Care Home: Merlewood Nursing & Residential Home

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What the care home does well Service users living in this home receive effective personal and healthcare support using a person centred approach based upon the rights of dignity, equality, fairness autonomy and respect. Service users are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home has sought the views of the service users, and considered their varied interests when planning the routines of daily living and arranging activities both in the home and in the community. Routines are very flexible and service users can make choices in major areas of their lives. All complaints made and the actions taken in response to them are fully recorded. A review of the number and nature of complaints made is used as part of the quality assurance procedures in use at the home. The home has demonstrated that it learns from complaints in order to improve its service. They pay particular attention to any themes within complaints that refer to dignity, respect, fairness, autonomy and equality. The AQQA contains excellent information that is fully supported by appropriate evidence. It includes a high level of understanding about the importance of equality and diversity and a wide range of evidence showing how they have listened to service users. The home demonstrates a high level of selfawareness and recognises the areas that it still needs to improve, and has clearly detailed the innovative ways in which they are planning to do this. The home fully recognises the importance of the AQQA and has used the content to inform its own quality assurance. The data section of the AQQA is accurately and fully completed and supports evidence in the self-assessment section. What has improved since the last inspection? The home has undertaken a complete overhaul of the car planning process, to include a minimum of ten care plans are audited each month. They have enrolled as a member of Care Aware which provides independent advocacy and advice to service users. The home has employed a new full time (seven days per week) Activities coordinator who has lifted the standards of activities to include a wide range of activities including adoptive interactive activities suitable to the needs and interests of the individual service users. A loop system has been installed in the drawing room to enable service users with hearing deficit to be involved in activities and meetings. Corridors have been redecorated, furniture has been replaced as required and six bedrooms have been refurbished. Two bathrooms, shower room and pantry are in the process of being refurbished. The carpet to the entrance has been replaced. What the care home could do better: Ensure that service users` personal files are kept securely in a locked cupboard. Ensure all service users are made aware that there is wine available at cost price. (non profit basis). CARE HOMES FOR OLDER PEOPLE Merlewood Nursing & Residential Home Hollow Lane Callow Hill Virginia Water Surrey GU25 4LR Lead Inspector Mavis Clahar Key Unannounced Inspection 18th March 2008 09:30 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 Merlewood Nursing & Residential Home DS0000065967.V359591.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. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merlewood Nursing & Residential Home Address Hollow Lane Callow Hill Virginia Water Surrey GU25 4LR 020 7396 6700 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) Elizabeth Finn Homes Ltd vacant post Care Home 53 Category(ies) of Old age, not falling within any other category registration, with number (53) of places Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th September 2006 Brief Description of the Service: Merlewood is a long established care home, owned and managed by Elizabeth Finn Care, a registered charity and managed by Elizabeth Finn Homes Ltd a not for profit sibsidiary. The original building is Victorian and is set in 23 acres of grounds. The home has been redeveloped to provide additional bedrooms and provides residential and nursing care for older people all on one floor. Accommodation is provided in single bedrooms, all of which benefit from ensuite facilities. There is ample car parking space available. Fees at this home are in the range of £800 to £1095 per week. There is an additional cost for hairdressing, chiropody and dry cleaning. Merlewood Nursing & Residential Home DS0000065967.V359591.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 3 stars. This means the people who use this service experience excellent quality outcomes. This unannounced site visit, which forms part of the key inspection to be undertaken by the Commission for Social Care Inspection, (CSCI) was undertaken by Mrs Mavis Clahar on the 18th March 2008 and lasted for eight hours; commencing at 09:30 hours and concluding at 17:30 hours. The CSCI Inspecting for Better Lives (IBL) involves an Annual Quality Assurance Assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This initially helps us to prioritise the order of the inspection and identify areas that require more attention during the inspection process. This document was received by CSCI and is referred to throughout the report. The registered manager of the home was on annual leave. The Clinical Care Manager (CCM) who assisted CSCI (us) on this site visit was managing the home in his absence. The majority of the service users spoken to were able to express their thoughts and feelings about the care they receive. The information contained in this report was gathered mainly from observation by the inspector, speaking with a number of service users, and with care staff and from information contained within the AQAA. Further information was gathered from records kept at the home. The first part of the inspection was spent discussing and agreeing the inspection process with the CCM, followed by a tour of the home, which included time spent in discussion with service users, care workers and the Hotel Services Manager and the Head Chef. The manager and staff are aware of the Laws regarding equality and diversity and Equal opportunities and this was reflected in the staff mix. All service users in this home are Caucasian and reflect the population of the area in which the home is situated. All records sampled were up to date with care plans being signed by the service users or by relatives. One requirement and one recommendation of good practice were issued on this visit Please see Daily Life and Social Activity and Management and Administration outcomes for full disclosure. The final part of the inspection was spent giving feedback to the CCM about the findings of this visit. The inspector would like to thank all the service users and care staff that made the visit so productive and pleasant on the day Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home has undertaken a complete overhaul of the car planning process, to include a minimum of ten care plans are audited each month. They have enrolled as a member of Care Aware which provides independent advocacy and advice to service users. The home has employed a new full time (seven days per week) Activities coordinator who has lifted the standards of activities to include a wide range of activities including adoptive interactive activities suitable to the needs and interests of the individual service users. A loop system has been installed in the drawing room to enable service users with hearing deficit to be involved in activities and meetings. Corridors have been redecorated, furniture has been replaced as required and six bedrooms have been refurbished. Two bathrooms, shower room and pantry are in the process of being refurbished. The carpet to the entrance has been replaced. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 7 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 summary of this inspection report can be made available in other formats on request. Merlewood Nursing & Residential Home DS0000065967.V359591.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 Merlewood Nursing & Residential Home DS0000065967.V359591.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 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Prospective service users and their relatives have the information needed to choose a home, which will meet their needs and service users are being assessed to ensure the home is capable to meet the needs of the service users prior to being admitted into the home. EVIDENCE: Review of service users documents and identified policies demonstrated the home has a policy and procedure on admission and discharge of service users. Within the admission policy all service users must have an assessment prior to being admitted into the home. The Registered Manager, and in his absence, the Clinical care Manager who is trained in the principles of assessment of service users’ needs based on what the care the home says it will provide carries out all pre admission assessments of service users prior to them being admitted into the home. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 10 The Annual Quality Assurance Assessment (AQAA) states “we admit a resident only following a full pre admission assessment ensuring that all personal, psychological, emotional and nursing needs can be met and the potential resident or their relative have visited the home”. Review of a random sample of service user’s files including one recently admitted service user, demonstrated that pre admission assessments are being carried out and relatives were being involved in the assessment process. The AQAA states “all residents are provided with a contract, which clearly identifies information about fees and any additional charges”. In discussion with service users they supported this statement, and contracts for the service users tracked on this visit were available for review. Merlewood Nursing & Residential Home DS0000065967.V359591.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 People who use the service experience excellent quality outcomes in this area. This judgement has been using a range of evidence including a visit to this service. Practices in the home reflect service users’ needs involving the six strands of diversity: gender, age, religion or belief and disability. The home has a good and clear care plan in place for service users and this includes appropriate risks assessments. This forms the basis for care based on the agreed care needs of the service users and demonstrated that trained staff met service users’ health and personal care needs. The home’s medication policy on receiving, storing and administering of medication was in place and being adhered to thereby ensuring the safety and protection of the service users. Care workers treated service users with respect and maintain their dignity and privacy when delivering personal care. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 12 EVIDENCE: One concern was received by CSCI and was directed to the Surrey safeguarding Team for investigation. Records received by CSCI and seen at the home on the day of the visit, revealed this has been investigated and suitable actions were put into pace to prevent a repeat of the concern. The randomly selected care plans were clear and easy to read, identifying potential and actual risks to service users and detailing how these risks would be managed. The daily work sheet along with discussion with service users and care workers demonstrated that service users care needs are fully met. The service user or relative signed the care plans to indicate their involvement in deciding what care they received. It was evidenced that care staff undertaking the development and monthly review of the care plans also signed and dated them. In discussions with service users on the day of the visit they confirmed they were involved in the planning of their daily care. The AQAA states “Comprehensive individualised care plans based on the Roper, Logan and Tierney Activities of Daily Living model are developed for all residents, involving residents and where appropriate their family or friends. Regular audits and reviews are undertaken as a minimum monthly”. We observed the home uses recognised tools such as Waterlow score and Malnutrition Universal Screening Tool (MUST) during the care planning process to support decisions made. Information contained in the home’s Annual Quality Assurance Assessment (AQAA) states “We have access to and consult with specialist practitioners such as dieticians, speech and language therapist, and tissue viability nurse when required”. This service enables service users to benefit from the involvement of specialist health professionals who supports the home in meeting the needs of the service users. All service users are registered with a local General Practitioner (GP) of their choice and visits are recorded, with access to specialist healthcare professionals through their GP practice as required such as sight and hearing tests which are carried out on a regular basis; and these visits are also recorded in the service user’s folder. Service users are offered access to chiropody service and weekly hairdressing facilities are available at a cost to the service users. In discussion with the registered nurse and care worker they were extremely proud of the high standard of care they provided to all service users in the home. We were told on the day of the visit that some service users at present are risked assess as capable to self medicate. The home had a policy on selfmedication. We were told Qualified and senior care staff have all received training in the receipt, recording, storage handling and administration and disposal of medicines. On the day of the visit staff were being trained by a local Pharmacist in the management of medication in care home. All medicines Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 13 are administered from a lockable drugs trolley. The home keeps a controlled drug register and records the temperature of the Medication fridge daily. This was evidenced as correct during a tour of the home. Care staff identified as capable to administer medication are requested to leave a sample of their signature, which is dated in the medication trolley. All service users have a recent photograph included in their personal folder and medication record, to reduce the risk of mistakes happening during medication administration. We observed that care workers wore name badges to enable visitors and service users with memory impairment to be sure of whom they are speaking with; and we also observed service users being treated in a friendly but respectful manner by care workers. In discussion with service users who were able to understand the questions, they told us that they are treated with respect and dignity, and that they are able to make their own choice. One service user told us “I am very happy here. Everything is so nice. I have my own room; I can have as much privacy as I want”. Another service user said “We have good staff here; they do not ill treat me. I have help to choose my own clothing every day”. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 14 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 People who use the service experience excellent quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Service users are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. The home has sought the views of the service users and considered their varied interests when planning the routines of daily living and arranging activities both in the home and community. Routines are very flexible and service users can make choices in major areas of their lives. Service users lifestyles matched their needs and preferences and where possible they are able to maintain contact with family, friends and the local community. Service users are able to make choices in accordance with their abilities and were provided with a balanced diet in mostly pleasant surroundings and in an unhurried way. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 15 EVIDENCE: The home employs a full time activity-co-ordinator who provides a range of activities based on the individual service user’s assessed and agreed needs, including their preferences, cultural beliefs and customs. We were told that wherever possible relatives are encouraged to participate in the planning and carrying out of service users’ activities. The AQAA states, “We have recently joined NAPA which provides up to date ideas and advice on activities. A steering group has been set up to develop social activities within the Elizabeth Finn homes which will also aid in the exchange of ideas and best practice in the social activity function”. In discussion with the activities co-ordinator we were told, “we are aware that by creating and maintaining a stimulating lifestyle for our service users we have minimised the risk of a decline in their mental and physical health, through boredom, depression and lack of exercise, hobbies and games.” The home provides a full programme of activities to include themed events such as, Burns Night, Chinese new Year, and Valentines Day as well as annual garden party and barbeque so that those who cannot usually get out or don’t travel well are treated to special days within the home. We were told the home has close links with the local college providing volunteers (who are CBR and POVA checked) who concentrate on reminiscence therapy and where appropriate produce a personalised book of the service users’ life experience. Service users have access to computers for sending and receiving e-mails; service users also enjoy various games such as tennis, boxing and golf using the latest adoptive technologies in association with the home’s wide screen TV in the activities room. In discussion with service users some were enthusiastic about being able to use the computer and one told us “imagine I can communicate with my family across the world, I never thought at my age I would be able to do this. I love it. It is also a social event for me as I get to choose the most outrageous coffee and biscuits you can imagine. I never knew they had so many different coffees”. Another service user told us “As a young girl I played tennis, I never dreamt I would be playing at my age, it makes me feel young”. Another service told us “I am not interested in the computer, if I need to find out anything I ring my family and have the information the next day. This way I keep in touch with my only surviving sibling”. We observed the activities programme displayed in the reception area of the home, in all the three lounges used by the service users and in the dinning areas. The home also has their own Mimi bus, which they use to transport service users to places of interest such as Saville Gardens, Windsor Great Park and for service users personal shopping and the theatre. The C/E Vicar holds weekly services at the home, except during the months with five weeks when no service is held on the fifth Sunday of the month. We were told by service users that they are able to have their friends and relatives visit any time it is convenient for them to visit. There is a private room set aside for service users and their guest to dine in privacy if they so wish. Five of the service users spoken to said they had choice in their clothing and sometimes they receive help from their key worker. On the day of inspection all service users were dressed appropriately for the weather. The AQAA states, “A resident representative attends meetings with the Hotel services and catering departments to provide resident input and suggestions on catering within the home and in development of the seasonal menu”. In discussion with the Hotel services manager we were told he visits all newly admitted service users on their first day to find out their dietary needs so that Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 16 this can be inco-orporated into the menu. Menus are planned with service users and then sent to the dietician for advice on suitability in terms of nutritional value. Service users are encouraged to choose their meal from the printed menu a day in advance, but they can change their mind on the day and a suitable replacement would be provided. On the day of the visit we observed the lunchtime meal and this consisted of a three-course meal with a choice of two hot main dishes. We also observed two service users having wine with their meal, and on enquiry were told they had their own personal wine. In discussion with the Hotel manager we were told wine is available to all service users but they have to ask for it. In discussion with service users we were told they are occasionally offered wine with their meals. A recommendation was made to ensure all service users are made aware of the availability of wine at no extra cost with their meal by offering them wine with their meal. We observed a comments book for service users to comment on the meal, but the staff completed this. We observed the home have created a very attractive and welcoming dinning room; the tables being dressed with freshly laundered and colour coordinated table linen, condiments and vases of flowers, and daily menus which includes alternative choices to the main courses are displayed for the use of our service users. We observed jugs of water available on each table. The inspector did not sample the lunch, but service users said the food was very good, tasty and the right amount. The inspector observed the presentation of the food was done in a way to stimulate appetite. The Chef told us that some service users had supplements as ordered by their GP or dietician, to maintain body weight or increase appetite. Lunch, which is served in the dinning room unless a service user requested to have their meals in their bedrooms. We observed care workers interacting in a friendly but dignified manner with service users during the lunch time, sitting down beside service users and speaking to them whilst helping them with their lunches. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 17 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 People who use the service experience excellent quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The home has a satisfactory complaints policy and procedure and training in place that evidenced that service users and relatives concerns are listened to and acted upon. Robust Safeguarding adults’ policies are in place to protect the service users from abuse. EVIDENCE: CSCI received one complaint about the home, which was referred to Surrey Safeguarding Adults Team. The home dealt with this satisfactorily and kept CSCI informed of proceedings on a weekly basis, until it was cleared up to the satisfaction of the complainant as the records demonstrated on the day of the visit. The AQAA stated “the home received four complaints in the last year all of which were dealt with within the home’s time frame for dealing with complaints, and one was upheld”. This was verified on the day of the visit by reviewing their complaints record, which demonstrated all complaints made, and the actions taken in response to them were fully recorded. We were told that a review of the number and nature of complaints made is used as part of the quality assurance procedures in use at the home. The home learns from complaints in order to improve its service. They pay attention to any Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 18 particular themes within complaints that refer to dignity, respect, autonomy and equality. The Clinical Care Manager (CCM) told us that the management team are in touch with service users on a daily basis and issues raised are dealt with immediately; this reduces the incidents of formal complaints. Service users spoken to said they know how to complain and will do so if they are not happy. Their complaint is always dealt with immediately and they were satisfied with the outcomes. It was observed that the home’s guest information pack situated in reception contained a complaints procedure and policy; whistle blowing policy and the homes’ statement of purpose. It was noted that the home received a number of compliments from relatives of service users commending the staff on their kindness and understanding and for the high quality of work they perform. A copy of the most recent CSCI report is made available for visitors to the home. In discussion with care workers, it was apparent they are aware of the homes’ policy and procedure on Safeguarding Adults and felt secure in the knowledge that if they had to use the whistle blowing procedure the manager and the owners of the home would support them. During discussion with care workers it became apparent they had a full knowledge on Equality and Diversity issues relating to the service users they were responsible for. A random sample of care workers training record demonstrated that care workers are being trained to undertake the duties of meeting the service users assessed needs, thereby protecting them from abuse. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 19 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 26 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables service users to live in a safe, well- maintained and comfortable environment, which encourages independence, and protect their privacy and dignity. EVIDENCE: The clinical care manager told us that the management and staff encourage service users to see the home as their own home. It presents as a comfortable, attractive home, which has all the specialist adaptations needed to meet the service users needs. The home employs a maintenance person who ensures the home and facilities for service users are kept in excellent condition with records of service history available for inspection. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 20 The home employs a full time gardener who ensures the attractive gardens, is well maintained and there is good access to the gardens from various parts of the home. It was noted that service users were able to personalise their bedrooms with small items of furniture, paintings on the wall and many family photographs. Service users call bells tested were in good working order and we were told a private contractor carries out the maintenance of the call bells. The home produced records of testing to verify this. Generally, the home presents as clean, safe, pleasant, hygienic and tidy and free from offensive odours. Random review of care workers training record demonstrated they have had training in infection control and this was evident in the storage of waste. On display in the home is the Regulatory Reform (Fire Safety) Order 2005 stating the home has met their requirements. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 21 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 People who use the service experience good quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to fulfil the aims of the home and meet the changing needs of the service users. EVIDENCE: The staff rota demonstrated the number and grade of staff on duty to provide care and attention to service users for any twenty-four period was adequate to meet the assessed care needs of the service users. Over 50 of care workers have attained the National Vocational Qualification (NVQ) Level 2 qualification with one care worker achieving NVQ Level 4 in care, one attaining the Registered managers’ Award (RMA) and one achieving NVQ L3. Review of care workers files demonstrated that care workers had regular and up to date training to enable them to fulfil their roles. A random review of care workers files found that the home complied with the regulation regarding employment of staff to work in care homes. Records contained evidence that care workers attended all training offered. Recruitment to the home is through a process of equal opportunity, and in accordance with the code of conduct and practice set by the General Social Care Council (GSCC). All care workers have Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks and two written references Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 22 prior to commencing employment, and they are in receipt of terms and conditions of employment as evidenced in their randomly selected files. There was evidence in the care workers files that they are supervised on a regular basis. All newly appointed care workers undertake an induction programme, and this was supported during discussions with a new member of staff. The home ensures that staff undertakes the mandatory training with yearly updates as necessary to maintain their competency to fulfil their duties. This was evidenced through discussion with the care workers and by checking care workers’ training files. In discussion with care workers some were able to give examples of how the home applied equality and diversity to the different needs and wishes of the service users in their care, and also within the diverse staff group. Staff files contained their up to date training records and it was noted that Equality and Diversity training has been undertaken by staff. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 23 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 37 38 People who use the service experience excellent quality outcomes in this area. This judgement has been made using a range of evidence including a visit to the service. The manager has the experience to run the home and works to continuously improve services and provide an increased quality of life for the service users. There is a strong ethos of being transparent and open in all areas of running the home. The views of service users and their relatives are actively sought in the running of the home and The service provides training on health and safety issues for all staff and service users are involved in the running of the home. Service users financial interests are safeguarded. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 24 EVIDENCE: The AQQA contains excellent information that is fully supported by appropriate evidence. It includes a high level of understanding about the importance of equality and diversity and a wide range of evidence showing how they have listened to service users. The home demonstrates a high level of selfawareness and recognises the areas that it still needs to improve, and has clearly detailed the innovative ways in which they are planning to do this. The home fully recognises the importance of the AQQA and has used the content to inform its own quality assurance. The data section of the AQQA is accurately and fully completed and supports evidence in the self-assessment section. There have been substantial management changes since the last inspection of the home, including a new home manager and deputy manager for the home. The new management arrangements have focused on a number of areas of concern that were raised and referred under the local authority safeguarding procedures and many improvements have been made as a result to the service provided for all service users. The management structure now includes one overall General Manager for the service, a Deputy Manager/Clinical Care Manager to support him in his role, three unit managers and Head of Care for the residential unit. The new manager was away on the day of the visit, but in prior telephone conversation he has demonstrated that he has kept himself updated on issues relating to care of service users and staff in his charge. He is a Registered General Nurse, and holds the Diploma in Management Studies qualification and has many years experience of nursing and management. In discussion with the clinical care manager it was evident she was knowledgeable about the care needs of the service users and the training needs of the care workers to meet the identified care needs of the service users. There are clear lines of accountability within the home; each member of staff spoken to on the day of the inspection was clear about their role and responsibilities. The majority of the service users are able to be involved in the running of the home, and one service user is on the dietary discussion and planning team. Relatives are encouraged and enabled to be as involved in the running of the home as their time will allow them to be. One service user said, “The manager listens to what we have to say and then he speaks with the top people”. Minutes of the residents meetings are kept on file for review. We were informed that the home does not become involved with service users’ finance except for those service users who have asked for their spending money to be kept by the home. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 25 Review of documented records demonstrated that health and safety checks are routinely carried out at the home. All equipment examined on the day was properly maintained. Records indicated that fire drills, fire alarm, water temperature were regularly checked. It was observed that service users’ personal files were not kept securely and a requirement was made on this standard. Random sample of care workers’ training files demonstrated that up to date and relevant training were carried out by care workers to protect service users’ health, welfare and safety. In discussion with care workers it was evident that they had an understanding and implementation of appropriate procedures to safeguard service users, and they spoke about their understanding of promoting safe working practices based on their health and safety training. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X 2 4 Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO 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 OP37 Regulation 17 (1) (b) Requirement Personal files of service users must be kept in a locked cupboard. Timescale for action 23/05/08 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 Refer to Standard OP15 Good Practice Recommendations Ensure all service users are made aware of the availability of wine at cost price. Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Merlewood Nursing & Residential Home DS0000065967.V359591.R01.S.doc Version 5.2 Page 29 - 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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