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Inspection on 03/08/09 for Mereside

Also see our care home review for Mereside for more information

This is the latest available inspection report for this service, carried out on 3rd August 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People are told about the Home. They have information so that they can choose whether they want to live there. The Home find out what support people need before they move in.People’s medicines are well managed.People can make choices every day. This helps them to be independent and use their skills and abilities. People have a say in what happens at the Home including menu planning and staff recruitmentPeople said that the food is good. The atmosphere at lunchtime was relaxed and friendlyVisitors are made welcome. People are supported to keep in touch with their families and friends.People live in a clean, tidy and comfortable home, which is warm and welcoming.There are good procedures to listen to people and keep them safe from possible harm.The staff have worked in the Home for a long time and know people well. The people living at the home have good relationships with staff. The staff are well trained and a most of them have an award in care to help them to do their job.Proper checks are done on the staff who come to work at the Home.The home is well managed so the people living there benefit from a well run service.Health and safety is well managed so that people live in a safe home

What has improved since the last inspection?

People can help to make some of their meals if they want to. People are encouraged to make their lunchtime sandwiches. Staff have a sleep in room with en suite for use at night time.Two care staff have been employed to do weekend activities with people.All staff have done medication administration and protection of vulnerable adults training. They are now doing a nutrition and health course.Staff can use sign language to communicate with people if needed.

What the care home could do better:

Care files contain a lot of old information. It was difficult to find the information that was needed. Care plans should be kept up to date.Some paperwork was not dated. It was difficult to see which information is current and which is not.Some health action plans did not have enough written to tell staff how to keep people healthy.There was no written information to show the amount of “as needed” medication that can be given, how long should be left between doses and the maximum dose within twenty four hours.Staff training records did not clearly show what training staff had done and what was needed.

Key inspection report Care homes for adults (18-65 years) Name: Address: Mereside 42 St Bernard`s Road Olton Solihull West Midlands B92 7BB The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Deborah Shelton Date: 0 3 0 8 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 42 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 42 Information about the care home Name of care home: Address: Mereside 42 St Bernard`s Road Olton Solihull West Midlands B92 7BB 01217076760 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Tom Eyton care home 15 Number of places (if applicable): Under 65 Over 65 15 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 15 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 15 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 42 A bit about the care home Mereside is a Care Home, for adults with learning disabilities. 15 The Home provides support for up to 15 adults. There are steep steps and no lift so people who are frail or physically disabled could not live here. Mereside can easily be reached by public transport. Care Homes for Adults (18-65 years) Page 5 of 42 GPs surgeries, churches and a grocery shop are within walking distance. The Home is nearly three miles from the centre of Solihull. The inspection report is available in the home for visitors to read if they wish to. Care Homes for Adults (18-65 years) Page 6 of 42 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 42 How we did our inspection: This is what the inspector did when they were at the care home. Two inspectors visited and spent some time talking to the people who live in the Home and to the staff who look after them. We looked at the care plans of four people. We looked at their medication. Staff files and health and safety records were looked at. Care Homes for Adults (18-65 years) Page 8 of 42 The inspectors looked around the building to make sure that it was warm, clean and comfortable. There were no immediate requirements after this visit. This means that there was nothing urgent that needed to be done to make sure people stayed safe and well. Care Homes for Adults (18-65 years) Page 9 of 42 What the care home does well People are told about the Home. They have information so that they can choose whether they want to live there. The Home find out what support people need before they move in. People’s medicines are well managed. Care Homes for Adults (18-65 years) Page 10 of 42 People can make choices every day. This helps them to be independent and use their skills and abilities. People have a say in what happens at the Home including menu planning and staff recruitment People said that the food is good. The atmosphere at lunchtime was relaxed and friendly Visitors are made welcome. People are supported to keep in touch with their families and friends. Care Homes for Adults (18-65 years) Page 11 of 42 People live in a clean, tidy and comfortable home, which is warm and welcoming. There are good procedures to listen to people and keep them safe from possible harm. The staff have worked in the Home for a long time and know people well. The people living at the home have good relationships with staff. The staff are well trained and a most of them have an award in care to help them to do their job. Care Homes for Adults (18-65 years) Page 12 of 42 Proper checks are done on the staff who come to work at the Home. The home is well managed so the people living there benefit from a well run service. Health and safety is well managed so that people live in a safe home What has got better from the last inspection Care Homes for Adults (18-65 years) Page 13 of 42 People can help to make some of their meals if they want to. People are encouraged to make their lunchtime sandwiches. Staff have a sleep in room with en suite for use at night time. Two care staff have been employed to do weekend activities with people. All staff have done medication administration and protection of vulnerable adults training. They are now doing a nutrition and health course. Care Homes for Adults (18-65 years) Page 14 of 42 Staff can use sign language to communicate with people if needed. What the care home could do better Care files contain a lot of old information. It was difficult to find the information that was needed. Care plans should be kept up to date. Care Homes for Adults (18-65 years) Page 15 of 42 Some paperwork was not dated. It was difficult to see which information is current and which is not. Some health action plans did not have enough written to tell staff how to keep people healthy. There was no written information to show the amount of “as needed” medication that can be given, how long should be left between doses and the maximum dose within twenty four hours. Care Homes for Adults (18-65 years) Page 16 of 42 Staff training records did not clearly show what training staff had done and what was needed. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Deborah Shelton 77 Paradise Circus Queensway Birmingham W Midlands B1 2DT Care Homes for Adults (18-65 years) Page 17 of 42 01216005300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 18 of 42 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 19 of 42 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the home is made available to people before they move in so that they can make an informed choice about whether to live there. There is a procedure for assessing peoples needs prior to admission so they can be confident the home is suitable for them. Evidence: The service users guide and statement of purpose are available in large print and picture format. According to the deputy staff also sit and discuss the contents of these documents to help people living at the Home understand what services are available to them. There have been no new people admitted to the Home since the last inspection. As there have been no new admissions this standard was not reviewed in detail. A discussion was therefore held with the manager to find out the pre-admission processes at Mereside. Pre-admission assessments are undertaken with social workers and hospital staff as Care Homes for Adults (18-65 years) Page 20 of 42 Evidence: needed. This helps the Home identify peoples assessed needs and allows them to decide whether they would be able to meet these needs. People are then encouraged to visit the Home, for a meal, look around and be introduced to everyone that lives there and then for an overnight stay. The manager confirmed that people are able to have numerous visits before they decide that they would like to move in. Once agreement to move in has been reached the Home develop their own care plans in readiness for admission. The AQAA records that Mereside residents have always been referred by social services, who include individual contracts to ensure that their terms and conditions are supported by the individuals social worker. Care Homes for Adults (18-65 years) Page 21 of 42 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have a good understanding of how to offer care and support to each person. This should make sure that people are supported according to their individual needs and preferences. Evidence: Four people were case tracked at this inspection. This involves looking at their care plans, talking to them and the staff that care for them. Looking at their living accommodation and some other documentation relating to their life at Mereside. Each person has a care file which is kept locked away when not in use. A separate folder contains all individuals risk assessments and a separate book is kept to record daily entries for each person. Care files contained information dating back to the date of admission. They were very large with lots of out of date information stored in them. This made the files confusing and difficult to get to the current information and cross reference to other related documentation quickly and easily. Care Homes for Adults (18-65 years) Page 22 of 42 Evidence: Some of the documentation in care files contained sufficient information regarding peoples needs and abilities. However, some of the details required updating as conflicting information recorded was not dated and was confusing, for example a mobility assessment for one person recorded sufficient information regarding needs and abilities both inside and outside of the Home. It recorded that the person needs support due to lack of road sense. There was a skills assessment in place regarding road sense which was reviewed annually. However, one document recorded that the person was able to go out of the Home with a member of their family, whilst another document recorded that the person was not able to go out of the Home with their family. As neither document was dated, staff may make the incorrect decision and follow out of date information. The manager confirmed that this person is no longer able to leave the Home without staff supervision for safety reasons. Documentation in the care file therefore needs updating. Another care file recorded that the person was not weight bearing and yet the person was seen during the inspection walking around and cleaning in the lounge area. Management guidelines in place were cross referenced to other documentation in care files. One set of management guidelines was dated November 2007 and other guidelines relating to a separate behavioural issue were dated 1997. There was no evidence that management guidelines have been reviewed to ensure that they are effective and therefore still relevant. Not all of the information recorded in care files had been dated or signed by the person recording the information. Due to the vast amounts of information it was therefore difficult to identify which records were current and which were out of date. One health action plan regarding seizures contained very brief information which was not dated. There was no date of review and no information regarding the action that staff should take if the person should have a seizure, what a seizure looks like for this person etc. During a conversation with the manager it was noted that this person has not had a seizure for over two years and that the health action plan needed to be updated. Information in another file relating to seizures which was not dated or signed and contained only brief information was also no longer applicable as the person had not had a seizure recently. One care plan records that the person is to have enemas. Records did not stated who gives the enema or when. During discussion with the manager it was noted that this person does not have enemas any more. This information is therefore out of date and may be confusing for staff. Some information recorded in care plans was brief and did not contain specific guidance for staff to meet identified needs, i.e. needs supervision whilst showering and bathing Care Homes for Adults (18-65 years) Page 23 of 42 Evidence: due to epilepsy, however, records did not say in what form the supervision takes or details regarding any personal preferences of the individual. Care files contained personality pictures which recorded detailed information about needs, abilities, likes and dislikes regarding various aspects of daily living. During discussions with a member of staff who was the key worker for one person being case tracked it was evident that she was fully aware of the likes, dislikes, needs and abilities of the person living at the Home as recorded in their care file. Risk assessments are in place for various activities which impact on the daily lives of those that live at Mereside. These were reviewed and updated on a regular basis. Records were available to demonstrate that people have access to external health professionals such as optician, dentist, chiropodist, psychiatrist etc. People are weighed on a monthly basis and weight is recorded in their care file. Care Homes for Adults (18-65 years) Page 24 of 42 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples lifestyle promotes their independence and is reflective of their individual needs. Evidence: People are able to choose where to spend their time and appeared to be at ease in their surroundings. During the day nine people visited a local day centre and two people helped at a local farm. The remaining four people stayed at Home and were occupying themselves in the lounge or dining room as they wished. The two people who visit the farm said that they enjoyed helping out at the farm and spoke about the animals that they care for. The deputy manager confirmed that they keep a log of in-house activities completed and do not record any information regarding the activities that take place at the day centre. The monthly activity log does not record family visits etc. The manager confirmed that they are meeting with the Liaison Officer at the day centre to discuss what the people who live at Mereside do at the centre, this information could then be recorded on information held at the Home as evidence of how they spend a majority of their time Care Homes for Adults (18-65 years) Page 25 of 42 Evidence: each day. During the day those people who stayed at the Home were seen vacuuming, wiping and setting the dinner table. People have tasks allocated to them to help with the running of the Home i.e. making beds, taking clothing to the laundry, cleaning their bedroom etc. Care files contain a four weekly in-house activity list, those seen recorded activities such as walk in park, walked the dogs, went to phab club, made sandwiches for the following day, went to gateway club, stripped bed, relaxation. Care files contained certificates evidencing some of the activities that people attend at various social clubs. Photographic evidence of activities undertaken are also available i.e. boat trip, pub lunch etc. From discussions with the deputy manager it was noted that people lead varied and active lives and that the activity records only record part of the daily activities that take place for individuals. The manager confirmed that they receive a lot of support from families. Families are encouraged to visit and maintain contact as often as possible. The Home have an open visiting policy and people are encouraged to maintain contact with families by phone or in person. Activity records show that people are involved in preparation of their sandwiches for the following day. The manager confirmed that a majority of people are involved in food preparation and cooking basic foods i.e. beans on toast, however, some people have no interest in cooking food and others do not have the capability. Those that have expressed a preference are involved in some form of food preparation. Three fridges are available to store foodstuffs. One fridge contained items that did not have the date of opening or disposal. Fresh fruit and vegetables are stored in a separate storage area outside of the main building. Food shopping takes place at least once per week, the deputy confirmed that some people enjoy food shopping and are able to go with her. Everyone shops for their own toiletries. Menus and records of food consumed by individuals were sampled to establish that a balanced and varied diet is provided that meets peoples needs and preferences. Three people were enjoying the lunchtime meal of bread rolls, salad and sausage rolls. The atmosphere at lunchtime was relaxed and people helped themselves to drinks as required. People spoken to said that the food was good and there was plenty of it. They talked about the food and said Its very good, I like the Sunday dinner, I decide what I have for tea. Care Homes for Adults (18-65 years) Page 26 of 42 Evidence: People are involved in menu planning and their food choices on a daily basis are recorded. There is a supper club for those people who need to gain weight, these people are offered sandwiches and a drink at supper time, other people who may need to loose weight are offered a drink and a biscuit. There are two people at the Home who are on a weight reducing diet and one dietary controlled diabetic. The deputy manager was aware of the foods that people can eat to help improve their health. All staff have undertaken a nutrition and health course Care Homes for Adults (18-65 years) Page 27 of 42 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements are needed to the systems in place to meet peoples personal and health care needs. Medicines are well managed for the ongoing protection of people who live in the home. Evidence: We looked at personal and health care plans for four people. There was some comprehensive information to describe how people should be supported in these areas and some information was brief. From information recorded it would be difficult to identify whether peoples personal preferences would be met. We met the people that live in the Home before they went off to their days activities. All people were appropriately dressed, hair was brushed and it appeared that personal hygiene needs had been met. Care plans seen did not record in sufficient detail how people are to be supported to bathe. Further information should be written as evidence of taking into account peoples needs and preferences. Records in care files demonstrate that people have access to external professionals such Care Homes for Adults (18-65 years) Page 28 of 42 Evidence: as chiropodist, optician, psychiatrist, dentist etc as needed. The health action plans seen in care files were not dated and it was therefore difficult to identify whether the information was up to date or relevant. Information recorded was brief and did not give a lot of detail regarding the action that staff are to take. The system of storing, administering and recording medicines kept in the home was looked at to establish that people are protected by robust procedures. All staff apart from the two newly employed have attended accredited medication training. There had been no change regarding the as needed (PRN) medication plans. One seen needed updating to include a medication which had been reduced and was now to be taken PRN. Plans recorded the name of the medicine but did not give full details of circumstances it is to be given, how long between doses and what is the maximum dose in 24 hours. This was identified at the last inspection of the Home. On one medication administration record (MAR) seen staff had not recorded the reasons why PRN medication was given on one occasion. Medication is delivered every 28 days (or more frequently if needed) and is blister packed where possible. A controlled drugs cabinet and register are available but not in use currently as there are no people taking controlled drugs. A locked medication trolley is used to store some medication which is used daily. PRN medication is stored securely in a separate locked cupboard along with any excess stocks of medication. Medication was seen being administered to people in an appropriate manner. Copies of prescriptions are available along with photograph of person and information sheets on each medication prescribed. These are all available with individual MAR charts. Medication and records for the four people being case tracked were reviewed and found to be correct. Care Homes for Adults (18-65 years) Page 29 of 42 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are appropriate procedures in place to listen to peoples concerns and complaints and safeguard them from the risk of harm Evidence: There have been no complaints made about the Home since the last inspection. A comments, compliments and complaints log book is available to record any complaints received. Currently the book only contains compliments and letters of thanks as no complaints have been received. The complaints procedure is discussed at each six weekly residents meetings. The Home have an open door policy and relatives and the people who live at the Home are able to discuss any issues or concerns with the manager at any time when he is on the premises. People spoken to during the inspection said I talk to staff if I am worried, they listen to you if youre sad, if Im not happy I tell Tom or Rose Behaviour management plans are in place which give guidance to staff, however as previously mentioned there was no evidence in these plans that the information is still relevant and effective. All staff have undertaken protection of vulnerable adults training. The manager discusses deprivation of liberty safeguarding and adult protection with staff during supervision sessions. Care Homes for Adults (18-65 years) Page 30 of 42 Evidence: During discussions it was noted that the manager has appointeeship for thirteen people. Financial records are externally audited every three months and evidence that audits take place was seen. Records were last audited in April 2009. Each person has their own bank paying in book and bank account statements were available for review. The financial records for the four people being case tracked were reviewed. Money for individuals is kept appropriately. An individual record of income and expenditure is kept for each person. Records seen balanced with funds available. One person signs their own financial records as evidence that they have received money. All other records are signed by two members of staff. Receipts for any expenditure are available. A weekend activity expenditure float is made available so that people have access to funds at all times. Care Homes for Adults (18-65 years) Page 31 of 42 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a clean, safe and comfortable environment that meets their needs. Evidence: Mereside is a large fifteen bedded property located in the olton area of Solihull. The Home consists of fifteen single bedrooms, twelve of which have en suite facilities. The three bedrooms without en suite are located on the top floor of the house. These people share one bathroom. The bathroom on this floor has a toilet, hand basin, bath with shower attachment. People keep their toiletries and towels in their bedrooms. This should reduce the risk of people using items that do not belong to them and minimise the risk of cross infection. Windows throughout the Home are restricted so that the risk of falls is minimised. The bedrooms of those people being case tracked were seen. One of these rooms had a television which was balanced on a table next to the bed. The location of the television would make it difficult to watch from the bed and as the television was not secured in place it could fall and cause injury. The deputy confirmed that they have tried to move the Television but the person moves the television back. The deputy was advised to undertake a risk assessment as the position of this television may present a hazard if not securely located. Care Homes for Adults (18-65 years) Page 32 of 42 Evidence: Lockable storage space is provided for personal belongings and some bedroom doors can be locked from the inside for privacy. The locks on these doors enable privacy but can be opened from the outside in the event of an emergency. One bedroom had a wall mounted fish tank which had recently been purchased. Fish food and water treatment solution were left out in this persons bedroom. Their key worker moved these items to a safer location during the inspection. The art work of one person whose bedroom is on the ground floor was framed and displayed in her bedroom and in the hallway near the bedroom. As this person has a hearing impairment they have a vibrating pillow device as well as a flashing fire alarm which are activated when the fire alarm goes off. Bedrooms seen contained lots of personal possessions and had a very homely feel. Appropriate security alarms are fitted throughout the Home as needed to protect those that live at Mereside. There is an external fire escape, which the deputy confirmed is used during fire drills. Part of the fire escape on the middle floor access is contained by use of wire mesh. The manager said that this was put in place to protect one person who used to crawl between the railings. Apparently this is no longer a problem, however the manager was strongly recommended to ensure that wire mesh is fitted at the top floor also to reduce the risk of falls. Shared space consists of two lounges on the ground floor. One lounge is the designated quiet lounge. There were sofas, chairs and a TV, caged budgie and some board games in this area. The other lounge is larger, with French doors to the garden. There are steps down from lounge, with handrails, but there is no access to the garden for people who would need to use a ramp. There is ramped access to the garden via a hallway to the side of the larger lounge, which continues down the garden to the BBQ and seating area. The dining room has four tables and fifteen chairs. The dining room felt cramped, however during the week many people are at day centres so eat lunch out. A hatch from is available between the kitchen and dining room and is used to serve food. It was noted that a large display cabinet takes up space by the serving hatch which restricts the space available for the person sitting in this area eating their meal. This currently does not cause a significant problem, however as the service user group age and their needs possibly change (may need staff to sit with them to assist with meal) the home will need to think of ways to support people to eat in comfortable surroundings. Staff sleep downstairs in the sleep in room and on the lounge sofa. Call bells are available on each floor for people to use if they need help in the night. These alarms can be heard in the staff sleep in room and in the lounge. There was no evidence to demonstrate that Care Homes for Adults (18-65 years) Page 33 of 42 Evidence: risk assessments had been undertaken to determine whether people are able to access the call bell. The issue of staff sleeping in a communal area was discussed with the manager and deputy. It was noted that staff are on duty until midnight before they are able to go to bed. This was documented on the duty rota. The manager said that people tend to go to bed earlier than midnight and therefore the fact that staff sleep on the sofa was not an issue. However, if people chose to stay up later, having a member of staff sleeping in the lounge could impact on their freedom to move around their home and place restrictions upon them. The manager said that this isnt a problem at this time and confirmed that there are plans to extend the premises which would address this issue. Since the last inspection the Home have re-layed block paving to the rear patio, added new work tops in the kitchen and widened the stairs leading to the top floor. When work has finished in this area a new carpet will be fitted and the area decorated. The Home was clean and hygienic on the day of inspection and fixtures and fittings were in a good state of repair. Care Homes for Adults (18-65 years) Page 34 of 42 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home operates a robust system of recruitment for the protection of the people who live there. Evidence: The Home has a stable staff group with a very low staff turnover. Levels of staff sickness are also low. The manager confirmed that they do not use the services of agency staff and have never used agency staff in the past. This helps to ensure that the people living at Mereside know the people that care for them. Staff on duty appeared to have a good relationship with those under their care and the atmosphere at the Home was relaxed and friendly. Eleven of the fifteen staff employed have a national vocational qualification (NVQ)at level two or above. The deputy manager is an NVQ assessor and they have access to an NVQ external verifier. This helps to ensure that staff are able to undertake the NVQ qualification as needed and that staff at the Home have the training needed to undertake their role effectively. Potential employees are introduced to the people that live at Mereside before a decision has been made to give a formal interview. Both male and female staff are employed at the Home. This helps to ensure that people have a choice about having personal care Care Homes for Adults (18-65 years) Page 35 of 42 Evidence: assistance from either only male or female staff. The personnel files of new staff employed since the last inspection were reviewed. Both of these people had previously completed work experience at Mereside and then applied to work at the Home. Personnel files seen contained application forms, two written references, Protection of Vulnerable Adults and Criminal Records Bureau checks. Relevant pre-employment checks had been undertaken to ensure that the potential employees are appropriate to work with vulnerable adults. Copies of training certificates were also available on both files. Training such as health and safety in the workplace, first aid have been undertaken. During a conversation with the deputy it was noted that all new staff undertake Skills for Care induction training. Induction records for the two new staff employed were not available on file as they were with the NVQ training organisation as these staff have recently started this training course. The Home do not have their up to date training records documented in a quick and easy to read format. Training certificates are kept on individual staff files. It would therefore be difficult to evidence whether staff training is up to date without looking through each personnel file. The personnel file of a long term staff member was reviewed to evidence training undertaken. The file showed that this staff member had undertaken food hygiene training in November 2008 and is booked to undertake First Aid training in August. Supervision records show that supervision sessions are themed to update staff on training issues i.e. abuse, COSHH as well as daily work etc. Records seen did not demonstrate that staff have up to date mandatory training. During discussions it was noted that the manager and the deputy have undertaken a dementia training course and are planning on providing this training for all staff. One of the senior members of staff is enrolled to undertake the management and leadership course in the near future. One member of staff spoken to demonstrated a good understanding of peoples individual needs and it was evident that they have formed positive relationships with them. People who live at Mereside also spoke positively about staff saying very good staff, I am very happy with the staff, The staff help me do things for myself, I have a laugh with them. Care Homes for Adults (18-65 years) Page 36 of 42 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and peoples health and safety is promoted and protected Evidence: The Home has a registered manager and a deputy manager in post and there have been no changes to the management arrangements since the last inspection of the Home. All three staff who responded to our survey confirmed that the manager gives enough support and meets with them to discuss how they are working. It was evident from discussion with the manager that he has kept up to date with training required and is dedicated to meet the needs of all people living at Mereside. Management system and practices in place are satisfactory and a competent and skilled management team manages the home. Quality assurance systems have been put in place. The methods used to evidence that people are satisfied with the quality of the service provided include satisfaction surveys, residents meetings and quality audits. Satisfaction surveys were seen for 2008. Positive outcomes were reported. Relatives have Care Homes for Adults (18-65 years) Page 37 of 42 Evidence: also been surveyed in July 2009 and their responses were kept in the compliments complaints register. All surveys seen record positive comments and outcomes. Some of the comments recorded on these surveys are as follows I have no comments or suggestions as Im so happy ... is so well looked after, its home from home I am more than pleased with the care my son .... gets when I go to Mereside its like calling at an ordinary household not a care home its great my thanks to tom and the staff. Residents and staff meetings are held on a regular basis. The minutes of the staff meeting held in June and April 09 were seen. Varied discussions were held regarding staffing, training, etc. Staff have the opportunity to air their views during staff meetings and any planned changes at the Home are discussed. The last quality assurance audit was undertaken in July 2009. Senior staff complete random checks of staff working practices and record their findings and details of any areas that may require further training. Records also demonstrate that medication audits are also undertaken. A selection of records were reviewed to evidence whether the health and safety of staff and the people that live at the Home is maintained. Records show that fire safety systems are checked on a regular basis. The deputy undertook a fire marshall course and is therefore qualified to train staff regarding fire safety. Records demonstrated that a fire evacuation took place in July 2009 and everyone in the Home responded appropriately. People at the Home were aware of fire procedures and said I know where the fire exit is. If a fire exit is blocked we use another one, We go outside when the fire alarm goes off, I know what to do if the fire bell goes. This demonstrates that fire safety is discussed with staff and those that live at Mereside. Care Homes for Adults (18-65 years) Page 38 of 42 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 39 of 42 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 Out of date information should be removed from care files and stored separately. Large amounts of out of date information make the files confusing and difficult to find current information. Information recorded in care files should contain a date of implementation and should be signed by the person recording the information. Care plans should be kept reviewed and amended to record the current health care needs of people. Plans must be written for as required medication and specify under what circumstances it is to be given, how long between doses and what is the maximum dose in 24 hours. Netting should be put in place on the corner of the upper level of the fire escape to prevent the risk of falls. 2 6 3 4 6 20 5 24 Care Homes for Adults (18-65 years) Page 40 of 42 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 24 A risk assessment should be undertaken to identify the risk of accident due to the location of the television in the bedroom identified during the inspection. Staff training records should quickly and clearly demonstrate staff training undertaken. It could not be demonstrated from reords seen tat staff have attended up to date mandatory training. 7 35 Care Homes for Adults (18-65 years) Page 41 of 42 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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