Care Home: Meppershall Nursing Home

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What the care home does well All information is detailed within the `What we found` section. What the care home could do better: All information is detailed within the `What we found` section. Random inspection report Care homes for older people Name: Address: Meppershall Nursing Home 79 Shefford Road Meppershall Bedfordshire SG17 5LL one star adequate service 26/05/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Katrina Derbyshire Date: 0 6 0 9 2 0 1 0 Information about the care home Name of care home: Address: Meppershall Nursing Home 79 Shefford Road Meppershall Bedfordshire SG17 5LL 01462811224 01462812027 gagroup@btconnect.com gacontracts@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager post vacant Type of registration: Number of places registered: Conditions of registration: Category(ies) : G A Projects Ltd care home 84 Number of places (if applicable): Under 65 Over 65 0 49 0 dementia old age, not falling within any other category physical disability Conditions of registration: 30 0 5 The Maximum number of service users who can be accommodated is 84 The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP Dementia - Code DE Physical Disability Code PD Date of last inspection 2 6 0 5 2 0 1 0 Care Homes for Older People Page 2 of 11 Brief description of the care home Meppershall is a purpose built care home with nursing in the the village of Meppershall, in Bedfordshire. The service is registered to provide residential and nursing care for 84 people: 54 in the main nursing home and 30 in the dementia care unit. At the time of this visit there were 52 people living at the home, leaving 32 vacancies. The main building referred to as the nursing home is built on two floors, and managed in four units, two on each floor. Each unit consists of a number of bedrooms which either have ensuite toilet and washbasin facilities, or have a washbasin in the bedroom, a sitting area, bathrooms and a nurses station. There is a dining room on each floor, and a large sitting room on the ground floor. The home was extended in July 2008. A separate, thirty-place unit was built next to the existing home, and attached to it by a glass corridor. This building is known as the dementia care unit and accommodation is on two floors accessed by a lift. There are fifteen bedrooms, all with ensuite facilities, a lounge, dining room and bathrooms on each floor. There are also kitchen and laundry facilities, and a small office. The home is surrounded by large grounds and parking spaces for staff and visitors are provided. The home has links with the local community and shares transport for people with its sister home. Hairdressing, newspapers, toiletries, and staff escorts to medical appointments are not included in the fees. People who have their own telephone are responsible for the bills. Information about this home can be obtained by phoning and visiting the home direct, and there is also an entry for this company on several care home websites. The fees for this service vary between £440 and £530 per week: the exact fees are reflected in individual service contracts for the residents. Care Homes for Older People Page 3 of 11 What we found: This unannounced random inspection was undertaken on 6th September 2010 by one Compliance Inspector. The reason for this inspection was The Care Quality Commission received information from the Central Bedfordshire safeguarding team on 31st August 2010. Central Bedfordshire Council had been informed of a serious incident at the home. In addition Central Bedfordshire Council shared information with us following visits they had undertaken to the home to look at the area of concern, and they reported on the measures they had taken to safeguard the people living at the home. CQC had carried out random inspections of the home on 2nd and 13th November 2009, significant shortfalls were identified and immediate requirements were made alongside other requirements:concerns raised included moving and handling. There has been a change of acting manager for the third time during a five month period. Subsequently a 0star rating was given to this service following a key inspection on 17th December 2009, we made 12 requirements and we also served the owner/responsible individual with a Code B Notice, a procedure in line with the Criminal Procedure and Investigations Act 1996, and allowing inspectors to seize or copy any documents relevant to their investigation. The Notice was in respect of medication not administered for 2 people. During this time the home were receiving significant input and support by health and social care professionals from various agencies including Central Bedfordshire Council. They undertook measures to support management and staff to improve standards of care, and safeguard the people living at the home. At a further random inspection of the home on 23rd February 2010 to follow up on the requirements we had made where the timescales for compliance had passed: We found that improvements had been made, but not in medication administration. We again served a Code B Notice and then issued a Statutory Requirement Notice, this related to failures in the management of medication. An inspection carried out to check on compliance with this notice was undertaken by two pharmacist inspectors, and the visit showed the service had complied with this notice. A key inspection of the home on 26th May 2010 changed the rating of the service to a1star. We reported that consideration had to be given to the level of support and monitoring by health and social care professionals to the home, and the impact this had on the improvements that were found. We reported that the owner and manager had to demonstrate their abilities and fitness to manage the home and to be able to sustain any improvements ensuring people were safe. The focus of our visit was to look at moving and handling management in the home, we did not check on compliance with any previous requirements. The outcome of this visit is as follows: On arrival at the home we were met by the owner. We had been asked by the contracts compliance department of Central Bedfordshire Council on 3rd September 2010, if we Care Homes for Older People Page 4 of 11 had been approached by the owner concerning information he had raised with them, we had not. We raised this subject with the owner, and then through discussion of the issue it was evidenced that it could have placed people at significant risk. The owner was fully aware of his responsibilities to report matters under regulation 37, as this had been subject to an immediate requirement on 2nd November 2009. He had failed to again notify us of a matter that should have been reported under regulation 37. CQC have written to the owner concerning this issue and other concerns. We then looked at information relating to moving and handling management at the service. At a random inspection on 2nd November 2009 an immediate requirement was made, this was to ensure safe and appropriate equipment was in place for moving and handling. At a random inspection on 13th November 2009 we found further equipment had been purchased by the provider, and the training of staff in moving and handling through a different external training company was being carried out. In June 2010 we were told guidance had been given by a health professional to the provider and management. They had previously assessed people at the home, guidance in terms of make of sling, type, size, loops on the sling that need to be used and how the sling should be fitted had been given by them, on visiting the home in June 2010 they found this had not been followed for a person living at the home. We wrote to the provider about this. The provider in his response submitted information to both CQC and the council by the owner to dispute this, he detailed that all equipment had been ordered that was required and that he had just chosen to use a different supplier. CQC and other agencies were made aware on 31st August 2010 of a serious incident at the home, this had been reported by a relative. We contacted the home for further information, as we had not been notified by them under regulation 37. The acting manager advised us that she had faxed a notification to us on 30th August 2010, this has never been received. When we contacted the service we checked if the Health and Safety Executive (HSE) had been informed, they had not and we prompted for this to be done the same day. As already outlined this service had been subject to an immediate requirement for failing to report matters under regulation 37 or following local safeguarding protocols or reporting serious incidents to the HSE. Again the service had not reported this incident, it was through a relative that agencies became aware and in turn CQC prompting the reporting to the HSE. A subsequent notification was received into the offices of CQC sent after this inspection. Central Bedfordshire Council had made arrangements in the week prior to this visit for observation of moving and handling practice to be carried out, re assessment of people who needed assistance when moving, they had ordered further equipment, arranged for an independent person to look into moving and handling, carried out monitoring visits as part of their commissioning protocols and arranged further training of staff in this area by 10th September 2010. Discussion was held with the owner and acting manager on the feedback following observation of moving and handling practice. On discussing issues raised on 1st September 2010 both the owner and acting manager disputed the findings. They stated that someone had been in at the weekend and everything was fine except carers did not Care Homes for Older People Page 5 of 11 speak to each other enough. We asked a Health professional who was in the home at the time who knew the feedback from this visit to outline the concerns that had already been raised to the home as they continued to dispute the information the inspector outlined, she agreed to do so and issues raised included: (1) Incorrect placement of the hoist observed resulting in the leg of the hoist tipping (deputy manager had been present when this happened), (2) Incorrect fitting of sling to a resident resulting in moving and handling adviser having to intervene to advise on correct fitting as there was a high risk the resident would fall out of the sling. (nurse in charge present). We then examined information on the mobile hoists available at the home, there were 8 hoists in place (1 of which was broken and not in use). All hoists had up to date servicing records, these had been carried out by an external contractor. We also looked at records provided by the training manager at the home, these showed that 60 out of 66 staff had up to date moving and handling training. The remaining 6 staff had received moving and handling training, although their annual update had become out of date. Training in this area had been provided by a training organisation selected by the provider, this is external to the service. Based upon this information the provider had made arrangements for moving and handling training, servicing of hoists and the purchase of slings that he deemed subtable. However moving and handling practice remains inadequate. There has been a failure to monitor moving and handling practice of staff and challenge poor practice when it occurs. The acting manager and senior staff at the home have failed to recognise unsafe moving techniques that have been used by some staff despite them having been trained. This information shows the service made changes and improvements when shortfalls in care were identified by various agencies, they have then received support from the local authority to make improvements, however following the withdrawal of this support they have not sustained the progress made, long enough, to improve the quality of service delivery and demonstrate their competency by operating the service safely so people are not placed at risk. Requirements relating to the failure to report matters under regulation 37 and failings in moving and handling practice have been made under the Care Standards Act 2000, we will use this information to inform our judgements in our assessment of the transitional registration of this provider from the Care Standards Act 2000 to the Health and Social Care Act 2008. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 8 12 Treatment by nursing staff through the provision of wound care must include support to secure required pain relief and nutrition. This will ensure people are free from discomfort and receive supplements to aid healing. 30/06/2010 2 16 22 All complaints received must 09/07/2010 be accepted in a professional manner and then responded to in accordance with the homes own policy. This is to ensure people and their relatives feel confident enough to raise a concern and feel listened to and their concerns are acted upon appropriately. 3 30 18 Staff must have sufficient 30/06/2010 levels of competency to meet the needs of residents in accordance with best practise. This is to ensure the safety and the protection of people using the service. 4 31 8 The Acting Manager must re submit her application to apply to be the Registered 09/07/2010 Care Homes for Older People Page 7 of 11 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Manager for this service. This will stop this service being managed on a day to day basis by someone who is not registered. 5 33 24 The system for quality 30/06/2010 monitoring on standards of care must improve to ensure any shortfalls are identified quickly and action taken to remedy this. This will ensure people receive the care that they require at an acceptable and safe standard. Care Homes for Older People Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 33 37 Every event which adversely 15/10/2010 affects the well-being or safety of people who use the service must be reported without delay. This will ensure the appropriate agency can commence any required investigation and would demonstrate that the service was acting in the best interest of the people who use the service by being open and transparent. 2 38 13 There must be systems in place to ensure safe moving and handling practice is carried out at all times. This is to ensure no person using the service will be at risk of pain or serious injury. 15/10/2010 Care Homes for Older People Page 9 of 11 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 11 of 11 - 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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