Inspection on 10/10/05 for Melbourne House

This inspection was carried out on 10th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Melbourne House 17/05/10

Melbourne House 20/07/09

Melbourne House 06/08/07

Melbourne House 31/08/06

Melbourne House 09/05/06

Melbourne House 22/04/05

Melbourne House 24/01/05

Melbourne House 03/08/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Melbourne House Chapel Road Foxhole St Austell Cornwall PL26 7UG Lead Inspector Philippa Cutting Unannounced Inspection 10th October 2005 09:30 Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 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 Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Melbourne House Address Chapel Road Foxhole St Austell Cornwall PL26 7UG 01726 823853 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) Mrs Janet Rosemary Brewer Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users to include up to 13 adults with a learning disability (LD) Total number of service users not to exceed a maximum of 13 Date of last inspection 22nd April 2005 Brief Description of the Service: Melbourne House is a detached property providing care and accommodation for up to 13 people with a learning disability. There are currently eight service users in home, all of whom have lived there for an average of 20 years (although not with the same ownership during that time). Accommodation is provided on the ground and first floor which are linked by a staircase. There are communal areas on the ground floor - a sitting room, dining room and small sun lounge. Externally there are two small patios, 18’ x 12’ and 15’ x 9’, a greenhouse and at the top of the garden a long building. Until recently this has been used as a workshop where people could go during the day to pursue any hobbies or interests. The premises are not suitable for any one with mobility problems as there are steps throughout, both inside and out. The external access would be very difficult to ramp with the correct gradient. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 9.30am and 3.45p.m. The manager (who is not a registered manager as the registered provider retains this role) is in charge of the day to day running at present as the registered provider is away due to personal reasons. The majority of service users were at home in the morning so, although one was attending an out patient appointment and one was at a Day Centre, the inspector had time to talk with and observe the service users. At the last inspection they went out to their various planned activities for a large part of the visit. After lunch people went into St Austell where they have join in a further education programme. The ones who did not attend this class were offered the opportunity to have a ride in the home’s mini bus when it took and collected the other service users. The inspector talked with the service users, manager and staff and inspected records relating to service users and staff and other statutory information. The premises were inspected. What the service does well: What has improved since the last inspection? What they could do better: Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 6 There are vacancies in the home but the registered provider needs to decide how she views the home’s future with regard to the level of need that can be supported. Accommodation , therefore to this end the statement of purpose will need to be reviewed. There was no evidence of training for the staff that related specifically to learning disabilities. As this is the home’s focus, it would seem to be essential that this is provided. More understanding of how staff should respond consistently to challenging behaviour is needed. A complaint made by a service user highlighted this. The premises are in need of a continuing overhaul although rewiring and replumbing has been undertaken. The shed/workshop at the rear of the premises is, in the inspector’s opinion, currently unusable and will remain so until it has been completely renovated and the toilet facilities upgraded. 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. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 Documentation needs to be reviewed. In view of the changes in the needs of people now seeking/needing accommodation, the home needs to consider carefully the level of care and support it can provide. EVIDENCE: The statement of purpose has not been revised. It does not explain sufficiently the limitations within the home due the odd steps and poor access, especially on the ground floor and externally. There have been no new service users for a considerable length of time in the home. Therefore the home’s/admission procedures have not been tested for their adequacy. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Service users are afforded opportunities to exercise choice but this is an area where they still help and encouragement. More detailed risk assessments are indicated. EVIDENCE: The service users who live at Melbourne House have been there for more than 20 years for the most part. Many moved there following the break up of big institutions where they had been for many years. Consequently the concept of decision making and exercising choice are skills that they have had to learn. A number still accept what they are told to do with very little questioning. Service user plans include more opportunities for them than they have experienced previously. However many have a poor concept of budgeting and finance so the home allocates people’s personal allowances on a daily basics to try and ensure that it lasts the week and put some into savings accounts so that service users can have holidays etc. Whilst this is obviously prudent, the current allocation of £8.00 per week seems tight when the service users have to pay for items at college. Little is left for personal ‘treats’ and essentials. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 10 Risk assessments are in place for various activities, particularly those involving road sense or travel etc. These need to be expanded to address problems that – depending on how they are handled – can result in challenging behaviour. Confidentiality is stressed to staff - a comment was made about this to the inspector during the inspection. It is also difficult to know whether the service users really understand the importance for this. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15, Activities and opportunities are sought for service users to try and extend their experiences and skills. EVIDENCE: The activities at the further education classes provide opportunities for the service users to meet with their peers. They also join in various village events that are held on a regular basis so they have become members of the community. Contact with families is encouraged but is not successful in all cases. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 The service users receive healthcare appropriate to their needs. EVIDENCE: The service users are generally in good health and staff reported that they had good support from the local surgery and community nursing service if needed, with referrals onto specialists if this was indicated. As service users are becoming older, staff must be alert to any conditions that may become more prevalent with age. The home is not able to care for anyone who becomes immobile due to the environmental limitations. No one is responsible for administering their own medication. This was seen to be recorded carefully on medication administration record sheets, which were fully completed. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Skills to deal with potentially abusive situations are not adequately demonstrated by all staff. EVIDENCE: The inspector felt that staff would benefit from considerable input into managing service users who can behave in a challenging way. A more relaxed and calm approach would probably defuse or prevent events from escalating into situations that can become abusive. One service user currently chooses to isolate himself due to the behaviour of another person. This situation should have been addressed, with professional guidance if necessary and not allowed to develop. A complaint made by a service user has now come to a resolution and has resulted in the service user moving to new accommodation. Service users’ finances were not inspected, as the inspector was told that the manager did not have access to the service users’ monies in the registered provider’s absence. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28 Service users’ own rooms meet their needs but the communal areas in the house needs to be re-arranged to provide the service users with sufficient space in a more homely manner. EVIDENCE: As already stated the home has severe limitations for anyone who is not mobile. Service users rooms were decorated and furnished in acceptable styles. High level cleaning is much improved. The national minimum standards recommended that the continued use of double rooms should be phased out by April 2004, unless service users chose to continue to share. In the case of the service users at Melbourne House, such a choice would have to be carefully appraised. The ground floor communal rooms comprise a sitting room and adjacent dining room with a small sun lounge off this. The sitting room, which houses the television, tends to be dark as it is furnished with deep red sofas and apricot walls; the dining room doubles as the office. There is a desk & filing cabinets etc as well as tables and chairs. This means that if a confidential meeting or discussion is taking place in the dining room, service users are excluded from this area. Service users came and tapped on the door during the inspection, as they wanted to know what was happening. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 15 This needs to be rethought as service users need free access to the dining room space and the small sun lounge to ensure that there is sufficient spatial area for their needs and to meet national minimum standards. With the television being in the sitting room the service users do not have any other quiet free space (apart from their own rooms) where they can sit, play games or otherwise entertain themselves or any visitors. The continued use of the building, even if habitable, at the rear of the garden has to be questioned. It may make a useful extra space for some occasional activities but should no longer be relied on for regular daily use. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Staff are undertaking National Vocational Qualifications and have skills in care but they do not have sufficient specialist knowledge of learning disabilities and current practice relating to its management. EVIDENCE: Staff files are kept as individual records in which there was evidence of written references and statutory checks. Basic induction is carried out, some in house and some via external courses. The registered provider needs to be aware of the new induction standards that have been published. Information will be enclosed with this report. Staff were studying for National Vocational Qualifications but no one has enrolled for any LDAF courses – these are especially pertinent to learning disability. There was little or no evidence of staff having undertaken training that was specific to learning disabilities and allied syndromes. From the discussions that the inspector had it was apparent that different staff had different approaches to service users, particularly when a problem arose. This is unsatisfactory. Consistency is important not only to help service users understand how their actions can affect people but to help them learn better social skills. The staff Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 17 who acknowledged ‘good behaviour’ rather than reacting to ‘bad behaviour’ said that they felt service users responded well to this. The manager said that she had started supervision sessions with the staff individually. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,41 The registered provider needs to evaluate the services that are offered and the way in which problems are addressed in order to ensure that service users’ interests are safeguarded. EVIDENCE: In the registered provider’s absence the ‘manager’ is organising the home. The arrangements appeared to be satisfactory but she is limited in what she can do as she does not have free access to everything, e.g. service users’ finances. The manager comes from a background of care and has achieved her registered manager’s award. She has a sound knowledge of care principles and the inspector formed the view that the home would benefit from her input in a recognised position as registered manager. The lack of knowledge and training specific to learning disability is of considerable concern. This needs to be thought through very carefully so that the home can decide which client group it is best able to care for. Today people are presenting with significantly varied problems so the registered Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 19 provider needs to consider the mix of staff skills and service users’ need in order to identify and organise the training and facilities that the home will offer. Records required by statute were all seen to be in place. They had been thoroughly revised by the previous manager prior to the last inspection and this has been maintained satisfactorily, although the need for expansion in parts - (risk assessments) has been mentioned. Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 X 2 X 3 Standard No 22 23 Score 1 1 ENVIRONMENT INDIVIDUAL NEEDS3 AND CHOICES Standard No 6 7 8 9 10 Score 2 2 2 2 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 2 X X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score 2 2 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Melbourne House Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 1 X X 3 3 X DS0000009192.V251291.R01.S.doc Version 5.0 Page 21 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 YA1 Regulation 4 Requirement The registered provider must revise the statement of purpose to reflect both the environment and client group. The current risk assessments must be expanded as part of a service user‘s care plan. They should indicate any problems and how these should be addressed. Staff must listen to and act on the views and concerns of service users and others and encouraged discussion and action on issues raised by service users before they develop into problems and formal complaints All staff must receive training into PoVA and the avoidance of abuse The registered provider must ensure that the service users have enough communal room space available at all times within the main house and they should be encouraged to use it. A training programme that encompasses training specifically about learning disabilities must DS0000009192.V251291.R01.S.doc Timescale for action 31/03/06 2 YA9 13 (c) 31/03/06 3 YA22 12 (3)(1) Schedule 1 31/01/06 4 5 YA23 YA28 13(6) 23(2)(g) 31/03/06 31/03/06 6 YA35 19(5) 31/03/06 Melbourne House Version 5.0 Page 22 be drawn up and instigated. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA3 YA7 Good Practice Recommendations The registered provider should check the home’s assessment process for ascertaining a new service user’s needs for its adequacy and relevance. The level of spending money (as opposed to saved money) that service users are given each week should be reviewed. The process of how that sum was calculated should be documented. All staff should respond to service users in a consistent and agreed manner. A suitably qualified person should be appointed as the registered manager for the home with the registered provider retaining her role as responsible individual. 3 4 YA35 YA37 Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Melbourne House DS0000009192.V251291.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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