Inspection on 20/07/09 for Melbourne House

This inspection was carried out on 20th July 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.

Other inspections for this house

Melbourne House 17/05/10

Melbourne House 06/08/07

Melbourne House 31/08/06

Melbourne House 09/05/06

Melbourne House 10/10/05

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 16/02/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Melbourne House Chapel Road Foxhole St Austell Cornwall PL26 7UG     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: Michael Dennis     Date: 2 0 0 7 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 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 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 Adults (18-65 years) 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Melbourne House Chapel Road Foxhole St Austell Cornwall PL26 7UG 01726823853 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Janet Rosemary Brewer care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Service users to include up to 12 adults with a learning disability (LD) Total number of service users not to exceed a maximum of 12 Date of last inspection Brief description of the care home Melbourne House is a detached property currently registered to provide care and accommodation for up to 12 people with a learning disability. There are currently nine residents in the home, most of whom have lived there for many years. Three residents have moved to the home within the past two years. 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, , a greenhouse and at the Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 12 Brief description of the care home top of the garden a long building. In the past this has been used as a workshop where people went during the day. It is not currently fit for use. 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. Care Homes for Adults (18-65 years) 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection which took place on the 20th.July 2009 over a 5 hour period. Records were inspected, the premises toured and residents and staff spoken with. The registered person called into the home during the inspection and stayed to answer queries and discuss the home with us. During the course of the day we observed the residents being attended to by staff in a courteous and professional manner. Residents were seen to be fully occupied in various interests and activities. Various records, policies and procedures were inspected and found to be satisfactory. We visited all parts of the building and noted a satisfactory standard of hygiene. Residents expressed satisfaction with all aspects of the home. They were keen to explain the activities and outings they had completed over the weekend. They also explained their lifestyles in some depth, explaining what they did at voluntary work placements, day centres etc. From observation and discussion it was Care Homes for Adults (18-65 years) Page 6 of 28 apparent that service users lead a varied lifestyle Staff in the home currently undertake the domestic tasks as well as caring ones. The fees Charged to the residents vary according to the assessed needs of each individual. What the care home does well: What has improved since the last inspection? What they could do better: 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 8 of 28 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 9 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, 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. Prospective users of the service are given the information they need in order to make an informed choice about living in the home. Evidence: The Statement of Purpose and Service User Guide is comprehensive and informative. The care needs and wishes of residents are assessed prior to admission to the home. There is evidence of comprehensive social services assessments, health and specialist assessments with the care home undertaking their own assessment. The initial care plan is based upon the care needs assessment and written in concordance with the resident with a signature obtained, where possible, from the resident to demonstrate this. From observations and talking with residents it was evident that they are settled in the home, and that in the main they get on well with each other and with the staff. Residents have signed a contract of care. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: Residents are able to visit the home prior to moving in and can also stay for trial periods. Care Homes for Adults (18-65 years) Page 11 of 28 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. Comprehensive care plans exist, are reviewed regularly and contain personal goals and assessed needs incorporating a risk management framework. Evidence: From discussion with residents, staff and inspection of documentation it was evident that individual care needs are identified appropriately. From inspection of residents files, and in discussions it is evident that Melbourne House encourages residents and their representatives to express their views in the formation of their care plans. The care plan specifies what actions staff should take to ensure that the care need is approached in a consistent manner. The care plans are reviewed monthly and include appropriate risk assessments Staff facilitate regular one to one opportunities for service users to express their opinions via a Key Worker system. The care plans include information on health care, personal care, social interests, daily living skills, behaviour patterns and likes and dislikes. Service users care plans consider their abilities to make choices for themselves. Their daily care records demonstrate the choices they have made, for example between different activities offered to them. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: Residents have clear, written risk assessments, which are shared with their representatives. These address specific activities, in such a way as to enable service users to take risks to enhance their skills, abilities and the quality of their lives. Any restrictions necessary to protect residents and/ or others are clearly documented and shared with their representatives. To obtain this evidence we case tracked five care plan files to include those of the more recent admissions. It was noted that all residents have had assessments under the Mental Capacity Act. In some cases restrictions have been agreed via the Deprivation of Liberty Safeguards. Care Homes for Adults (18-65 years) Page 13 of 28 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. Residents are experiencing an improving lifestyle both within the home and outside in the wider community according to their abilities and wishes. Support systems are in place to allow appropriate leisure activities and relationships. Residents rights are respected and appropriate relationships sustained. A healthy diet is provided. Evidence: Each resident has a daily plan for activities. These activities include visits to local colleges, Link to Learning, pottery, gardening and arts and crafts. Residents also attend day centres, a local mental health group, age concern friendship group, and a drop in club. Various other activities, mostly in house, include bingo, quizzes, colouring cards and singing. Residents told us that they enjoy going for walks and to dancing. The home Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: has its own mini bus to facilitate transport. Several residents also participate in household chores to include keeping their rooms tidy, washing up, preparing vegetables etc. In discussion with residents, several informed us that they had been on the Dunmere Motor Cycle Trail Ride over the weekend. They were proud to show us the certificates obtained. Others presented themselves as being talkative and keen to introduce themselves. Staff were observed treating residents with due deference, respecting privacy and dignity. Food is prepared by the general staff on duty, (all have basic food hygiene certificates) with the occasional help from residents. The main meal is served in the evening. The menus are agreed with the residents input and choices are available. Records are kept of the food provided. Care Homes for Adults (18-65 years) Page 15 of 28 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. The physical care needs of residents are noted and addressed by supportive medical staff and carers. Medication is undertaken carefully with training for staff organised. Evidence: The physical health of the residents is monitored by the local health centre, who, the staff report was supportive and helpful. Reference is made to professionals depending on need. Records showed that residents use the local surgery for health appointments. Medication reviews have occurred and the dietician and psychiatrist are consulted as required. The importance of referring to both the minimum standards for adults with a learning disability and minimum standards for older persons is again reinforced. Medication is undertaken on behalf of all residents via a monitored dose system. This was seen to be kept securely with the medication administration record sheets being completed. Care staff are enrolled on a safe handling of medicines course. The member of staff on duty demonstrated the methods that she had been taught when administering medication. It was satisfactory. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: You are advised to replace your current medication storage facilities with the required metal cupboard. The Medicines Act and guidelines issued by the Royal Pharmaceutical Society apply. Care Homes for Adults (18-65 years) Page 17 of 28 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. Residents are listened to and the home is pro-active in obtaining their views. Any form of abuse is not tolerated. Evidence: Residents have and are encouraged to voice their opinions at all times to include areas of dissatisfaction. Complaint procedures are available and residents are aware of their rights and the process to follow, as confirmed to us by the residents. A record of any complaints will be kept. Policies and procedures concerning Abuse are in place and the Registered Provider and staff are aware of actions required and what constituted the various forms of abuse. The residents require support with the organisation, storage and decision making of their personal finances and valuables. All residents are financed by a local authority. A schedule of the financial arrangements detailing the local authority and service user contribution towards fees was seen on individual files. The registered person is an appointee for some residents and a detailed record is maintained of these contributions, personal allowances and Disability Living Allowance. The DLA (Mobility Allowance) is used to finance the homes minibus and provide for the transport needs of residents. The homes policy and service user guide provides details of this agreement. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: The personal allowance records were inspected and three separate entries of residents spending was seen to cross reference with the records of activities and outings. These records also record details of residents spending on personal items. An individual account, held on behalf of a resident, was checked and found to be accurately maintained. The registered person stated that the savings held by these processes would fund a holiday for residents. Care Homes for Adults (18-65 years) Page 19 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, 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. The residents rooms meet their requirements. Other parts of the home are in need of attention but are not being used until renovation has been completed. Communal areas are satisfactory. The kitchen and utility areas have been refitted and present no problems. Evidence: Melbourne House has been home to the majority of residents for on average 20 years. Residents rooms were clean and contain personal affects to include items of interest that people have collected. Beds were properly made and rooms left tidy. The furnishing and decor is deemed adequate. Residents told us that they were satisfied with the accommodation provided for them although their expectations are not thought to be high. The kitchen has been renewed. This and the back lobby & laundry area were clean and tidy. The rear portion of the house has been improved. Two bedrooms have been renovated and a new bathroom installed. Further renovation work continues but does not appear to interfere in the daily lives of residents. Externally the garden was tidy and there were tables & chairs provided where people Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: had been able to sit outside in the fine weather. The site of the home means that there are steps at both the rear & front of the property and to the first floor internally. It would not be suitable for anyone with mobility difficulties. The temperature of the hot water from domestic outlets was tested and found to be within the recommended limits. Care Homes for Adults (18-65 years) Page 21 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, 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service benefit from a staff team who have been properly recruited and receive training and supervision to enhance their skills. Evidence: We met with the Registered provider and the two support workers on duty and had conversations with all. A discussion occurred with a relatively new support worker regarding the induction process, routines and procedures at the home. Support workers are also responsible for cooking and cleaning duties at the home. There is a minimum of two carers on duty by day and a waking night carer is supported by an on call system. The registered provider is on the staff rota from 5pm and provides evening support at the home and the on call support at night should staff and residents require assistance. Records were provided regarding staff recruitment, induction and training. There was evidence that induction training is undertaken in line with skills for care. Individual staff profiles were inspected and appropriate training opportunities have been completed in NVQ level 2 and above, first aid, protection of vulnerable adults procedures and food hygiene. Support workers have completed a six month distance learning course regarding the management of and safe handling of medication. The Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: recruitment records inspected showed that support workers complete an application form. PoVA First check and appropriate references were received. Written evidence was produced to indicate that staff are receiving supervision at regular intervals. This was confirmed by the staff spoken to. There are 15 support workers employed at this time. A total of 13 have achieved an NVQ at level 2 or above. Care Homes for Adults (18-65 years) Page 23 of 28 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. Service user views are sought in the promotion and development of this home. Policies and procedures are reviewed as necessary and appropriate records are kept. The health, safety and welfare of the service user is promoted. Evidence: We were informed by residents that their views and opinions are sought and where appropriate transferred to the running of the home. This was also evidenced by way of a recent quality audit surveys. The methods used for such consultation are one to one discussions, group meetings, paper surveys etc. The information gathered provides the home with its quality assurance data. The registered provider returned the Commissions Annual Quality Assurance Assessment when we asked for it. The information contained in this document helped us to make some judgements about the home. The home ensures that the health, safety and welfare of service users and staff is promoted and protected as far as is practicable. Training and maintenance records were available for inspection. Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: The management of employment practices and financial practices are dealt with in respect of the two homes owned and managed by the registered provider. We looked at evidence of employment practices to include the take up of CRB and POVA checks. General financial management was discussed and evidenced as was the handling of residents money. All was found to be satisfactory. Various records as required by legislation were inspected and found satisfactory. A number of policies and procedures have recently been reviewed, added to and updated. You are advised to ensure that all personal and confidential records are securely locked away when not in use. Care Homes for Adults (18-65 years) Page 25 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 Adults (18-65 years) Page 26 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 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 20 You are advised to replace your current medication storage facilities with the required metal cupboard. The Medicines Act and guidelines issued by the Royal Pharmaceutical Society apply. You are advised to ensure that all personal and confidential records are securely locked away when not in use. 2 41 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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). 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. 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