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Inspection on 05/01/09 for Melbourne Home

Also see our care home review for Melbourne Home for more information

This inspection was carried out on 5th January 2009.

CSCI 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

We saw all staff at Melbourne being helpful and friendly to people who live there and largely treated them with respect. `You could not have a better home`, one resident said. People are supported to maintain relationships with family and friends. A resident said, `Family can come at any time and they are welcomed by staff`. Visitors confirmed that they are always welcomed by staff. The menu is varied, and the food is well presented. People living at Melbourne have a good choice of food for each meal time. The home is clean and tidy, and good standards of hygiene are maintained with no odours present. `The domestic people are really good at their jobs. The home is always clean and fresh`, one resident said. Members of staff have received training in many different areas of care practice to help them improve their skills. Management are very supportive of staff so that they can produce a high standard of care to residents.

What has improved since the last inspection?

Care planning has been agreed with residents or their representatives so that the care given is right for that person. Corridor areas and bathrooms have been redecorated. There is a detailed Quality Assurance system in place to check that services to residents are of a high standard. Residents are frequently reminded of the complaints procedure so they can get issues resolved if they need to.

What the care home could do better:

Staff need to follow best moving and handling practice to fully protect residents health and safety and to refer to medical services for any potentially serious injuries to residents. Medication must always be administered safely. We found some gaps in the recording of medication, and the storage of controlled and in fridge medication needs to be improved. Residents should not be denied choice, even though it may be in their best interests. Staff can only encourage residents to follow their best health interests. There must be a clearer understanding of how to `safeguard` people who live at Melbourne so all staff are fully aware of outside Agencies if they needed to `whistleblow` on the home if the in house arrangement fails - this will further protect people at the home from abuse. The service would benefit from having the environment audited by a dementia specialist to help improve the quality of life of people living at with dementia. Care staffing levels need to be reviewed to ensure that all residents needs are always met.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Melbourne Home 263 London Road Leicester LE2 3BE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Keith Charlton     Date: 0 5 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. that people have said are important to them: They reflect the things 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. Copies of the National Minimum Standards – Care Homes for Older People 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Melbourne Home 263 London Road Leicester LE2 3BE 01162706771 01162700682 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Melbourne Hall Home Trust Name of registered manager (if applicable) Deborah Edwards Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: No additional conditions of service. Date of last inspection Brief description of the care home The date of the last key inspection was the 1st February 2007. The fees for 2009 are from #380 to #448 A copy of the most recent inspection report can be found in the entrance hall. Melbourne Home is a large three storey Victorian building situated on the corner of London and Springfield Road. The home is set in pleasant well kept grounds which are easily accessible to service users. The home is close to a range of facilities and services. The home can accommodate up to seventeen older people in very spacious, well-equipped single rooms. Rooms are available on all three floors. All floors are accessible by lift. The communal areas of the home are comfortable and homely. There is a large lounge and additional sun lounge and dining room, together with a veranda on the first floor. The Home is owned by a charitable trust and describes itself as a Christian residential care home. The Home organises in house Care Homes for Older People Page 4 of 28 care home 17 Over 65 17 0 Brief description of the care home religious services every week, which are generally appreciated by the people who live there. Care Homes for Older People Page 5 of 28 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included a visit to the service. We (the CSCI) visited Melbourne on the 5th January 2009. The Registered Manager and staff in the home helped us during the visit. The main method of inspection we used was case tracking. This means looking at the care given to people in different ways. We did this by, - talking to the people who live in the home, - talking to staff and management, Care Homes for Older People Page 6 of 28 - watching how people are given support, - looking at records. We also looked at the Annual Quality Assurance Assessment (AQAA). This is a document the provider (the person who is legally responsible for the service) sends to us at the CSCI, and it tells us what the provider thinks about the service they deliver to people who live at Melbourne. As well as this, we looked at information that had come to our attention since the last key inspection in February 2007. We spoke with nine people who live at Melbourne during our visit. People told us that staff were always friendly and caring. One person said staff are the best here. None of the people spoken with had any complaints about attitude of staff, however two commented on the lack of availability of staff. One person said people are getting more disabled so staff have more to do and we have to wait more than we did. We spoke with four members of staff during our visit to the home who told us about working in the home and gave us their views. They all were very positive about working at Melbourne and wanted to provide excellent care to people living there. One staff member said:Management are really supportive here which helps us to give good care to residents. We checked all the standards that the Commission for Social Care Inspection has decided are key standards during this inspection. The information below is based only on what we checked in this inspection. We have kept details about individual people out of the report to make sure we respected their confidences. What the care home does well: What has improved since the last inspection? What they could do better: Staff need to follow best moving and handling practice to fully protect residents health and safety and to refer to medical services for any potentially serious injuries to residents. Medication must always be administered safely. We found some gaps in the recording of medication, and the storage of controlled and in fridge medication needs to be improved. Residents should not be denied choice, even though it may be in their best interests. Staff can only encourage residents to follow their best health interests. There must be a clearer understanding of how to safeguard people who live at Melbourne so all staff are fully aware of outside Agencies if they needed to whistle Care Homes for Older People Page 8 of 28 blow on the home if the in house arrangement fails - this will further protect people at the home from abuse. The service would benefit from having the environment audited by a dementia specialist to help improve the quality of life of people living at with dementia. Care staffing levels need to be reviewed to ensure that all residents needs are always met. 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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. People living at Melbourne have had their needs properly assessed before moving into the home. Evidence: Residents spoken to said they had enough information at the time of their admission to make up their minds about the home. Yes, I was given something which told me about the home, one resident said. We case tracked a person living in the home who had moved in to Melbourne. We checked that she had received information to help with the choice of home, and she said she had received enough information. We also checked that this person had her needs properly assessed prior to moving in, to ensure that the staff at the home could meet the needs identified. Care Homes for Older People Page 11 of 28 Evidence: The AQAA stated that prospective residents are invited to the home and can stay for the day and have lunch, relevant information is provided to them and assessments are carried out by the management at home/hospital etc. Care Homes for Older People Page 12 of 28 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. People at Melbourne receive good health and social care practice though some areas need improvement to ensure residents health is fully protected. Evidence: Residents said that staff were excellent in providing personal care to them: staff could not be kinder to me and you cannot have friendlier, more helpful staff than the staff we have here, were some of the many very positive comments that residents made. Residents spoken to could not recall having a care plan though the plans we saw were signed by residents to indicate they agreed with the content of them. We checked the care plans of three people living at the home who were case tracked and had care plans to support their care. Plans showed good detail regarding the support required by staff to ensure the physical health of people living at the home, and there was information to inform staff of the preferred daily living routines of residents to ensure their social and emotional well-being is supported. However there Care Homes for Older People Page 13 of 28 Evidence: were gaps on nutritional assessments insofar as the weight loss of some residents was not explained with an action plan to improve this if necessary. There was also only minimal information regarding peoples past history to properly inform staff as the individuality of residents. The AQAA stated that care plans are to be improved. The Deputy Manager confirmed this was the case. Accident records were also checked and whilst practice was generally good there were occasions when medical services were not contacted when a resident had a bump to their head following a fall. We checked the medication records, and found that mostly there was accurate recording of the administration of the medicines in the home except where there were a small number of gaps where staff had not signed that medication had been issued to residents, therefore potentially compromising their health if medication had not been supplied. It was also found that staff issuing the medication signed the record before issuing it to a resident though then realised the mistake and said it was not normal practice. Controlled medicines were stored in a separate wooden cabinet in the office, which did not conform to current regulations. The controlled drugs were checked against the register were found to be accurately recorded. The fridge where medications are stored was not fully secure with the locking mechanism on the office door. We spent time watching staff interaction with people living at Melbourne. We saw staff being gentle and caring to people as they got up and were assisted to and from the lounge, and throughout the day we observed the staff at Melbourne as doing their best to meet the needs of people living at the home. The only issue of concern were where a resident was helped on to a frame by staff using an underarm lifting technique, which is a potential health and safety risk for the resident and the staff. Care Homes for Older People Page 14 of 28 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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 opportunities for people to take part in activities and have a relaxed lifestyle. Evidence: Residents said that they were satisfied with the current activities. One resident said There are enough activities and we have lots of trips. The AQAA stated that there are regular outings, that the cook had had dietetic training, that there is referral to the GP if residents have poor appetite and the Environment Health Department has given an award to the home for kitchen hygiene (we saw this displayed in the hallway). There are one-to-one activities such as walking around the garden, taking residents to the shops if they want to go, reminiscing with people, communal activities such as crafts (making easter bonnets, creating a picture of the home etc) chair exercises and games. Residents said they enjoyed all activities especially the craft activity. Visitors are welcomed at Melbourne and we were informed by residents that they could come at any time. The visitors spoken with also confirmed this and said they had never had Care Homes for Older People Page 15 of 28 Evidence: any concerns about the care that staff supplied to residents. Some people living at the home have some form of dementia, and we found out that staff have attended a course to help them understand more fully how to care for people with dementia. The only issue of concern was where a resident was told by staff that he could not go to his room until he had drank more water to help with his medical condition, which denied his choice and dignity. We observed lunch being served. There was a choice of two hot dinners. Food was well presented and looked appetising, with good portions being served to each person. One resident was helped to eat in a helpful manner by staff. There was a displayed menu to provide information to residents. All residents spoken to said the food was always very good. We spoke to the cook, who was very enthusiastic about providing a good service to residents. She said that she had the right equipment to carry out her tasks and maintenance was swift if this was needed. Food temperature charts were available to prove that residents are protected from food poisoning. Care Homes for Older People Page 16 of 28 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Residents are listened to and protected from abuse. Evidence: Residents said that they had no complaints but if they ever did raise anything in the future they thought the staff or management would quickly get it sorted out. A resident said, We have nothing to complain about. Its a lovely home. The AQAA stated that there is a displayed complaints procedure and residents are reminded at residents meetings as to how they can complain if they need to - we found evidence of this statement as the procedure was displayed in the hallway and residents are reminded of the procedure in the minutes of meetings. We saw the complaints record and there were no complaints for the past year. We talked to staff to find out how much they knew about protecting people in the home from abuse. Records showed they had received training about safeguarding adults from abuse, and they knew the in house procedure but struggled on the Agencies to whistle blow to if the in house procedure failed, though there was a procedure available on the staff noticeboard for staff to refer to. We looked at the staff recruitment records to see whether all the proper checks had Care Homes for Older People Page 17 of 28 Evidence: been made on staff before they started employment at Melbourne. We found records which showed staff had started work with written references and legal checks in place to help reach the judgement that people were safe to start employment. Care Homes for Older People Page 18 of 28 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, 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. 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 living at Melbourne live in a safe and well maintained environment. Evidence: All residents spoken with said that they liked their bedrooms: My bedroom is large and I have a nice view out. I can please myself here, the home is kept really clean. There are never any smells, residents said. We saw people at Melbourne living in a clean and well maintained environment. The furnishings in the communal area are homely, and people are encouraged to bring their personal possessions into their bedrooms. The AQAA stated that there is an annual development plan to improve facilities, that three bathrooms have been refurbished in the past year, that some corridors have been repainted and that more will be done this year, and a platform lift is to be installed on a small staircase to aid residents. We saw the new decor of corridors and bathrooms, which looked attractive. Records show that the home is well maintained, and good measures are in place to control infection and keep the home hygienic. There are radiator covers and water valves to protect residents from burn risks. Care Homes for Older People Page 19 of 28 Evidence: There were items in the environment to support people with dementia, such as photographs in the entrance hall and notices on peoples bedroom doors. This could be extended to other things like tactile objects, pictorial signs to bathrooms and information boards showing date, weather, place, activities today etc. Care Homes for Older People Page 20 of 28 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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 many good training initiatives at Melbourne, though care staff input needs to be reviewed to ensure there is sufficient staff to cover all the care needs of residents. Evidence: Some residents said that with more people with high dependancy needs in the home that staff did not have enough time to spend with them and there was a lot more waiting for help with personal care. I know we cant expect things to be done straight away but there is a lot more waiting now, one resident said. There was also evidence from some information in the homes Quality Assurance questionaires that this was the case though a number of residents and staff we spoke to thought staffing levels were good and met residents needs. The AQAA states that there were four residents that needed assistance with personal care from two care staff, which will obviously use a lot of staff time. We spoke with the Deputy Manager about the staffing - excluding the Manager there are four to five care staff on duty from early morning until 3.00pm, and then three staff on duty to 9.00pm with a waking staff and a sleeping in staff at night. This is in addition to kitchen and domestic time each week shown in the staff rota. The AQAA stated that staff had training on essential care practice (which we saw was Care Homes for Older People Page 21 of 28 Evidence: the case on staff records), and that further training was planned for a number of issues - first aid, food hygiene, palliative care, abuse and pressure sore prevention, and that over fifty oer cent of staff had attained at least NVQ 2. We found that staff have been on a number of training events to help update their practice on areas such as Moving and Handling, Fire Safety, Infection Control and Dementia, residents conditions such as Sight and Hearing Impairment, Stroke, Parkinsons etc. Staff said that they were encouraged by the Manager to attend training courses. Staff records showed that proper checks had been carried out to protect residents from unsuitable staff. Care Homes for Older People Page 22 of 28 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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. Management maintain a high quality of life for people at Melbourne. Evidence: Both staff and residents said that Debbie, the Manager was very friendly and approachable and efficient. One resident said, Mrs. Edwards is very efficient in a quiet but thoughtful and effective way. This positive view of the Manager was shared by staff who said that management were very supportive to staff and this created excellent staff morale. I love coming to work. Its just like a family here, one staff member said. The Registered Manager has the relevant qualifications to be in charge at Melbourne and is currently engaged on management training. She updates staff practice with ongoing training. The AQAA states that there are plans in place to do more staff supervisions. Currently this is carried out approximately twice a year according to staff we spoke with and there is also a yearly staff appraisal - the National Standard is six supervisions a year. Care Homes for Older People Page 23 of 28 Evidence: We saw evidence that management use different ways of finding out from people who live at the home and their relatives, what their views are about the care given at Melbourne and how they can improve. We saw safe working practices, and were informed by staff that they felt appropriately supervised to do their jobs. There are regular checks for fire safety and hot water temperatures are monitored to protect residents from scalding risks. We checked the hot water temperature from a bathroom and found it was within the safe standard and would not cause injury to a resident. We checked records of money transactions, and were satisfied that the service was properly managing the personal allowances of people living at the home. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Older People Page 25 of 28 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 Requirement 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 Requirement Timescale for action 1 9 A more robust CD cabinet in 07/04/2009 line with current legislation is needed and all medication needs to be kept securely. To ensure that medication is secure and reduce the risk of theft. 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 7 Care plans need to contain more detail as to the action to take regarding weight loss, history of the person and dates of medical checks. Referral needs to be made to medical services if a resident has a potentially serious injury. Residents choice must always be respected. The Lead Agency in the Complaints Procedure should be altered as this has been changed to the Social Services Department. The Provider needs to ensure staff know all relevant Agencies to refer to if they suspect abuse has taken place. 2 8 3 4 14 16 5 18 Care Homes for Older People Page 26 of 28 6 27 The Provider needs to review that there are sufficient care staff on duty throughout the day and night to meet the needs of people living at Melbourne. It is recommended that the frequency of one to one supervision is increased to check that staff are working to all the care policies of the home, discuss any concerns, identify training needs etc. 7 36 Care Homes for Older People Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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