Care Home: Merseybank Nursing Home

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What the care home does well Many people said that staff assisted them in the way they prefer and treated them with dignity and respect. People said they usually enjoyed the food provided and that the cook would provide something to their liking if they decided they did not wish to have food from the menu. People living in Rosewood and Bankswood units (younger adults) told us there were usually activities provided they could join in with. What has improved since the last inspection? A manager had been in post since August 2009 and had applied for registration with CQC. Staff had received training in safeguarding vulnerable adults and about equality and diversity. Repairs had been carried out to meet a requirement made at the previous inspection, ensuring a safer and more pleasant environment for people to live in. What the care home could do better: Ensure that all needs assessments and care plans are fully detailed and are kept under review. This will help to ensure that the changing needs of people in the home are properly recorded and fully met. Make improvements to the home to ensure a safer and more pleasant environment for people living there. Ensure that improvements are made in consultation with people/their representatives and that facilities are provided to encourage and maximise independence. Ensure there are always sufficient staff available to meet the assessed needs of people in the home. Ensure that staff have appropriate training so they are fully aware of and are competent to meet people’s needs. Develop policies to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that people`s rights are promoted and upheld CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Merseybank Nursing Home Carriage Drive Hadfield Glossop Derbyshire SK13 1PJ Lead Inspector Rose Moffatt Key Unannounced Inspection 17th December 2009 09:30 Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 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 Merseybank Nursing Home DS0000025442.V378761.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 and Care Homes for Adults 18 – 65*. 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. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merseybank Nursing Home Address Carriage Drive Hadfield Glossop Derbyshire SK13 1PJ 01457 855175 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) merseybank@craegmoor.co.uk www.craegmoor.co.uk Parkcare Homes Ltd Manager post vacant Care Home 74 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (18), Physical disability (38) of places Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 18 elderly mentally ill; Aged 55 years and over; 1 first level registered nurse throughout 24 hours. 18 elderly physically infirm; Aged 55 years and over; 1 first level registered nurse throughout 24 hours. The Home Manger shall be supernumerary to the stated staffing levels for 37.5 hours per week. 38 young disabled aged between 18 - 55 years; 1 first level plus 1 first/second level registered nurse over 24 hours. The Home Manager to be supernumerary for 37.5 hours per week Date of last inspection 2nd June 2009 Brief Description of the Service: Merseybank Nursing Home accommodates up to 74 people with nursing and personal care needs, including up to 18 older people with dementia and up to 38 younger adults with physical disability. The home is situated in Hadfield, near to the town of Glossop. The home is divided into four separate units on 3 floors. The units are staffed separately. There are large, accessible gardens, including a patio area. Information about the home, including CSCI/CQC inspection reports, is available in the home. Fees at Mersey Bank range from £344.82 to £527.84 per week. Fees can be higher, depending on individually assessed needs. In addition to the fees, people in the home pay for hairdressing services, newspapers, and privately arranged physiotherapy and chiropody. This information was provided by the acting manager on 17th December 2009. Merseybank Nursing Home DS0000025442.V378761.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 1 star. This means the people who use the service experience adequate quality outcomes. The focus of our inspection is on outcomes for people who live in the home and their views on the service provided. The inspection process looks at the providers ability to meet regulatory requirements and national minimum standards. Our inspections also focus on aspects of the service that need further development. We looked at all the information we have received, or asked for, since the last key inspection or annual service review. This included: information we have about how the service has managed any complaints; what the service has told us about things that have happened - these are called notifications and are a legal requirement; the previous key inspection and the results of any other visits we have made to the service in the last 12 months; relevant information from other organisations; and what other people have told us about the service. We carried out an unannounced inspection visit that took place over 7 hours on 17th December 2009. The inspection visit focused on assessing compliance with requirements made at the previous inspection and assessing all the key standards. We sent out 15 surveys to people living in the home, 15 surveys to the relatives or representatives of people living in the home, and 10 surveys to staff employed at the home. However, we only received 1 completed response from a member of staff. There were 52 people accommodated in the home on the day of the inspection visit. People who live in the home, visitors and staff were spoken with during the visit. The acting manager was available and helpful throughout the inspection visit. Some people were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Case tracking was used during the inspection visit to look at the quality of care received by people living in the home. 4 people were selected and the quality of the care they received was assessed by speaking to them and / or their relatives, observation, reading their records, and talking to staff. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Ensure that all needs assessments and care plans are fully detailed and are kept under review. This will help to ensure that the changing needs of people in the home are properly recorded and fully met. Make improvements to the home to ensure a safer and more pleasant environment for people living there. Ensure that improvements are made in consultation with people/their representatives and that facilities are provided to encourage and maximise independence. Ensure there are always sufficient staff available to meet the assessed needs of people in the home. Ensure that staff have appropriate training so they are fully aware of and are competent to meet people’s needs. Develop policies to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are promoted and upheld. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 7 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. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 (Adults 18-65) 3 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst many aspects of peoples needs were well accounted for, this was not consistently achieved which may compromise the health, safety and welfare of people admitted to the home. EVIDENCE: We looked at the admission arrangements and needs of four people living in the home. These people came under the placement categories of younger Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 10 adult, (two people), dementia (one person), and older people nursing care (one person). We found that there was a standardised format for staff to follow for the recording of individual needs assessment information, including for preadmission assessment. For all the people we case tracked there were copies of their external care management assessment and care plan, including where applicable their nursing care determination, together with records of reviews for these. With the exception of mental capacity and end of life needs, the needs of the two older people we case tracked were well accounted for in a person centred manner and their known choices and lifestyle preferences recorded. For the two people in the younger adults category that we case tracked, we found that assessed needs were well accounted for in many areas. However, we also found areas of omission and inconsistency for some of these. For one of these people, we had previously received three written notifications from the home telling us about the occurrence of events affecting their wellbeing and safety, and, in one instance, also relating to the safety of others. We found that their recorded needs assessment identified any risks to their safety and where applicable, to others. However, although staff were conversant with most of that person’s needs, their written plan regarding dealing with any physical aggression was not sufficient or in accordance with recognised practise concerned with this. Staff also confirmed they had not received any accredited training in recognised non-physical and physical interventions to assist them in dealing with aggression. Staff clearly knew the resident well and were able to identify some non-physical diversionary interventions that they had used with effect. We have also referred to this under Section 2, Individual Needs and Choices, in this report. For the same person, we also saw conflicting information recorded in their care records from an outside healthcare professional, a consultant psychiatrist and registered nurse employed in the home as to the homes capacity to meet the person’s needs. For the other service user whose placement category was that of younger adult, we found that the risk assessment and moving and handling plan recorded in their care file conflicted with the actual care delivery and interventions from staff. Discussions with staff told us that the interventions they used were consistent in approach. They described the reasons why they were not able to adhere to that persons recorded moving and handling plan and we discussed this with Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 11 the acting manager. We also found that the care interventions being used here, risks that may arise from these, and also relating to their nutritional requirements. We found that these were not underpinned by a mental capacity assessment or formally agreed best interests decision. The acting manager told us that a multi-disciplinary care review for this person was planned for the week following our inspection and we saw documentary evidence that this was so. We found that there was a standard form provided for staff to complete regarding the individual mental capacity of people admitted to the home. However, the records we saw were not consistently completed and lacked clarity. We found that peoples needs and wishes with respect of their end of life care were not well recorded, often being left blank. This included one person (younger adult), whose medical representative had instructed in a letter to the home that they had end of life needs. These had not been determined by the home. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7, and 9 (Adults 18-65) 7,14 and 33 (Older People) Quality in this outcome area is adequate. Peoples changing needs were mostly reflected in their written plans in accordance with their risk assessed needs, and they were supported to make some decisions about their lives. However, omissions in care planning may not be in their best interests. EVIDENCE: Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 13 Many care plans were well recorded in accordance with peoples risk assessed needs and kept under review. For one person these were signed as agreed by them and people said they usually received the care and support as agreed or expected. However, as referred to under the Choice of Home section of this report. We found some peoples’ risk assessed needs were not fully or effectively accounted for within their written care plans. These related mostly, but not exclusively, to the two people accommodated under younger adult category with regard to moving and handling, nutritional needs, end of life care, behavioural care needs/care of aggression and mental capacity. In all other respects, there were appropriate risk assessments in place, which were regularly reviewed and updated. People accommodated in the younger adults unit told us about some of the daily living choices they regularly made concerning their preferred routines. They told us that regular ‘Your Voice’ meetings were held with them or their nominated resident representative. Two people told us that they used to have access to independent, outside advocacy but no longer do so and that they were not asked their opinion as to changes here. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 15 12,13,15,16 and 17 (Adults 18-65) 10,12,13 and 15 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there was a reasonable range of activities provided for people, this could be improved further in consultation with people. Staffing arrangements on Kinder and Wilman did not best ensure suitable activities or meal time experiences for people. EVIDENCE: People living in Rosewood and Bankswood units (younger adults) told us there were usually activities provided they could join in with. These included trips out, games, arts and crafts, quizzes and musical entertainment. Each unit had TVs, music equipment and a range of CDs, DVDs and videos. Recent events on Rosewood and Bankwood included a Christmas pantomime, a clothing party and shopping trips and people told us they particularly enjoy activities organised by a youth group who regularly visit the home. People also said they are supported to go on holiday. A group had recently been to Tenerife with staff support and they said they had enjoyed this. We saw that a ground floor room was in process of being made into a recreation room for people in the home. However, people told us that the computer there did not work and that there was no internet access provided. They also talked about improvements being made as raised by them at ‘Your Voice’ meetings held. These included keeping chickens in the rear garden. People said they would like improvements to be made concerning trips out, development of the garden to provide better independent wheelchair access, and also to enable them to develop a herb garden. They said they were informed via ‘Your Voice’ meetings that these items are to be addressed. We saw photographs of residents engaging in activities displayed around the home and some basic information about activities provision in each unit. There were also minutes of meetings held for people in the home and their relatives. We saw that an organist regularly visits Wilman unit which people were said to enjoy. At our visit we did not observe any activities on Wilman or Kinder, other than music playing and children’s TV on in the lounge during the afternoon. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 16 Peoples preferred daily routines were well accounted for in their care records and said they could choose what they do during the day and also night time routines. Menus were displayed in the home and showed a suitable variety. The menus were in small print and covered four weekly menu rotas. People said they usually enjoy the food provided and that the cook would provide something to their liking if they decided they did not wish to have food from the menu. There were separate kitchenette areas on Rosewood and Bankswood for people to make drinks and snacks. However, on Rosewood, the kitchen unit worktops, although lowered did not provide access for people who use wheelchairs and we found food open and/or with no dates and with no system for checking for out of date food. We have also referred to the kitchenette areas in the Environment section of this report. Bankswood unit dining room was totally refurbished with suitable flooring and space afforded for wheelchair users. We observed on Kinder and Wilman that some residents were sitting waiting for assistance with breakfast at 10.15 am and 10.40 am due to inadequate staffing levels. Staff on duty were busy assisting other residents, including with their eating and drinking and with their medicines. On one of the units prepared porridge was left out in individual bowls and was cold. We observed staff re heat this in the microwave. At our last inspection here we found that improvements were made, including increased staffing provision to ensure that mealtimes were a more pleasant experience for people. However, we found at this inspection that staffing levels were reduced again. (See Staffing section of this report). Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 (Adults 18-65) 8,9 and 10 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s individual healthcare needs were mostly accounted for, they received personal care and support in accordance with their preferences, and they were treated with dignity and respect. There were omissions in recording end of life care so people’s individual needs and wishes may not be met. EVIDENCE: Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 18 Many aspects of peoples personal care and support needs were well accounted for, including additional specialist support and advice and routine healthcare screening as needed from outside health care professionals. We found that end of life needs and care planning were not well documented and often not recorded at all. We have referred to this also under the Choice of Home and Individual Needs and Choices sections of this report. Peoples’ likes, dislikes and preferred routines were recorded and promoted. Many people said that staff assisted them in the way they prefer and treated them with dignity and respect. Any input from family and friends was also recorded. For one person we found there were conflicts in terms of their needs, wishes and risk management strategies employed in respect of their personal support and moving and handling needs. These are referred to under the Choice of Home and Individual Needs and Choices sections of this report. We found the overall arrangements for the ordering, receipt, storage, administration and disposal of peoples’ medicines to be generally satisfactory and in accordance with recognised practise. There were two exceptions to this: the storage of creams and lotions, and medicines to be administered on an ‘as required’ basis. For the former, these medicines were stored in wooden drawers rather than suitable metal storage cupboards. For the latter there was no information in the care plan to say under what circumstances the medicines should be given, particularly where the person had dementia and was not able to ask for this medicine themselves. Staff spoken with who were responsible for peoples’ medicines were not aware as to the existence or whereabouts of a spare set of medicines keys, should the ones in use be missing. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 (Adults 18-65) 16,18 and 35 (Older People) Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There were satisfactory procedures in place to safeguard people in the home and to address any complaints raised. People did not have easy access to local advocacy services to ensure they could obtain independent support and advice. EVIDENCE: People in the home and their relatives told us they knew how to make a complaint. They said they could go to staff with any problems and these were usually sorted out. They told us they used to have access to an advocacy service, but this was no longer available to them. There were meetings for people in the home to air their views and raise any concerns, the ‘Your Voice’ meetings. However, we found that these meetings were facilitated and attended by staff which might inhibit people from freely expressing their opinions. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 20 The complaints procedure was displayed in communal areas in the home and was available in an ‘easy read’ format. We looked at records of complaints and found these had details of the action taken and the outcome. We had received one complaint since the last inspection regarding staffing levels on the Wilman unit for people with dementia. We asked the provider to investigate this complaint and we were satisfied with their response. Following previous safeguarding issues, there is an inquest to be held in February 2010. There had been a safeguarding incident since the last inspection where correct procedures were not followed by staff. Since then, most staff had received training about safeguarding vulnerable adults. Staff spoken with were aware of the procedures to follow if abuse was alleged or suspected. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 (Adults 18-65) 19 and 26 (Older People) Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was not well maintained and was not fully adapted and equipped to ensure that people’s needs and expectations were met. EVIDENCE: Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 22 People told us the home was usually clean and free from offensive odours. They told us they would like more information from the providers about when the planned refurbishments would be completed. Refurbishment of the home had been planned for several years and some work had been carried out to the ground floor unit before the last inspection. No further refurbishment had taken place since then. As at previous inspections, we were told the refurbishment work was planned and approved but there were no timescales available of when the work would be carried out. To comply with a requirement made at the last inspection, toilets had been repaired and ceiling tiles replaced on the Wilman and Kinder units. We found the following issues requiring attention: Kinder: • Walls were scuffed and marked, wallpaper borders were peeling in places and had pieces missing, and carpets were stained. Wilman: • Few changes had been made to the unit to ensure that it was suitable for the needs of people with dementia, for example, the use of colours, appropriate signs and visual cues. One toilet door had a suitable sign for people with dementia to understand. There were no other signs in place, however, the acting manager showed us signs that were being developed for use. • The shower room door had a keyhole but there was no key available and no other lock to ensure the privacy of people using the shower or toilet. There was no shower curtain or screen so that anyone using the shower would be easily seen from the corridor and dining room if the door was opened. The cladding to the walls around the shower was warped and coming away from the walls due to water penetration. The linen store room just outside the Wilman unit had a towel placed over the top of the door, preventing it from closing properly. The acting manager told us that staff at night sometimes did this to reduce noise from the door being opened and closed. As this was a fire door, this practice put people at risk. The towel was removed immediately. In this store room part of the flooring had been removed and there was a ceiling tile missing. There was a piece of carpet lifting away on the stairs between the Wilman and Rosewood units. • • Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 23 Rosewood: • The sluice room was dirty and untidy. There were water stains around the window. The corner of the wall near the door was badly damaged. • There was an emergency trolley kept in a store cupboard. The trolley and equipment was dusty and untidy and had not been checked since October 2008 according to the records. The carpet in the kitchen area was badly stained and greasy. The carpet was badly frayed in the doorway to the corridor. There was unlabelled food stored in the fridge and the fridge appeared in need of cleaning. Coffee, teabags and sugar were stored in the kitchen cupboards in open plastic tubs with no indication of ‘use by’ dates. There was an uncovered jug of milk left out on the work surface. In a toilet off the main corridor the hand wash basin was loose and coming away from the wall. Also in this toilet there was a foam ring on a shelf. When this was removed it was dirty and dusty and clearly the shelf had not been cleaned for some time. In one bathroom there was dust and debris on the floor immediately below the extractor fan and a ceiling tile missing. In another bathroom there was a used commode pan left on the windowsill. The smoking room door was left open and so the smell of cigarette smoke pervaded the unit. • • • • • Ground floor units: This area had been redecorated and refurbished in the last 12 months and was bright and pleasant. • The smoking room had been recently repainted. The carpet was badly marked by cigarette burns. The doors were left open and the smell of cigarette smoke drifted out into the unit. There were areas of damage to the corridor walls requiring plastering and redecorating. The small kitchen was dimly lit. The worktops were at a suitable height for use by people in wheelchairs. There were no other adaptations or equipment provided to enable people with disabilities to use the kitchen. The kitchen fridge needed defrosting and had unlabelled food stored. Coffee, teabags and sugar were stored in the kitchen cupboards in open • • • Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 24 plastic tubs with no indication of ‘use by’ dates. The cupboards and microwave oven needed cleaning. The laundry was suitably equipped and was laid out to ensure that dirty laundry was handled in a separate area to clean items. A window in the laundry was awaiting repair as it let in water. There were some areas where the render had come off the wall, leaving brickwork exposed. We were told that there was 1 maintenance person employed at the home and that previously there had been a team of 3. The acting manager said that the providers were in the process of recruiting another maintenance person. The garden was accessed through the ground floor smoking room or through the smaller lounge. Two hens had recently been purchased and were kept in a run in the garden. Nearly all staff had received training about infection control. Staff spoken with were aware of infection control procedures, such as using disposable aprons and gloves, and effective hand washing. Internal audits carried out monthly by the acting manager included some aspects of infection control, although there was no specific audit of infection control practices. We found the communal areas and bedrooms were generally clean and free from offensive odours. Some areas were not sufficiently clean, such as some toilets and bathrooms, sluice rooms and store rooms. We found several waste bins without lids in toilets and bathrooms. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 (Adults 18-65) 27,28,29 and 30 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment procedures and staff training were sufficient to protect people and ensure they were supported by competent staff. Staffing levels were not calculated according to the assessed needs of people in the home and consequently were not sufficient to ensure their needs could be fully met in a person centred and holistic way. EVIDENCE: Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 26 The staff rotas showed that staffing levels had been reduced since the last inspection. There were a similar number of people accommodated in the home as at the last inspection and with a similar range of needs. The acting manager told us that a method of calculating staff numbers against the needs of people in the home was being developed but had not been put into practice yet. The staffing levels were calculated by the provider based on the numbers of people on each unit, with a higher ratio of staff provided to meet the needs of people with physical disabilities. On the Wilman and Kinder units there were usually 2 care assistants plus a registered nurse for the morning and afternoon shifts. (At the previous inspection staffing levels had been increased to have 3 care assistants with a nurse during the day). Staff told us the current staffing levels were not sufficient to fully meet the needs of people. We observed that people on Wilman and Kinder were still having breakfast at 10.15am. We observed that most people on Kinder needed some assistance with eating and drinking and needed 2 staff to assist with personal care. We observed that staff on Wilman had little time to interact with people and they were left to sit in the lounge or walk up and down the corridor. Staff told us that staff morale was low due to the reduced staffing levels and the provider’s plans to make redundancies. Staff were waiting for decisions about who would be offered redundancy and were frustrated at the lack of information from the provider. We looked at the records of 4 staff. All the required documents and information were in place. As noted at the last inspection, there was no evidence that people in the home, particularly the younger people, were involved in the selection of staff. There was an induction programme for new staff that met the Skills For Care standards. Training records showed that staff were mostly up to date with all required training, such as fire safety, food hygiene, manual handling, and protection of vulnerable adults. Approximately 33 of care assistants had achieved a relevant National Vocational Qualification (NVQ) at level 2 or above. Staff confirmed the training they had received. They said they would like additional training about specific conditions, such as Multiple Sclerosis and Huntingdon’s disease. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 28 37,39 and 42 (Adults 18-65) 31,33,35 and 38 (Older People) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was effectively managed so that people generally received a consistent service to meet their basic needs. However, omissions in care records, changes in staffing and lack of progress in refurbishing the home were having a negative impact on the care and welfare of people in the home. EVIDENCE: The acting manager had been in post since August 2009 and had applied for registration with CQC. People in the home and staff told us they were pleased there was a manager in post again. We had mixed comments about the acting manager, including “she’s all for the residents and staff”, and “she doesn’t listen to staff”. As noted in the Staffing section of this report, the providers were looking at making staff redundancies and had reduced staffing levels in the home. The reduced staffing levels were based on a ratio of numbers of people in the home to numbers of staff and had not been calculated according to the assessed needs of people in the home. Soon after the inspection visit, the acting manager informed us that staffing levels had been increased with immediate effect on the Wilman and Kinder units. However, there was still no assessment of staffing ratios in relation to the needs of people in the home. As noted in the Environment section of this report, the providers had not completed the planned refurbishment of the home. The quality assurance system included annual surveys of people in the home and their relatives. There were regular meetings for people in the home – ‘Your Voice’ meetings. However, as noted in the Concerns, Complaints and Protection section of this report, we found that these meetings were facilitated and attended by staff which might inhibit people from freely expressing their opinions. Also, as noted previously, people in the home did not have easy access to advocacy services. Incidents and events were notified to us as required, although we had been made aware of 2 incidents that had not been notified to us. When brought to the attention of the acting manager, the appropriate notifications were sent to us. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 29 There were records of accidents in the home and a monthly audit of accidents to show any trends or areas of concern. The maintenance and checking of fire safety systems and equipment was up to date according to the records seen. Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 X 2 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 X 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 2 40 X 41 X 42 X 43 2 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Merseybank Nursing Home Score 2 3 2 2 DS0000025442.V378761.R01.S.doc Version 5.2 Page 31 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 YA2 OP3 Regulation 14 Requirement The needs of people in the home must be kept under review and revised as necessary with regard to any change in circumstance. Timescale for action 18/02/10 2 YA6 OP7 15 This will ensure effective determination of how individual needs can be met, and ensure the home does not continue to accommodate people whose needs they can no longer meet. The care plans must detail how 18/02/10 each person’s needs in respect of their health and welfare are to be met. The care plans must be kept under review and revised as necessary. This will ensure that people’s assessed and changing needs are properly recorded and met. The Wilman shower room must have a suitable lock on the door to ensure that the privacy and dignity of people in the home is respected and promoted. Topical creams and lotions prescribed for the use of people DS0000025442.V378761.R01.S.doc 3 YA18 OP10 12 31/01/10 4 YA20 13 28/02/10 Page 32 Merseybank Nursing Home Version 5.2 OP9 in the home must be stored in suitable, (metal), medicines cupboards and must be stored separately to internal preparations. This will ensure the safe storage of medicines for use by people in the home. The following environmental 28/02/10 issues must be addressed to ensure a safe and pleasant home for the people living there: • the Wilman shower room wall cladding must be repaired or replaced • the carpet on the stairs between Wilman and Rosewood must be repaired or replaced to eliminate the trip hazard • the wash basin in the toilet on Rosewood must be repaired to ensure it is securely attached to the wall • the carpet in the Rosewood dining room must be repaired or replaced to eliminate the trip hazard in the doorway area For all the other items noted in the Environment section of this report, a plan must be produced to address the work required with timescales of when this will be achieved. A copy of this plan must be sent to CQC. This will ensure a safer and more pleasant environment that meets the needs and preferences of people living in the home. All areas of the home must be kept clean and there must be effective arrangements in place DS0000025442.V378761.R01.S.doc 5 YA24 OP19 23 6 YA24 OP19 23 28/02/10 7 YA30 OP26 13 28/02/10 Merseybank Nursing Home Version 5.2 Page 33 to prevent the spread of infection. This will protect people who live in the home and help to ensure a pleasant environment. There must always be sufficient 28/02/10 staff available to ensure that the assessed needs of people in the home can be fully met. Staff must have training 28/02/10 appropriate to their work and to ensure they are competent to meet the needs of people in the home. Specifically, training in physical and non-physical interventions for people with aggressive behaviour. 8 YA33 OP27 18 9 YA35 OP30 18 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 YA2 OP3 Good Practice Recommendations The admission assessments should be effectively completed to record: • whether the person has made an advance decision on receiving medical treatment • if they have a Lasting Power of Attorney, Independent Mental Capacity Advocate, or Relevant Persons Representative. • consideration of the persons capacity to make decisions about their daily lives, care and treatment. • if there is a need for a mental capacity or best interests decision This will ensure that people are safeguarded and their rights are promoted. The needs assessments completed before and following admission should include the person’s needs and wishes regarding their end of life care. There should be an agreed individual care plan that includes personal preferences and any specified palliative care, assistance and treatment. DS0000025442.V378761.R01.S.doc Version 5.2 Page 34 2 YA2 OP3 Merseybank Nursing Home 3 4 5 YA7 OP14 YA14 OP12 YA17 OP15 6 7 8 YA18 OP14 YA24 OP19 YA35 OP30 This will ensure people’s needs and preferences regarding end of life care are properly recorded and met. People in the home should be encouraged and supported, if they wish, to find and participate in local independent advocacy/self-advocacy groups. The range and choice of activities should be increased to ensure that the needs and preferences of all the people living in the home are met. The menus should be displayed in a suitable format and position for people to easily see and understand. This will ensure that people, (and/or their representatives), are able to find out independently about the meals offered. People in the home should be encouraged and supported to access services such as counselling and support groups. This would help to address individual mental health needs. A shower room should be provided for the people living in the Rosewood unit to meet their needs and preferences. Staff should have training to ensure they are familiar with the conditions and needs of people in the home, for instance, training about Multiple Sclerosis and Huntingdon’s disease. The Wilman unit should be refurbished and redecorated in line with current guidance and good practice to ensure an appropriate environment for people with dementia. There should be a report produced from the quality assurance audits and surveys and made available to people in the home and their representatives. This would ensure that people know their views and ideas are taken seriously and used to guide changes in the home. Policies should be developed to demonstrate how the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards will be implemented in the home. This should include how the provider will ensure that staff are conversant with this legislation and their roles and responsibilities. This will ensure that peoples rights are promoted and upheld. The acting manager and providers should ensure the home is compliant with legislation about smoking to promote the health and safety of people living in the home, visitors and staff. 9 10 OP19 YA39 OP33 11 YA39 OP33 12 YA42 OP38 Merseybank Nursing Home DS0000025442.V378761.R01.S.doc Version 5.2 Page 35 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Fax: 03000 616171 Email: enquiries@cqc.org.uk Web: www.cqc.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. 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