was a potential that these needs would not be met. The pharmacist inspector findings were as follows. The pharmacist inspection took place at the same time as the main inspection. General audits were undertaken to check whether the medicines had been administered as prescribed and records reflected practice. Whilst the majority of medicines had been administered as prescribed some had not. Audits indicated that some staff were signing the medicine chart but not actually administering the medication. Concern was raised that one medicine was reported missing, but this was not found to be the case during the inspection. This suggests that staff had signed the medicine chart to cover up the discrepancy. This is very poor practice. Senior members of the managerial team were currently investigating the practices and systems used at the home. The medication round was underway during the inspection. The care assistant kept the medication trolleys in the conservatory and prepared the medicines in open tots, then locked the conservatory door as apposed to the medication trolley and took the open tot containing the medicines to the resident in the home. Concern was raised that the care assistant may inadvertently give the medicine to the wrong resident, or if an emergency occurs would put down the tot and another resident could pick it up and take it because there would be nowhere secure the tot. This would put the residents at risk. A quality assurance system to check the medicines in the home was in use but it was very cumbersome. It involved a member of the management team observing each medication round throughout and also counting all the tablets on a daily basis. A quicker and more accurate system should be installed which would identify the care assistants who failed to administer the medicines as prescribed and accurately record what they had done. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 14 Four residents’ care plans were also looked at to see if they supported the prescribed medication and their clinical condition. The standard of information recorded was inconsistent. Some was well documented, for example, a risk assessment for one resident taking warfarin. It clearly recorded side effects and what staff should do if these were seen. Other care plans lacked any detail and would not support the care assistants to help them look after the residents in the home. One resident was recorded at risk of choking and was administered many tablets but no information was recorded of how best to administer them to ensure that they did not choke. The person was also offered normal food but did require a thickening agent to be added to their food. The care plans recorded different and often insufficient information, so it was not clear what exactly the resident’s clinical needs were or how to support them taking their medicines. Residents were encouraged to self-administer their own medication. No risk assessments had been done to check that the residents understood the medicines they take. No compliance checks had ever been done or documented to confirm that the residents do safely take them. The home still has no homely remedy policy. This would enable staff to administer medicines for minor ailments for example a headache or a cough, following a clearly written protocol. This was raised at the last inspection. One resident suffered from arthritis but no pain relieving medication was prescribed. A homely remedy would have been useful in this case if the resident required some pain relief before the doctor visited. One care assistant that handled medication was spoken with during the inspection who had a good understanding of the residents cared for and knew what the majority of medicines were for. Information about the medication in the home was also readily available for staff to read. Medicines received into the home for respite care residents were recorded on blank medicine charts. The home did not check all new residents medicines with their doctor on entry to the home. One mistake was seen which would have resulted in the resident not receiving the prescribed dose as the doctor intended. This was immediately corrected. Some medicine had been dispensed in January 2008 but was being administered to the resident. Apparently spouse had secondary dispensed what was required to be used in the home in an old box. This is poor practice as the home was not sure if it was in date, whether the dose was the same or whether the doctor still wanted it to be administered. In addition the spouse had changed the dose. The medicine chart must record the prescribed dose only and further clarification must be obtained if a different dose is requested to that prescribed. Surplus medication and that awaiting return to the pharmacy was stored in a separate locked cupboard in a small locked medication room. The temperature in the room was 31°C. All medicines must be stored below 25°C at all times to WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 15 guarantee their stability. Medicines requiring refrigeration were correctly stored in the locked medication refrigerator but the maximum, minimum and current temperatures whilst in range had not been recorded on a daily basis. All controlled drug balances were correct and recorded accurately in the controlled drug register. Terms of preferred address were on the residents care plan and heard to be used by staff. Residents were cared for in a respectful manner ensuring that their dignity and self-esteem are maintained. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. Residents were not always occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives, with limitations to affecting the décor of the home. Residents enjoyed the tasty and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new post of activity organiser had been created but a person had not yet been recruited. One resident spoken with said that they had nothing to do all day but when asked what they would like to do said that there was nothing that they were interested in doing. All care plans looked at had details of residents’ interests and hobbies although this had not been reflected in the activity programme on display at the time of the visit. This showed a different planned activity for each day of the week and included reminiscence, games, dominoes, puzzles, hairdressing, reading the local paper and manicure sessions. These were uninspiring and offered little stimulation. Discussion with staff and residents suggested that these activities did not always take place as planned, for example, when they were busy meeting residents personal care needs. This indicates that there are insufficient staff at times to meet the social WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 17 and emotional needs as well as the personal needs of the people living at the home. There were also Catholic and Methodist church services and communion offered in the home at regular intervals, to meet the religious needs of some of the residents. The home had a shop within the premises where residents could buy such things as toiletries, sweets and drinks. There was also a licensed bar that although storing items at the time of the visit staff said was used by residents on special occasions and from where drinks can be purchased at other times. A hairdressing room was also provided in the home for residents’ use. Fund raising was taking place at the time of the visit. Senior staff said that this was to pay for entertainment and other purchases to benefit the residents. Residents meetings are held where activities and meals are included in the agenda and residents are asked their views and suggestions giving them the opportunity to make decisions about their daily lives. Observations made and discussion with residents indicated that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time, although there were some concerns when discussion with staff showed that it was not routinely accepted that residents would be involved in choosing decoration for the home. Visitors spoken with said that visiting was unrestricted and that they were always made welcome. Visiting could take place in the communal areas or in the resident’s bedroom. Three surveys were offered to people visiting the home at the time. One person chose not to accept a survey to complete and the other two were not returned to us. Meals are taken in the dining room known as the restaurant. This caters for all the residents and day care clients. The restaurant is attractive and well furnished. Arches/pillars in the room detract from an institutional appearance. Staff were available to offer assistance to the large group of people eating throughout the meal. A meal was taken with the residents. The meal consisted of roast pork with roast potatoes and vegetables and was tasty and well presented, although staff relied on what vegetables they thought residents wanted rather than offering them the choice. When asked what they thought of this one resident said that there are occasions when they are given vegetables they do not want and just leave it on the plate. However gravy boats and condiments were on the tables for residents to help themselves, enabling some independence and choice. Appropriate tableware was provided. There were a variety of desserts offered including cheesecake, fruit flan and fresh fruit salad. These were taken around WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 18 the restaurant on a trolley to enable residents to see the choices. Residents spoken with said that they enjoyed their meals at the home. Fruit juice was available on all the tables and tea and coffee was brought to the tables after the meal. The kitchen was visited and it was clean and in good order. Discussion with the catering staff with showed that they were happy to provide individual dishes requested by the people living at the home and for tea on the day of the visit were preparing three or four different types of meals for them. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The home has appropriate policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure provided by the Local Authority that has clear timescales and was displayed in the reception area to inform residents and visitors of how to complain if they should need to. There is also a complaints, compliments and suggestions box in the reception area. Records were kept of all complaints made and showed that complaints were taken seriously. Four complaints had been made in the past year. Two were related to the attitude of staff, one related to care and one to a housekeeping issue. These had been investigated and managed in a timely and appropriate manner, indicating that complaints are taken seriously. There was a Local Authority policy and procedure related to adult protection available and in use. All staff undertake training related to adult protection and this subject is included in induction training. The manager and staff spoken with showed that they were knowledgeable about adult protection issues. Residents were therefore safeguarded against abuse. All recruitment practices safeguard residents from the employment of unsuitable people. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,26 Quality in this outcome area is adequate. The home offers the people living there fairly comfortable surroundings, which are clean, free of offensive odour and generally safe and well maintained but with some shortfalls in décor and furnishings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was carried out including the bedrooms of those residents case tracked. The corridors on the ground and first floors on one side of the home had been decorated since the last inspection and looked bright and attractive. However corridors on the other side of the home continue to be dark, drab and in need of redecoration. The walls on the newly decorated corridors were bare with staff saying that new pictures were being provided that would be the staff’s choice. As it is the residents’ home they need to be included in this choice and the new acting manager said that this would now be the case. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 21 The home has communal and private accommodation on two floors. The ground floor also has offices for management use, and a shop and a hairdressing salon for residents’ use. The large main dining room, known as the restaurant, on this floor caters for all people living and staying at the home and those using the day centre. There is a conservatory adjoining it. The décor of the dining room was satisfactory but the lighting whilst attractive was not very bright. Appropriate dining room furniture and table settings were provided and offered the people at the home a comfortable, although busy, place to take their meals. A lounge and a sitting room / kitchenette were located at the recently decorated end of the ground floor. The lounge was comfortable and satisfactorily decorated and furnished but the sitting room / kitchenette was scantily furnished and had light fittings that were unsightly and fitted with exposed low energy bulbs. This was not a pleasant room for residents to spend time in, although had the potential to be with patio doors looking out onto the garden. One resident was sitting in there to watch the birds and squirrels. This area of the home was used for people admitted for respite or assessment purposes and were therefore generally staying at the home short term. The bedrooms viewed in this unit were pleasantly decorated and made to look homely. The manager’s office was badly in need of upgrading, needing redecoration and replacement floor covering. The main office was adequately decorated but rather cluttered. The first floor has a large pleasant lounge that had been recently redecorated. There is a further sitting area, known as the library, that provides three separate areas divided by two archways, but with furniture that was dated and rather drab. Staff said that this was not used a great deal. The rear garden was in need of some care and attention, although the grass was cut during the day of the visit. Seating had been provided for residents’ use. All garden areas were accessible to residents. The home provides adequate toilet facilities and assisted bathroom/shower rooms for the number of residents. These were clean and free from unpleasant odours. The bedrooms viewed that belonged to permanent residents were personalised with their own small pieces of furniture, ornaments, plants, pictures and photos, and looked comfortable and homely, although some of the furniture was past its best. The manager advised in discussion and in the AQAA that two bedrooms had been fitted with a track hoist to enable appropriate transferring from the bed. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 22 Call bells are now checked daily to ensure that they are in full working order so that people living at the home are able to summon assistance from their room when necessary. Laundry facilities were inspected and found to have appropriate equipment with appropriate washing programmes and to be well organised, clean and hygienic. Protective clothing was available in order to maintain infection control. Appropriate hand washing facilities were available in all communal areas where staff and residents wash their hands and protective clothing was available for care staff when needed, in order to maintain infection control. The inappropriate practice of using protective goggles and masks had ceased following the last inspection. Some staff had undertaken infection control training WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. There are not sufficient care staff available to meet the social, emotional and physical needs of the residents and the low numbers of ancillary staff may have further impact on this. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The acting manager advised that the normal complement of care assistants was two on the first floor during the day shifts and three on the first floor and two night care assistants. In addition to this two cooks worked opposite shifts, a laundry assistant worked 20 hours during the week, two domestic assistants worked mornings during the week and a third worked evenings also during the week. There were no laundry/domestic hours allocated during weekends. This would mean that care staff or managers would have to carry out any relevant tasks during weekend hours, taking them away from caring for residents. There was one care assistant and one domestic assistant vacancy at the time of the visit. Permanent and bank staff generally covered absences, although agency staff had also been used in the past. Residents spoken with said that staff were caring and respectful. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 24 58 of the care staff had achieved National Vocational Qualification Level 2 in Care with a further 24 undertaking the training. This qualification demonstrates that the person has been assessed as competent to do their job. Three staff files were looked at. All included all the information required for people working at the home, including appropriate Protection of Vulnerable Adults and Criminal Records Bureau checks, two written references and evidence of induction training and staff supervision. References had also been verified to ensure their validity. All recruitment practices safeguard residents from the employment of unsuitable people. A training matrix of training undertaken by staff in the current year was provided. Training was the responsibility of the deputy manager. The records showed that staff had undertaken training related to COSSH, dementia, stroke awareness and DVD training related to Parkinson’s disease. This would give staff the skills and knowledge to meet these needs. The AQAA advised that all staff had a training development plan. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. A person with the appropriate training and who has previous management experience manages the home. Monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Residents’ financial interests are safeguarded and the premises are a safe place to live and to work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager of the home was not present on the day of the visit and was retiring that week. All management responsibilities had been transferred to the acting manager from that day and she was the person in charge for the first part of the inspection. The acting manager was temporarily in post until the post was advertised. She had achieved the Registered Managers Award and had several years of experience in senior positions in similar environments, giving her the appropriate training and experience for WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 26 this post. During discussion she showed general awareness of where she needed to improve the home and said that she was confident that she would have the support of the other senior staff to take the home forward. An on call rota was in place for all senior staff so that night staff knew who to call in an emergency. The home had implemented the Local Authority quality assurance programme, which was comprehensive and covered all the services provided at the home. A representative of the registered provider visited the home monthly and made a report on their findings. These systems indicate that the home is monitoring the service in order to enable growth and improvement. The majority of the residents had money that was held by the home for safekeeping. A secure location was provided for this. There were good records of transactions, and cash that balanced against these records, for any money held on behalf of residents. Receipts for all purchases were kept for each purchase made on behalf of the residents. Staff files showed evidence of formal supervision taking place but this was not at the required six times a year. This is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. Training records showed that the majority of staff had undertaken training related to Control of Substances Hazardous to Health (COSHH) and Fire Awareness; some staff had undertaken infection control training. The matrix gave no further information about mandatory training in the last year but the AQAA advised that all staff had undertaken training related to food hygiene and at the last inspection training records showed that staff had undertaken mandatory training related to health and safety issues, including moving and handling, basic food hygiene, first aid and fire training. The AQAA confirms that routine servicing/testing of equipment had been carried out as recommended by the manufacturer or by regulations. There was further evidence from a check of records, that equipment was regularly serviced and maintained, health and safety checks, including hot water temperature checks, were carried out and that in house checks on the fire system were up to date. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 27 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 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement All care plans must relate to identified needs and contain detailed and updated information. This will ensure that the residents’ needs are met. Timescale for action 30/07/08 2. OP7 13 3. OP8 13 4. OP9 13(2) All care plans must include 30/07/08 action required as identified in individual risk assessments. This will ensure the risk for the resident is minimised. All individual risk assessments 15/07/08 must include all relevant hazards. This will ensure that the risks to the resident are minimised. The correct medication must be 05/06/08 given to the correct person at the correct time. This will safeguard the well being of the people staying at the home. Not met at this inspection. Timescale 30/01/08 5. OP9 13(2) The medicine chart must record the current drug regime as prescribed by the clinician. It must be referred to before the DS0000034958.V365649.R01.S.doc 15/07/08 WCC Mayfield Version 5.2 Page 29 preparation of the service users medicines and be signed directly after the transaction and accurately record what has occurred. 6. OP9 13(2) Staff must transport medicines throughout the home in a safe manner and all medicines must be able to securely held in a locked facility in the event of an emergency A system must be installed to check the prescription prior to dispensing and to check the dispensed medication and the medicine charts against the prescription for accuracy. All discrepancies must be addressed with the healthcare professional. A system must be installed to check with their doctor all new service users medication brought into the home to ensure that they are administrated their current drug regime 8. OP9 13(2) All dose regimes must be clearly written on the medicine chart and checked by a second member of staff for accuracy to ensure that the staff have clear directions to follow. 30/06/08 30/06/08 7. OP9 13(2) 30/06/08 9. OP9 13(2) A quality assurance system must 30/06/08 be installed to assess individual staff competence in their handling of medicines. Appropriate action must be taken when these indicate that medicines are not administered as prescribe and records do not reflect practice, to ensure that all medicines are administered as prescribed and this can be demonstrated. DS0000034958.V365649.R01.S.doc Version 5.2 Page 30 WCC Mayfield 10. OP9 13(2) All service users must be risk 30/06/08 assessed as able to self administer their own medication and regular compliance checked undertaken and documented to ensure that they can handle their medication safely All medicines must be stored in compliance with their product licences to ensure their stability All medicines must be stored in compliance with their product licences to ensure their stability. There must be an assessment of staffing required to meet the residents’ needs and sufficient staff be employed to achieve this. This will ensure that residents’ needs are met. The previous timescale of 30/01/08 was not met. 30/06/08 11. OP9 13(2) 12. OP9 13(2) 30/06/08 13. OP27 18(1) 30/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP1 OP12 OP9 OP19 Good Practice Recommendations The amount to be paid for accommodation fees should be included in the Service User Guide. There should be activities offered to provide appropriate stimulation and occupation for the people living at the home. A homely remedy policy should be in place in order to treat minor ailments safely. For the benefit of the people using the service the home should be in good decorative order throughout. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 31 5. 14. 15. OP25 OP30 OP36 Lighting should be of sufficient brightness to enable people using the home to be able to see clearly. Staff should undertake training related to needs in later life, including physical and sensory impairment. Staff supervision should take place at a minimum of six times a year. WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 WCC Mayfield DS0000034958.V365649.R01.S.doc Version 5.2 Page 33 - 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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