Care Home: Murrayfield Care Home

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What the care home does well The home provides good outcomes for people. We found that the needs of the people case tracked were within a range of those specified in the statement of purpose. The home provides a statement of purpose that is specific to the home and the resident group that they care for. The statement of purpose confirmed that the cultural and religious needs of people would be respected. People are supported to maintain their cultural and religious identity. A person who lives at the home said, "The manager visited me and asked what help I needed." Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. A person spoken to told us "staff are kind and caring." Care plans make sure that people`s needs are addressed in a person centered way. Detailed nutritional, tissue viability, falls and manual handling assessments have been put in place. Management of risk ensures that safety issues are addressed whilst at the same time improving the quality of life for people living at the home. People spoken to told us that activities are provided regularly. People are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. There were policies on handling abuse and protection. People feel safe and well supported by the home, which has their protection and safety as a priority. People spoken to felt that staff had the necessary skills to meet their needs. Staff are supported through training to meet the individual needs of people. The registered manager has extensive experience of managing a service for older people. The registered manager has a clear understanding of how to deliver good outcomes for people living at the home. We discussed health and safety issues with staff and they demonstrated their understanding. Health and safety checks, procedures and training make sure that people living in the home are safe. What has improved since the last inspection? There were three areas for improvement identified at the last inspection. The registered manager was able to show 50% of staff have achieved the National Vocational Qualification in care. The home ensures that all staff receive relevant training that is focused on delivering improved outcomes for people. At the last inspection a requirement was made that a program of refurbishment and redecoration be put in place to improve the home`s environment. The regional manager was able to show us a detailed and costed programme for the refurbishment and redecoration of the home. Since the last inspection the registered manager has appointed a deputy to assist her in managing the home. The deputy manager makes sure that people receive the care and support they need. CARE HOMES FOR OLDER PEOPLE Murrayfield Care Home 77 Dysons Road Edmonton London N18 2DF Lead Inspector Tony Brennan Unannounced Inspection 20th June 2008 10:00 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 Murrayfield Care Home DS0000068280.V365542.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. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Murrayfield Care Home Address 77 Dysons Road Edmonton London N18 2DF 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) 020 8884 0005 020 8884 0006 murrayfield@fshc.co.uk Four Seasons (No 10) Limited Linda June Slade Care Home 74 Category(ies) of Dementia - over 65 years of age (74), Old age, registration, with number not falling within any other category (74), of places Physical disability over 65 years of age (74) Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Frail elders over 50 years require nursing care. Elderly mentally ill. Two specified service users who are under 65 years of age and also have a learning disability may be accomodated in the home. The home must advise the regulating authority at such times as either of the specified service users attains 65 years or vacates the home. Two specified service users who have a learning disability may be accommodated in the home. The home must advise the regulating authority at such times as either of the specified service users vacates the home. 12th April 2007 4. Date of last inspection Brief Description of the Service: Murrayfield care centre is a purpose built nursing home. There are three floors. One floor provides dedicated dementia care. There are dining and sitting rooms located on each floor. There is a garden to the rear of the building. All bedrooms are single and en suite. Bathrooms and toilets have the necessary adaptation. The home is located near to shops and public transport. The home aims to provide care that meets the individual needs of people. Fees are currently between £551 and £789 per week and are are on a sliding scale, dependent on the nursing needs of people. This report is available on the Commission web site. Murrayfield Care Home DS0000068280.V365542.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. This unannounced key inspection was undertaken as part of the annual inspection programme. We sought to confirm that the three areas for improvement identified at the last inspection had been addressed. Prior to the inspection the home had completed its Annual Quality Assurance Assessment. The Annual Quality Assurance Assessment provided us with information about the home and how it was seeking to provide the best outcomes for people. We also looked at any other information we had received about the home since the last inspection. This included any information regarding incidents that the home had told us about. The inspection took place over two days. We were assisted by the registered manager, Linda Slade, with the inspection. The regional manager also assisted us by providing details of the home’s refurbishment programme. We spoke with five people who live at the home, and three members of staff. We observed care practice and interaction between staff and people living at the home. We toured the building and examined a number of records relating to the care, health and safety and management of the home. At the end of the inspection feedback was given to the registered manager, and areas for improvement were discussed. Because people with dementia are not always able to tell us about their experience for the service they receive, we have used a formal way to observe people in this inspection. This helped us to assess the quality of care that they receive. We call this a Short Observational Framework for Inspection (SOFI). This involved us observing up to five people who live in the Herriot unit, part of the home that caters for the needs of people with dementia. We did this for two hours and recorded their experiences at regular intervals. This included their state of well-being, and how way interacted with staff members, other people living at the home, and the environment. We would like to thank the staff that assisted us by answering questions about the running of the home. We would also like to thank the people who live at the home who discussed their views of the service they receive. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 6 What the service does well: The home provides good outcomes for people. We found that the needs of the people case tracked were within a range of those specified in the statement of purpose. The home provides a statement of purpose that is specific to the home and the resident group that they care for. The statement of purpose confirmed that the cultural and religious needs of people would be respected. People are supported to maintain their cultural and religious identity. A person who lives at the home said, “The manager visited me and asked what help I needed.” Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. A person spoken to told us “staff are kind and caring.” Care plans make sure that people’s needs are addressed in a person centered way. Detailed nutritional, tissue viability, falls and manual handling assessments have been put in place. Management of risk ensures that safety issues are addressed whilst at the same time improving the quality of life for people living at the home. People spoken to told us that activities are provided regularly. People are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. There were policies on handling abuse and protection. People feel safe and well supported by the home, which has their protection and safety as a priority. People spoken to felt that staff had the necessary skills to meet their needs. Staff are supported through training to meet the individual needs of people. The registered manager has extensive experience of managing a service for older people. The registered manager has a clear understanding of how to deliver good outcomes for people living at the home. We discussed health and safety issues with staff and they demonstrated their understanding. Health and safety checks, procedures and training make sure that people living in the home are safe. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Two areas for improvement have been identified at this inspection. Given that the homes environment was generally in need of improvement we asked the regional manager complete the programme of work as a priority. People need to live in an environment that is appropriately decorated and furnished to meet their needs. We observed that people were left on their own without staff to support them. This was discussed with the registered manager who agreed to review the staffing levels to make sure that there are sufficient staff to meet peoples needs. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 8 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. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 9 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 Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 10 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): 13 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The statement of purpose is an accurate description of the service provided. People’s needs are assessed prior to admission to the home to make sure they receive the care and support they need. National Minimum Standard number 6 is not applicable to this service, as the home does not provide intermediate care. EVIDENCE: We found that the needs of the people case tracked were within a range of those specified in the statement of purpose. The statement of purpose Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 11 identified the skills and staffing resources available to meet the needs of people. The statement of purpose stated that the home would meet the needs of people who have dementia. We observed how staff supported people with dementia, they demonstrated an awareness of good dementia care practice. Staff spoken to were able to explain in detail how they met the needs of people who have dementia. Training records showed that staff had completed some training on meeting the needs of people with dementia. The home provides a statement of purpose that is specific to the home and the resident group that they care for. The statement of purpose confirmed that the cultural and religious needs of people would be respected. Records showed that people were supported by the home to maintain contact with their church or other community groups. We spoke with the registered manager who told us that cultural and religious needs would be addressed and identified through initial assessments and care planning. One person said, “I take part in a weekly service.” People are supported to maintain their cultural and religious identity. People living at the home have varying degrees of disability and dementia. The environment has been adapted so that it is accessible. We observed that people were able to move about the home safely. The registered manager explained that the home is being redecorated. As part of this colour schemes would be chosen to enhance the accessability of the home for people with dementia. The homes environment is adapted to meet peoples diverse needs. A person who lives at the home said, “ staff here are very understanding.” The annual quality assurance assessment stated that there were comprehensive pre admission assessments in place. The people case tracked had both assessments from placing authorities, and ones carried out by the home. These identified the individual’s needs for support and care. The initial assessment included information on the dementia care needs. This included any behavioural issues that the individual might have. As part of the assessment process information on the needs of people had been obtained from health professionals. This had been used to inform the home’s own assessment. Admissions are not made to the home until a full needs assessment has been undertaken to ensure the best outcomes for people. Initial assessments recorded the involvement of people and their representatives in identified areas where they needed support. Both relatives and people living at home told us that they had been actively involved in the initial assessment process. Detailed initial assessments are carried out with the involvement of people and their representatives to make sure their needs are identified. A person told us, “Staff are very caring.” Care staff spoken to were able to explain the individual needs and preferences of the four people case tracked. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 12 We observed the interaction between staff and people who have dementia. We found this supported their continued well-being. Admissions to the home only take place when staff have the necessary skills to meet the assessed needs of perspective residents. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s personal, social and medical care needs are fully planned for. People who use the service are fully protected by safe procedures for handling medication. Peoples right to privacy is supported. EVIDENCE: The annual quality assurance assessment stated, “We ensure that individualised care is provided for service users as detailed in their care plans.” One person said, “ they talked to me about what I needed help with.” We found that the care plans of all the people case tracked were detailed and clearly identified how the needs of people would be met. Care plans were based on initial assessments of the people case tracked. There were clearly defined actions highlighted in the care plans to meet the needs of people. We found that people’s choices and preferences are recorded in their care plans. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 14 The care plans for the people case tracked were found to reflect their choices and preferences. People commented that they had been asked about how they wish to be supported by staff. Staff were observed to interact respectfully and sensitively with people living at the home. People said that staff respected their privacy and treated them with respect. People we spoke to told us that they felt staff understood their needs. We saw examples where staff members did relate well with people living at the home, for examples speaking to people in a way that was appropriate given their age. A key worker system is in place. The registered manager explained that she was supporting key workers to be involved in the care planning process. Care plans were personalised, and referred to the cultural needs of people. This included whether or not they wish to take part in religious services. People are involved in the planning of their care that affects their lifestyle and quality of life. Detailed nutritional, tissue viability, falls and manual handling assessments are in place. The people case tracked all had nutritional assessments. People were being weighed regularly and action taken if their weight changed. The continence needs of people had been assessed and recorded as part of their care plans. Each care plan includes a manual handling risk assessment. Equipment had been provided to assist people to mobilise safely and independently. Management of risk ensures that safety issues are addressed whilst at the same time improving the quality of life for people living at the home. Diary notes showed that appropriate medical attention and advice is sought. Diary notes also confirmed that the people case tracked had access to their General Practitioner when necessary. A person told us, “The doctor always visits regularly.” We observed that people were alert and able to interact with staff. When we checked the medication we found that the people case tracked were not on large amounts of sedative medication. Where the General Practitioner had recommended specific medical interventions these were followed up. People’s health is promoted to ensure their continued well being. The records of medicines received, administered and returned to the pharmacist were all complete. We were able to confirm that people were getting their medication as prescribed by their general practitioners. We found where the General Practitioner had made changes to peoples medication this was signed to confirm the change had been made. We found that the medication for each of the people case tracked was accurately recorded. All people living at the home are supported by staff to take their medicines. The people we case tracked had their consent to staff administering their medication recorded in their care plans. Two of the people did not have the capacity to make this decision. This was recorded in their care plan and the appropriate consultation had been carried out with their relatives and relevant Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 15 professionals. Medication records are fully completed, contain the required entries, and are signed by appropriate staff to ensure people’s safety. Medicines were stored safely. All medicines are stored at the appropriate temperature. Separate records were maintained for controlled drugs. We found these were complete and the amount of medication held corresponded with those recorded in the controlled drugs books. The management team monitor staff to make sure that the correct procedures are followed when administering medication. Regular management checks are carried out to make sure that medication is administered safely to people. Training has been provided on the safe administration of medicines. Training records confirmed that this training had taken place. We were able to observe staff administering medication, and confirmed that this was done safely. Staff understands how to administer medication safely to people living at the home. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are provided with varied activities to meet their needs. People living at the home are supported to maintain contact with relatives and other representatives of their choice. The menu reflects the preferences of people living at the home and offers a balanced diet. EVIDENCE: We spoke with people who live at the home who told us that they are provided with regular activities. One person told us, “There are regular activities to do.” The annual quality assurance assessment highlighted that, “The program is of preferred activities, taking place each month. We have regular theme activities and invite the local community to attend.” We observed that activities were taking place at various times throughout the day. We saw that people were enjoying playing a game catch, talking with staff and singing along to music. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 17 People spoken to told us that these activities are provided regularly. Peoples’ interests were recorded as part of their care plans. People are involved in meaningful daytime activities of their own choice and according to their individual interests and capabilities. We observed that staff spend time talking with people who live at the home and listening to what they had to say. Staff spoken to understood the importance of one-to-one contact for people. One person said, “ Staff are friendly.” Relatives commented that there were no restrictions on visiting the home. People told us that they could see visitors in private if they wished. Diary notes showed that people had regular contacts with family, friends and the wider community. The menu showed that options are offered at each meal. This included meal options reflecting the cultural and religious backgrounds of people living in the home. The menu is varied offering a number of choices of meals. We spoke with people who were generally pleased with the quality of the food provided. A person who lives at the home said, “ the food is very good.” We observed that people are asked whether they preferred the first or second choice on the menu. Another person commented about the choice of food offered and that staff, “ do bring an alternative to whats on the menu.” People are offered a variety of meals that reflect their personal preferences and meet their dietary needs. Meals were balanced and nutritious. People’s dietary needs recorded as part of their care plans (for example if they were diabetic or needed a puree meal). We observed that meals were well presented in a warm and friendly way. We saw that people were supported to eat. We observed that this was done at the pace of the people being assisted. People are able to enjoy the food they prefer and like. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are confident that their complaints will be listened to, taken seriously and acted upon. The home’s procedures protect people from abuse. EVIDENCE: The annual quality assurance assessment confirmed that a clearly defined complaints policy with agreed timescales for managing complaints was in place for people to use. We found that the detailed policy was in place. People living at the home told us they had received a copy of the complaints policy. No complaints had been referred by the Commission to the home since the last key inspection. A complaints book is available to record all concerns, allegations and complaints. We found that the complaints book recorded the actions that had been taken to address issues. The complaints record showed actions taken to resolve complaints. People with whom we spoke confirmed that they knew how to make a complaint. A person told us, “I can tell the manager or my relative if I had a complaint.” The home has an open culture that allows Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 19 people to express their views, and concerns in a safe and understanding environment. There were policies on handling abuse and protection. People living at the home felt confident that any concerns they raised would be handled sensitively and appropriately. A person told us, “ I can tell staff if I am worried about things.” There had been one adult protection issue since the last key inspection. The home had co-operating fully with this investigation. We found that in response to the issues raised by this allegation a number of improvements to the service had already been made. We found that staff had received training on adult protection. Staff spoken to could recognise the signs of potential abuse, and explained how they would respond to it. People feel safe and well supported by the home, which has their protection and safety as a priority. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People do not live in a home that provides a safe and homely environment. The home is clean and hygienic. EVIDENCE: We walked round the home and found that it was accessible for people. A passenger lift provided access for people to all floors. We observed that people were able to access all areas in the home safely. The home has the necessary adaptations to support people to move around safely. There are adapted bathrooms and toilets on each floor. These are accessible to people who have mobility difficulties. Hoists were available on the three floors. Records showed that these had been maintained. There are large dining and sitting areas for Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 21 the use of people. The home provides an accessible environment for people to live in. At the last inspection a requirement was made that a program for the refurbishment and redecoration be put in place to improve the home’s environment. We spoke with the regional manager who explained that over £150,000 would be spent on improving the home. The regional manager was able to show us a detailed and costed programme for the refurbishment and redecoration of the home. We saw that work had already commenced on redecorating one of the floors. Given that the homes environment was generally in need of improvement we asked the regional manager to prioritise the completion of this work. People need to live in a home that is appropriately decorated and furnished to meet their needs. Bedrooms were personalised with items of furniture and pictures belonging to people. All bedrooms are single occupancy and have en suite facilities. As part of the home’s refurbishment plan bedrooms will be redecorated. We found on our walk round the home that a number of bedrooms were in need of redecoration and new carpets. New items of furniture, curtains and bed linen had already been bought for some of the bedrooms. The registered manager explained this was part of the ongoing plan to refurbish the home. The registered manager explained that as part of the refurbishment programme bedroom doors would be painted a specific colour. They would also, with the agreement of the person whose bedroom it is, have a photograph of the person on the door to help them identify their bedroom. One person said, “ My bedroom is very nice. I have my own things.” People are encouraged and supported to personalise their bedrooms. Appropriate measures are in place to prevent cross infection. The home has detailed policies on the prevention of cross infection. Staff have received training on infection control measures. Staff spoken to understood how to work to minimise the possibility of cross infection. Staff confirmed that they had access to disposable gloves and aprons. Liquid soap and paper towels were available throughout the home. Effective infection control measures are in place to ensure the safety of people living at the home. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Sufficient staff are not always available to meet the needs of people who live at the home. Staff do have all the skills to meet all the assessed needs of people who live at the home. People who live at the home are protected by the home’s recruitment practices. EVIDENCE: The rota showed that a consistent staffing level was being maintained in the home. Staff said that the current staffing level allowed them to meet the needs of people. However, people living at the home said there could be times when they felt that there were not enough staff available. One person told us, “ Sometimes staff dont have time to spend talking to you.” We observed that people were left on their own without staff to support them. This was discussed with the registered manager who agreed to review the staffing level to make sure that there is always sufficient staff to meet peoples needs. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 23 The annual quality assurance assessment highlighted that staff had been on a range of courses. People spoken to felt that staff had the necessary skills to meet their needs. One person said, “ Staff really do know how to care.” Training records showed that staff had been on a range of courses relating to the needs of people who live at the home. We found that this included training on dementia. There were certificates available to confirm this. We observed that staff understood how to respond and communicate with people who have dementia. Staff spoken to were able to explain how they supported people in a person centred way. Staff are supported through training to meet the individual needs of people who live in the home. The registered manager was able to show 50 of staff have achieved the National Vocational Qualification in care. Training records we examined confirmed this. Staff training records showed that staff had done training in the essential areas, such as food hygiene, health and safety, administration of medication and infection control and first aid. Training records we saw confirmed this. We observed that staff demonstrated that they knew how to support and care for people. The home ensures that all staff receive relevant training that is focused on delivering improved outcomes for people. We looked at two staff files. These contained all the necessary documentation to ensure that these members of staff were safe to work with people who live at the home. Their employment record had been checked. Two references and a POVA first/CRB check had been obtained prior to them starting work at the home. This showed that the home followed a clear recruitment procedure that ensures the safety of people. The staff group reflect the cultural backgrounds of people living at the home. People living in the home said they felt that staff could be trusted. Robust recruitment procedures are followed to ensure the safety and well being of people. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Appropriate management structures are in place to ensure that people receive the care they need. People who live at the home are consulted about the quality of the service, and encouraged to make suggestions for improvement. People who live at the home have their financial interests protected by the home’s procedures. People who live at the home and staff are protected by the home’s health and safety procedures. EVIDENCE: Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 25 The registered manager has extensive experience of managing a service for older people. The registered manager has maintained and updated her skills regularly. She has a clear understanding of the key principles and focus of the service to make sure that people receive the care they need. She has also providing training on a range of areas to staff. We observed that the registered manager spent time talking to people who live at the home. The registered manager has a clear understanding of how to deliver good outcomes for people living at the home. Since the last inspection the registered manager has appointed a deputy to assist her in managing the home. We spoke with the deputy manager, she was able to demonstrate a detailed knowledge of the needs of the people living at the home. We observed that the deputy manager works with staff to promote good practice in the home. The deputy manager makes sure that people receive the care and support they need. Staff spoke very highly of the registered manager and the deputy. They said they felt well supported and received clear directions and leadership. The managers and staff work to make sure that the home is running in the best interests of people who live there. We observe this throughout the inspection. Relatives and other professionals provided positive feedback about how the home was managed and has been improving how it makes sure that the needs of people are met. The registered manager works to continuously improve the home and provide an increased quality of life for residents. She has completed a detailed annual quality assurance assessment and this provides a clear picture of how the service will be developed for the benefit of people living at the home. The registered manager has improved the communication with, and support provided to, relatives. The registered manager has done this by setting up a dementia support group and expanded links with the local community. A relative had attended one of these meetings told us that they were “ very helpful” in explaining how dementia affects people. The registered manager explained that she would be developing other support groups in the home. There is also a residents committee meeting to encourage people to share their views about how the home is run. People told us they felt that this helps them to be more involved in what was happening in the home. People and relatives are encouraged to participate in determining the future development of the service. The home has a system for obtaining the views of the quality of the service it provides. The home makes sure that any areas for improvement are addressed. A survey of the views of people who live at the home, relatives and professionals had recently been carried out. The findings of this survey had been action to improve the home. Minutes of meetings with relatives and people who live in the home were seen and these confirmed their involvement in the running of the home. People who live at the home have meetings on a Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 26 regular basis to discuss how they wish the home to be run. Staff meetings take place to make sure that staff are aware of how they should support and care for people. People’s views are sought and provide the bases for improving the quality of the service. The home does not hold money for people who live at the home. The home invoices their families or the relevant social service department for any expenditure made on their behalf. A system is in place to ensure receipts are obtained for any expenditure. People who use the service can have confidence in the home’s procedures for handle their money safely. The home has a consistent record of meeting the relevant health and safety requirements and closely monitors its own practice. Fire drills were taking place and the fire alarm was tested regularly. We found that the fire risk assessment includes an assessment of all the potential fire risks in the home. We questioned staff on the fire safety procedures and found that they understood fire safety issues. All health and safety policies were available. Certificates for gas, legionella and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. We discussed health and safety issues with staff and they demonstrated their understanding. The home has an effective system for monitoring accidents to ensure the safety of people who live and work at the home. The temperatures of the fridges and freezers were recorded and within safe limits. Health and safety checks, procedures and training make sure that people living in the home are safe. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 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 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 28 No Are there any outstanding requirements from the last inspection? 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 OP19 Regulation 23(2)(d) Requirement Timescale for action 30/08/08 2 OP27 18(1)(a) The registered persons must make sure that the redecoration and refurbishment programme is completed. All areas of the home must be appropriately decorated and furnished to make sure people have a pleasant and homely environment in which to live. The registered persons must 10/08/08 make sure that the staffing level is reviewed to confirm that sufficient staff are always available to meet people’s needs. The staffing levels need to be sufficient to make sure that enough staff are available to meet peoples needs. Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 29 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 Murrayfield Care Home DS0000068280.V365542.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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. 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