Care Home: Merry Hall Nursing & Residential Care Home

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What the care home does well What has improved since the last inspection? A bi-monthly quality assurance is conducted by the home and the Statement of Purpose has been updated. Following an internal survey of the residents, the programme of activities has been increased, including entertainment and trips out and a news notice board has been established that includes details of planned and regular events. The hours have increased from 6 hours a week to 24 hours covering Monday to Friday. Staffing levels have been increased and training has been improved to promote issues relating to equality and diversity, and understanding of the Mental Capacity Act. Almost every carer has or is working towards a National Vocational Qualification. The first floor bathroom has been upgraded to include a walk in shower and a bath, and the wc has been repositioned. Progress has been made in replacing some of the beds with profile beds.Care documentation has been improved to include nutritional assessments, a falls register to enable analysis of occurrences, and new wound assessment forms are in use. What the care home could do better: The home could improve the pre-admission assessment form to include a more comprehensive history relating to falls and nutritional problems. The paperwork in relation to all staff records including the necessary recruitment checks could be ordered better. (It is however acknowledged that the information in the files of more recently recruited staff are in better order.) From the survey returns received from residents and their families there is still room to improve on the accessibility of staff at key times of day at the point when residents need them, in order to further reduce their waiting time. CARE HOMES FOR OLDER PEOPLE Merry Hall Nursing & Residential Care Home 30 Kiln Road Fareham Hampshire PO16 7UB Lead Inspector Joyce Bingham Unannounced Inspection 26/03/08 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 Merry Hall Nursing & Residential Care Home DS0000057235.V359594.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. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merry Hall Nursing & Residential Care Home Address 30 Kiln Road Fareham Hampshire PO16 7UB 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) 01329 230024 01329 825562 merry.hall@virgin.net Buckland Care Ltd Mrs Pamela Ann Johnson Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (3), Physical disability of places over 65 years of age (32), Terminally ill (3), Terminally ill over 65 years of age (32) Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care Home with nursing (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 (OP), Physical disability (PD). The maximum number of service users to be accommodated is 32. 2. Date of last inspection 15th December 2006 Brief Description of the Service: Merry Hall is situated in a quiet residential area, close to local amenities, being only a short distance from the centre of Fareham. An Edwardian house, Merry Hall has been carefully restored and retains much of its original period character. There is good parking at the front of the premises and a small garden at the rear, with an internal courtyard accessible to residents. All but one of the rooms are single and all have en-suite facility. The Home is registered as a care home, with nursing, for thirty two people over the age of 65 in the categories of old age and physical disability. The home’s fees at the time of an inspection visit to the home on 26 March 2008 ranged from £550 to £770 per week excluding the cost of hairdressing, chiropody treatment, newspapers, magazines and some toiletries. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.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 2 star. This means the people who use this service experience good quality outcomes. The purpose of the inspection was to find out how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included the Annual Quality Assurance Assessment (AQAA) completed by the home, and a trawl of survey comments from residents, supporting family/friends, staff, and visiting professionals. An unannounced visit to the home was carried out on 26 March. During this time we were able to have a full tour of the premises and have discussions with the staff and with the residents of the home. On this occasion an expert by experience, someone who has experience of working with the elderly, assisted us with the inspection. The expert walked around the home to look at the environment and spent time speaking with people who use the service, and observing the staff as they interacted with each other and the residents. Her comments are integrated in the body of the report. We sampled staff and care records, policies and procedures that are related to the running of the home. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection (CSCI). There was one area at the last inspection where a requirement had been made. This was reviewed and found outstanding. What the service does well: There are a number of significant positives about Merry hall that have been expressed by the residents, their families and the staff team. A high number of survey forms were returned, including 22 residents, 15 staff, 11 family and 2 visiting professionals. The home is welcoming, clean and odour free. It is light, bright and in a good state of décor. The furnishings and fabric are modern and tasteful. People told us that the home provides a happy, secure atmosphere for residents and their relatives’, it is a ‘very welcoming and caring home,’ that ‘staff are very friendly and kind’ and ‘the home has the ability to make residents feel at home’. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 6 A strong team spirit exists. The staff team is professional, well trained and at the same time, friendly. A culture of openness operates where suggestions are welcome on how things could be improved for the residents, from everyone involved in the home. Relatives commented, ‘I’ve been visiting for 10 years and have never found any reason to complain’, ‘the loving care of all the staff is ‘NULLI SECUNDUS’ i.e. second to none, ‘it has a great nursing/care team’, ‘the nursing care is excellent’, ‘the home has a friendly, professional workforce’. Attention to care details is of a high order and outcomes for the residents are good. People said, ‘it takes good care of my mother’, ‘it attends promptly to any nursing needs’, ‘it caters to each individual resident to the highest care.’ From the staff perspective the level of training following induction is of a high order. Staff are encouraged and supported to develop their knowledge and understanding, and are sponsored on relevant courses. They are then encouraged to cascade their learning to benefit the whole staff team. To the survey questions about the availability and relevance of on-going training the staff gave 100 positive responses to all the questions. ‘Training is of the highest standard’. ‘Training is given where relevant’. An activities organiser is employed each day to stimulate a variety of activities on a single, shared or group basis, including planning trips out and in-house events. This stimulates engagement and relationship between the residents in the shared rooms. What has improved since the last inspection? A bi-monthly quality assurance is conducted by the home and the Statement of Purpose has been updated. Following an internal survey of the residents, the programme of activities has been increased, including entertainment and trips out and a news notice board has been established that includes details of planned and regular events. The hours have increased from 6 hours a week to 24 hours covering Monday to Friday. Staffing levels have been increased and training has been improved to promote issues relating to equality and diversity, and understanding of the Mental Capacity Act. Almost every carer has or is working towards a National Vocational Qualification. The first floor bathroom has been upgraded to include a walk in shower and a bath, and the wc has been repositioned. Progress has been made in replacing some of the beds with profile beds. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 7 Care documentation has been improved to include nutritional assessments, a falls register to enable analysis of occurrences, and new wound assessment forms are in use. 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. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.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 Merry Hall Nursing & Residential Care Home DS0000057235.V359594.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 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a procedure of assessment in place to ensure potential residents have their key needs and wishes identified before they move into the home. EVIDENCE: Potential residents and/or their representatives are given a service user guide describing the home and the service it provides. They are also made aware of the availability of a copy of a report of the most recent inspection of the home by the Commission for Social care Inspection (CSCI) and are invited to visit the home and view the premises. The detailed pre-admission assessment usually takes place at the home and is conducted by the Manager or the Clinical Manager. We discussed the pros and cons of doing these assessments on site as on the one side it enables the person looking for care to make a visit (which they could do anyway), but on Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 10 the other side the manager lacks the opportunity to assess the environment/condition/style of living of the person concerned. The assessments of four current residents were randomly sampled. A comprehensive form was used. It was in the main fully completed, dated and signed. Following admission a more thorough and wide ranging assessment is completed after the staff have had the opportunity to actually provide support and can fine-tune the requirements of each person. A plan of care is created, agreed with the resident and/or their family. Usually at this point a more detailed social history is written down, provided in part by the resident and their family and facilitated by the Activities organiser. This is kept in the office, separate from the main care plan. The manager communicates significant information of a non-confidential nature to the staff at handovers and regular staff meetings. One of the four files sampled for someone who had been resident for over two months lacked a social history and we were told this document was currently left with the family for completion. On moving into the home individuals and/or their representatives are provided with a terms and condition of residence/contract. The care plans are reviewed regularly each month, dated and signed. People spoken with on the day said they did not know a lot about the home before they moved in but had ‘heard it was very good’. They said the home had a good reputation in the area. They remembered ‘talking with staff about what they could and couldn’t do’ and that ‘people were very understanding’. They knew that the records were kept in their room and they could read them if they wanted to. The expert by experience discovered that the majority of residents could not remember getting any information about the home, that it was by word of mouth, but nevertheless they were ‘happy to get in’. Everyone she spoke to said they heard about Merry Hall by word of mouth and that it was the best home in the area – all the people she spoke to were local. Of the 22 residents who completed a survey 20 confirmed they had received a contract and the two who said not, were uncertain whether they had been given one. Only 8 said they had received information about the home before they were admitted. However, some added: • I was not sure what to expect but I was pleasantly surprised • I didn’t know but the staff are very friendly and I am satisfied with my care. • My son chose this for me and he made a very good choice. I am happy here. • My coming here was arranged by my family. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 11 The home does not provide intermediate care, so this standard could not be assessed. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 12 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, and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has systems in place to ensure the personal and healthcare needs of residents are met and medication is managed safely and effectively. Staff working practice ensures that residents’ privacy and dignity is promoted. EVIDENCE: We saw that plans of care are drawn up based on the detailed assessments conducted. These are left in the rooms with the main file held in the office. Several files were sampled. They provide good instruction to staff on the level of care. They are person centred, and there was evidence of adjustments being made to the care plan when needs had changed. Reference was also made to other NHS services and private services that people were accessing. The daily records completed by the staff showed the action they had taken to meet the need detailed in the care plan. The expert by experience confirmed that care plans were in place and siblings seemed to have signed them rather than the residents themselves. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 13 The AQAA from the home told us that waterflow charts are in situ for all residents and any resident susceptible to pressure sores have suitable equipment put in place. This was confirmed on the day of the inspection. Residents with pressure sores or ulcers have wound care charts and photographs taken. A full range of pressure relieving equipment is provided, prevention being the aim of the home rather than cure. From the written and confidential staff survey we were told that 12 of the 15 staff said they have sufficient information provided by the home to enable them to meet the needs of the residents. Two said they ‘usually’ do and one said ‘sometimes’. One said, ‘care plans are updated as the needs of a resident changes. They are also reviewed on a monthly basis’. Written risk assessments are included for the majority of residents on moving and handling, and where needed, on prevention of falls, pressure areas, continence care, nourishment, weight checks. Specialist equipment and supplies were provided and in use. Staff spoke encouragingly to residents while using hoists and stand aids. There was evidence of ample nursing supplies and protective clothing for staff. The Manager confirmed that additional profile beds were being provided as often as possible, replacing the hospital style beds in some rooms. The care plans included reference to the psychological/social needs of people as well as their physical needs, e.g. encourage to mix/engage/change location. It was noted that the residents were helped in an unhurried way. Time was given for movement and bathing, dressing, and preparing for going to the lounge. This meant that some residents seemed to be waiting longer than they wanted to for assistance. We noted that one lady was waiting until lunchtime for her bath/shower. To the survey question relating to sufficient staff numbers on duty, 6 out of 15 of the staff said ‘yes, always’, and 9 said ‘usually’. Of the latter group, some clarified that the home always conforms with the legal minimum numbers but may be short in busy periods. This links with some of the residents’ comments. Of the 17 returns from the residents only 4 said staff are always available and 13 said ‘usually’. Also, the AQAA from the home states their intention to employ an extra evening carer from 7 – 9:30pm to assist with putting residents to bed at time more suitable to them. We noted that in four of the rooms where people were in bed, the call bells had fallen out of reach and this was drawn to the Manager’s attention. For two of these people we were told that their mental state meant they would be unable to use them, and that staff keep an eye on them regularly. However, any resident’s inability to use the staff call system should be documented in the plan of care, with a strategy for alternative management. We asked the residents about their experience of the home and we were told: • It is very, very nice here. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 14 • • • • • You can’t complain about anything here really. It feels like home. You can’t find better, but don’t make them big headed! It’s wonderful. I’m very comfortable. You’ll get some good reports as you go round. Relatives said; • I’ve got no worries. • It’s absolutely brilliant. • There’s no place like it around here. • Mother has come on leaps and bounds since she came here. • You really can’t fault it. Not so positive verbal comments included: • ‘My room is small and there’s no air’-this was checked and found to be a reasonably sized room and windows could be opened. • ‘I hate these plastic beakers- I feel like a child’. However, the person concerned was unable to hold weight and had a hand tremor. • ‘For me, it’s only OK here. I’ve lost my life partner and nothing will change that wherever I live’.. Written comments from the surveys give very positive appreciation of the quality of the care provided by the home. Residents said: • I always get the care I need. I am very happy. • Staff seem very aware of my needs. They have called the doctor when necessary and have ensured I have the necessary equipment to enable me to walk etc. • Action is taken very quickly should there be a need • I’ve never been refused any request • It’s an excellent service Relatives/advocates said: • The home shows genuine respect for those in their care • The loving care of all staff to the residents is NULLI SECUNDUS i.e. second to none • The home takes good care of my mother • It’s a very welcoming and caring home • The staff and communications are very satisfactory • The provision of occasional physiotherapy would enhance mobility considerably. The home had written policies concerned with the administration of medication. Medicine was kept locked in trolleys, and in a treatment room a metal, lockable safe for controlled drugs. An audit of controlled drugs indicated that the records were accurate and up-to-date. All medication was dispensed from the original container. The Registered General nurses are responsible for administering the medicines. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 15 The AQAA states that a signed declaration from each GP surgery is obtained regarding the giving of homely remedies. There is only one shared room in the home. The privacy of the majority of residents is promoted by their having their own rooms. All bedrooms are provided with en-suite wcs and wash hand basins. Generally bedroom doors are left propped open with a dorguard, but it was noted that when care is provided the staff close the door, and at times draw the curtains also. The one shared bedroom had previously had a curtain screen fitted to divide the room in half and provide limited privacy. This had been taken down/fallen down, and was propped nearby. The Manager said it was currently being dealt with by the maintenance person. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.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 to 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are enabled to follow their own personal interests, entertain visitors at any reasonable time, and largely determine the shape of their own day, within the constraints of staff time. Their dietary needs are well catered for, allowing for personal choice. EVIDENCE: The home employs an activities organiser for 5 days a week (24 hours in total). She was present at the time of the inspection, and was seen to be moving around in the lounge stimulating some shared activities e.g. two playing dominoes, and some individual crafts. People were reading newspapers/magazines. The programme was printed out and available on notice boards for people to see. Feedback from the homes internal quality assurance indicated that short afternoon outings were preferable to long day trips, and at least two outings a month were offered to residents. In-house activities include bingo, crafts like knitting, games, chair exercises. Residents said: • I enjoy arts and crafts and quiz games and the trips out. • There is a good variety Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 17 The expert by experience reported that the home seemed pretty flexible as regards to bed time – some residents preferred to go to bed to watch TV after tea and others stayed up much later. If they wanted to stay in bed all day they thought they could but the ones she spoke to had never tried. One very articulate lady was not a morning person – she was up and dressed nicely by lunch time and she had a laugh with the Manager saying she liked to stay around until midnight – this seemed acceptable. Another resident she spoke with had been at Merry Hall a few months and spends her entire day in the hall in her own chair and thoroughly enjoys the experience. She is local lady and has many friends to visit her. She came to Merry Hall on the recommendation of the hospital. She could find no fault with the home and is happy to be there. She did not know of a complaints procedure but told me she had nothing to complain about. She also said she tried not to be any trouble. Her laundry gets done very quickly and so far she had not lost any. She thought she could stay in bed if she wanted to. The home has a monthly visit from a manicurist paid for by the home, and a hairdresser visits regularly. All of the residents, apart from one bedfast lady, said there is always some activity to engage with. The AQAA said that external entertainers visit at weekends. Residents are invited to local schools for small shows and Christmas parties, and clergy visit from different churches. Residents meetings are held regularly for them to put forward ideas they may have. Notes of these were seen on the activities board in the home. An Easter party had recently been organised with special food prepared by the kitchen staff and we were told this had been really enjoyed by many of the residents. Residents and relatives confirmed there were no constraints about visiting times as long as they were reasonable. Two visitors confirmed that they had been invited to stay for lunch with their family member, and if they happened to visit at a mealtime unannounced they could always ask for a sandwich which the kitchen staff were happy to make. The serving of lunch was observed in the dining room and in some bedrooms. Only 12 residents sat in the dining room for lunch, the other residents had their food on a tray or in their room. The expert by experience noted that where they had their meals was the residents’ choice. She commented that one lady was to have her food in her room and then felt lonely so she came and ate in the dining room. Another lady requested custard with her tinned fruit and the chef went off to make it. She noted that staff were courteous and respectful to the residents and their relatives. The dining room tables were covered in nice tablecloths, using real glasses and flowers were on each table. People in the dining room were offered a small glass of sherry, wine or non- alcoholic sparkling fruit juice. The meal was well Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 18 presented and served hot. Plate aids were available as needed. Pureed food was done separately to maximise colour and taste. The main meal on inspection day was roast chicken, roast potatoes, parsnips, carrots and cabbage with gravy, or as a second dish, poached haddock. One lady said she didn’t feel like a roast and didn’t like fish, so the cook recommended and prepared an omelette for her. A dessert trolley was also brought around with a selection of four or five desserts, including provision for diabetic residents and healthy alternative. Residents spoke well of the meals offered, confirmed they are given a choice of two main meals a day, and that snacks and drinks are available during the day. Water and a fruit juice was available all day in the lounges. A member of the care staff is dedicated to her main role of encouraging fluid intake, and where necessary monitoring this. The internal quality assurance that has been conducted during the previous 3 months were seen and evidenced general satisfaction with the meals although the number of Bs rather than As indicate there is still room for improvement. The budget for food was also seen and we confirmed a good allowance for meals each day per person is provided. Ample bowls of fruit are available all day should people want to help themselves. Comments from residents’ written survey returns included 9 out of 17 who ticked ‘usually’ they like the meals. Others said: • There is always a very good choice • I am amazed how nice the meals are • There’s a very good selection available • It’s a very fine menu • I don’t eat cake. I have always been offered an alternative • There is a good choice Relatives who commented said: • She is well fed and, if sometimes she cant feed herself, the staff feed her. • The chef has recently moved on-I hope a new one is soon appointed and has a good knowledge of elderly people’s dietary (The previous chef had actually moved on and a second chef was on his probationary period-the manager informed us that he had all the necessary knowledge and training.) Merry Hall Nursing & Residential Care Home DS0000057235.V359594.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are confidant that any concerns or complaints are dealt with quickly and responsibly. EVIDENCE: Merry Hall has a complaints procedure and training and policy on the various types of abuse that can occur. A copy of the complaints procedure was available in the entrance hall along with forms to enable people to give their views. We drew to the Manager’s notice the need to amend the stage of complaint referral to the CSCI as the address of contact and telephone number has now changed. When asked who they would talk to if they felt concern about anything in the home the residents said they could talk to the staff or the Manager. They felt it was unlikely they would ever have to make a formal complaint because the home was kindness itself and ‘things just got dealt with’. The expert by experience said she was told the residents thought there was a formal complaints procedure but no-one she spoke with had ever needed to use it. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 20 There had been two complaints since the last inspection. Both had been logged in the complaint record. They had been dealt with promptly and in a satisfactory manner, drawing the issues to positive conclusions. The CSCI have not received any formal complaints about this service, and no issues of safeguarding have occurred. Three staff were spoke with in relation to protection issues and we noted they were each aware of what constitutes abuse, and would have no hesitation in raising matters with the Manager and about whistle blowing bad practice if that ever occurred. 16 out of 17 knew how to complain, but comments included: • I have no complaint • It’s a pleasure to be here • I have never needed to • Anything gets dealt with very quickly The home’s methodology for recording and safeguarding personal monies belonging to residents was discussed. Records were sampled. The cash is held in a coded safe in the office, with limited access by named personnel. Receipts are kept and signatures obtained from residents for most of the exchanges. Where this is not possible two witness signatures are provided by the staff. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 21 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 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well maintained to a high standard of décor and furnishings. The people living there benefit from a safe, clean and hygienic environment. EVIDENCE: At the time of the inspection the exterior and interior of the premises were in good decorative order. There were no unpleasant odours. One visitor said ‘the only thing you will smell in this home is home cooking.’ The home is light, clean and fresh. There is a dedicated maintenance person who we were told undertakes minor repairs and decoration, and looks after the grounds. There is a choice of three communal lounge areas, to provide alternative relaxing space, allow for a variety of activities, and privacy other than bedrooms when people are visiting. These are laid out in a hotel style, with Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 22 colour co-ordinated plant arrangements, large mirrors and soft furnishings. There is an enclosed, paved courtyard area accessible from the internal corridor with tables and seating, usable in the warmer months. It has level, wheelchair access. The dining room is small, seating up to 15 persons at a time but attractively designed with tables for three/four persons. The table had cloths, mats, place settings with glasses, flowers and condiments. All of the rooms apart from one are single and en-suite with a wc and wash hand basin. Rooms are lockable and have a lockable facility within them for small valuables. We saw a wide range of personal memorabilia in the rooms and a member of staff said that people are encouraged to make them their own rooms and bring in what they want. There are ample assisted bathrooms, including a wet/level access room, and a separate hairdressing room. Communal bathrooms were equipped with liquid soap and paper towels. There were alcohol gel dispensers strategically placed at the entrance to the home (and exit) and at various locations around the building. Protective clothing was observed to be worn by staff and additional supplies were seen around the building. A number of hoists and stand aids were seen around the home. There is a fully equipped laundry with commercial washing machines (going up to 90 degrees), a large tumble dryer and a flat iron. A dedicated member of staff ensures the linen is sorted and cleaned to return to residents usually within 24 hours. The expert by experience was told that sometimes the laundry goes missing but usually it turns up again later. There is a separate sluice facility. Clothes and sheets are colour coded. We were told that protocols exist and are followed to deal with contaminated waste and control of cross infection. Residents’ clothing was unstained and in good repair. No complaints were made by them about the laundry service. The recent AQAA provided by the Manager informed us that reports from the Fire Service and Environmental Health department are satisfactory. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.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): 27-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an appropriate number of staff with a mix of skills. Training is ongoing and residents feel staff are competent and confident in providing for their care. EVIDENCE: The number of staff on duty during this inspection was found to be well above average. There are normally 5 carers and two trained staff on duty during the day, in addition to housekeeping and catering staff. At least two staff work in the kitchen and there is a dedicated staff member for laundry duties. There is an activities organiser, maintenance person, a part-time administrator, and the Manager is not rostered on shift. At night there are four staff on ‘awake’ duty. There are three male carers including one trained nurse and two male staff working in the kitchen. The staff told us that the residents have a choice of receiving personal care from staff of a different gender. This is handled sensitively. The home has a small pool of bank staff and we were told that they do not, as a practice, engage agency staff. In the last three months the AQAA informed us that the home had no agency staff. The AQAA provided by the home states that there are 16 full time nursing/care staff and 13 other staff. 25 of the care staff have NVQ level 2 or above. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 24 Four staff files were inspected. Essential documents were not easy to locate as papers in the files are not held in date or subject order. More recently created files have a front sheet with a simple checklist of the content. Recent files showed evidence of all necessary documentation, including a photo ID, birth certificate, two references, application form, medical check, Criminal records Bureau check. The Manager said that one person, recruited with a clear statement of history but without a CRB, was engaged only in domestic work and was always supervised. Two files for employees recruited some time ago lacked a second reference and we recommended that these all need to be brought into order. In one case a reference had been provided by the deputy matron from Merry Hall in lieu of a reference from the previous care establishment where the carer had been working. We advised that previous care work history should be thoroughly checked out during the recruitment process. A former member of staff who was taken on before all checks had been completed had been dismissed by the home when the CRB revealed a criminal history she had not disclosed. The importance and legal requirement to complete these pre-employment checks, highlighted in the last inspection report, was again reinforced. Residents were asked about the staff relations and comments from them include: • They are very kind • They work very hard • I have to wait a bit sometimes but I understand they’re busy • One or two can be moody but generally they are very nice people Survey comments demonstrate a high level of confidence in the staff with 15 out of 17 stating that staff listen well and provide the care they need. We interviewed three of the staff in private. All felt the home was well managed and that the leadership given by the Manager was positive and affirming. We were told that staff meetings are held regularly (confirmed by the notice board and minutes), staff supervision is regular and annual appraisals are conducted. Each staff member had been given a Code of Conduct from the General Social Care Council when they started. Induction included three long days, followed by a period of shadowing an experienced member of staff, and then days and half days foundational training. Records are kept of the in-house and external training, and staff are encouraged to cascade training when they attend external courses of interest to the whole team. We were told that these are paid for by the employer. Morale was defined as very high amongst the staff, some giving it 9 out of 10. Comments include: • We feel part of a team Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 25 • • • • • • Everyone is very friendly It feels like home It’s brilliant working here It will be hard to work anywhere else after here I thought where I worked before was good for the residents but that was awful compared to this It has a high standard. All of the staff in the confidential survey agreed that training was available to them, that it is relevant and up-to-date. Comments include; • I regard the level of training and opportunity to further knowledge is to a very high standard • Training is of the highest standard Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 26 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 32 33 35 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is an experienced registered nurse and has been in post approximately a year. She provides effective leadership, supported by systems and procedures for monitoring and maintaining the quality of service, and promoting the safety and wellbeing of everyone living and working in the home. EVIDENCE: The manager has been in post approximately a year and we were told by the staff, she has formed good working relationships with the staff team and by the residents, that she is respected and appreciated by the residents and their families. She has managed other care homes and she told us she enjoys being ‘hands on’ at times. She is accountable to the Area Director of Buckland Care who visits regularly. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 27 We perceived a strong sense of team work among the staff, a value that has been greatly encouraged by the manager. A staff meeting took place during the inspection and we joined in for part of that time. It is expected that all staff attend, and are paid to attend when they are off duty. Staff are given opportunity to contribute their views and ideas, and are encouraged to complete service surveys. In relation to the culture of the home, staff commented • Everyone works well together as a team. It’s a happy and friendly bunch. • Communication between colleagues is good • If we need to know or ask something the help is always there • The management of the home is very good-always supportive • I am very proud to say I work at Merry Hall. • The manager is always open to suggestions from staff/family/friends and most importantly, residents on how things could improve to suit them. • Policies are in place to cover every eventuality and all are available to the staff • The home has a friendly and professional workforce • All the seniors are very approachable • Our manager is an easy person to go to and talk to if you have any problem. She will always ask if all is OK • I feel we have her full support • We have regular staff meetings where we discuss any issues that need to be addressed. The home has a continual process of self monitoring and survey forms are left at the entrance for residents/visitors/ relatives/professionals/staff to complete. These are usually reviewed every quarter. The last 3 months were provided for the inspector to see. The AQAA provided information about the dates of the last review of all the key policies and procedures followed by the home. A copy of the last inspection report was available in the reception. The home’s methodology for recording and safeguarding personal monies belonging to residents was discussed. Records were sampled. The cash is held in a coded safe in the office, with limited access by named personnel. Receipts are kept and signatures obtained from residents for most of the exchanges. Two witness signatures are provided by the staff where this is not possible. The homes’ records and practice of staff recruitment were inspected and the manager’s attention was drawn to the need to both update existing files to ensure the records contain all of the legally required documentation, and to ensure that any new staff have all the required checks undertaken before they commence employment. As the need for CRB checks on potential staff has Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 28 featured in the last inspection report and the outworking of it is still presenting an issue for the home it has been repeated as a requirement at the conclusion of this report. All staff are protected by compulsory training in moving and handling, fire safety, first aid and infection control. Those staff responsible for food preparation are trained in food handling. Risk assessments are conducted for all safe working practices. Accidents are recorded. Not all had been countersigned by the manager but we were told this is the usual practice. It is recommended that the manager ensure she counter-signs each record to ensure that any necessary review has taken place and corrective action completed where necessary. Guards or low surface radiators are fitted. Window restrictors are fitted on all high level windows. There are hoists and other equipment in the home to promote safe working practices. When asked, the staff were unable to detail anything further they required in order to fulfil their job description safely. Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 29 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 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 X 2 Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 30 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 OP29 Regulation 19 and Schedule 2 Requirement All statutorily required preemployment checks must be completed and information received before any person works in the home in order to protect residents from potential abuse. Timescale for action 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 31 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 Merry Hall Nursing & Residential Care Home DS0000057235.V359594.R01.S.doc Version 5.2 Page 32 - 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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