Inspection on 22/04/05 for Melbourne House

This inspection was carried out on 22nd April 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 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 20/07/09

Melbourne House 06/08/07

Melbourne House 31/08/06

Melbourne House 09/05/06

Melbourne House 10/10/05

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 Announced 22 April 2005 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 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 Stationary 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 Version 1.10 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 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 Rosemay Brewer Care Home 13 Category(ies) of Learning disability (13) registration, with number of places Melbourne House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 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 is a small patio area, a greenhouse that looked abandoned and at the top of garden a long shed which has been decorated in bright colours where people go during the day to pursue any hobbies or interests. There is scope in the workshop for group activities such as collage or craft work. 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 correct gradient. Melbourne House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first time this inspector had visited the home. Service users were in the home at the start of the inspection but the majority left after a brief chat with the inspector during which time they showed off their rooms. They were going to attend one of the various activities in which they are involved. Three remained in the home and spent their day in the home’s ‘workshop’. All returned towards the end of the inspection and spoke again with the inspector but most were getting ready to have a meal and then go out again. Records, the premises and two members of staff were seen, (the staff briefly), as well as the registered person. There was insufficient time on this occasion to spend long with the service users due the timing of the inspection and their programmes. Concerns arose following the inspection when a number of people approached the Commission for Social Care Inspection and made comments that were contrary to the information in the paper records and service users’ comments. These subsequent comments have been taken seriously and are being followed up. Consequently this has skewed some of the recording and various standards may have to be revisited. What the service does well: What has improved since the last inspection? What they could do better: A service user spoke to the inspector and said she got distressed at being called derogatory names. More respect for, and observation of, people’s rights and sensitivities is therefore indicated. If demeaning behaviours occur, they Melbourne House Version 1.10 Page 6 should be addressed immediately and the perpetrator cautioned as to his/her behaviour. The ground floor of the home needs considerable work to bring it up to a satisfactory standard. The premises used as a workshop are not commented on, on this occasion. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Melbourne House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Melbourne House Version 1.10 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 standard(s) 1,3,5 Documentation is available in the home but it was not clear whether all service users were able to access or understand it. The home should consider moving towards alternative ways of helping people understand their rights and responsibilities. EVIDENCE: Copies of the home’s statement of purpose, service users guide & complaints procedure were seen to be available in the dining room. The description of the environment does not indicate that the premises have steps, especially the front and back access. There is only a brief mention towards the end of the service users guide under philosophy, that the home cannot accommodate anyone who is not ambulant. The statement of purpose & service users guide should be amended to include a fuller description of the premises. It would be good practice to consider whether all the service users can understand these documents, especially the complaints procedure, or whether providing alternative formats could enhance this (i.e. pictures or symbols etc). Amongst the present service users, there have been no new admissions in recent years. Melbourne House Version 1.10 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 standard(s) 6,7,8,9, The records indicated that service users are involved in making choices and decisions based on risk assessment. If this level of service uses’ participation is maintained, service users will be encouraged to be more active and participative in decision making about their lives. EVIDENCE: Up to date care plans were in place for all residents. These outlined each person’s opportunities and work placements that have been arranged. Risk assessments were included in each person’s notes. The majority of service users moved to the home from a background of institutional care and many were denied the opportunities that people might expect today. Decision making, choice and involvement in the home etc are therefore areas that need to be encouraged with service users. Melbourne House Version 1.10 Page 10 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 standard(s) 12,14,5,16,17 Service users are encouraged to participate in activities that provide them with learning opportunities and situations where they can be part of the local community. Two comments were made that will be the focus of future inspections. EVIDENCE: All service users have a programme of activity that includes evening as well as day time activities. It was noted that these took into account the increasing age of people so that older service users had quiet periods included in their programme. This may become an increasing reality for other service users. The activities include college attendance, music & craft work, link into learning, horticultural work placements, Gateway and local Friendship clubs. These are all opportunities that service users said they enjoyed. The results of a group activity organised by a member of staff were displayed in the workshop. The activity had involved a number of different tasks to which everyone could contribute and had a theme that was explored in different ways. Melbourne House Version 1.10 Page 11 As most people are out by day a main meal is provided for all in the evening. Those in the house at lunchtime have a sandwich or ‘cuppa soup’. Service users will help prepare the vegetables for the meals. Diet appeared to be part of the derogatory remarks that a service user referred to. A record of personal finance and the savings held for service users tallied with the monies in each person’s wallet. Further inspection of finance was not undertaken at this time although one person indicated that he received £6.00 per week and did not think enough for his needs. He left at that point so this could not be pursued at that time. Melbourne House Version 1.10 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 standard(s) 18,19,20,21 Service users said they were content but concerns have been raised by former members of staff regarding some aspects of certain service uses’ care. EVIDENCE: The health of the service users is generally good. They utilise medical services as required but the need to refer anyone to any specialist learning disability services in recent times appears not to have arisen. None of the service users are self-medicating. Medication is supplied via a monitored dose system, which the deputy manager oversees. The registered person said that all staff have done a course in the safe handling of medication. Written policies and procedures are available with the action to be taken in the event of an error prominently displayed with the medication. A terminal illness could present a problem for staff if a service users became immobile. Melbourne House Version 1.10 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 standard(s) 22,23 The Commission for Social Care Inspection has concerns about incidents that may have involved verbal abuse. EVIDENCE: The home’s policy and complaints procedure is displayed in the home. Comments have already been made regarding service users’ ability to initiate it. One person has indicated to her social worker that there are aspects of her care with which she not happy. Senior staff have recently attended a seminar on ‘No Secrets’ & whistle blowing. The comments made to the Commission for Social Care Inspection following the inspection have to influence the assessment of these standards. Melbourne House Version 1.10 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 standard(s) 24,225,26,27,28,29,30 Whilst service users’ rooms in use appeared to be furnished appropriately, the home needs some major work to ensure that remainder of the property, including the bathing and toilet facilities are brought up to a satisfactory standard. EVIDENCE: The home was toured. Service users’ rooms in use, appeared to be tidy and included peoples’ own possessions and personal items. Attention was needed to high level cleaning on the tops of wardrobes and light shades. There were rooms on the ground floor that are currently not in use for various reasons. They are in need of refurbishment. It was noted that there are several small ledges at doorways on the ground floor. These seem increasingly likely to present a trip hazard for ageing or less mobile service users who are the most likely people to have ground floor rooms. The registered person said that they were formed by covering pipework and she anticipated that some planned refurbishment could lower/remove the pipes. The ground floor bathroom has a hoist, the seat of which is heavily stained from the unguents that one service user has to use. There were holes in the Melbourne House Version 1.10 Page 15 wall where pipes had once been. The inspector was unable to make the wall heater work and the plug for the wash hand basin appeared to be missing. It was noted that there were two razors in the bathroom and a couple of hairbrushes, only one of which was named. It would be better to either ensure that all personal items are named or – preferably –returned to the service user‘s room each time to prevent the temptation for communal use. The floor covering in the bathroom was not a non-slip surface; a risk assessment is needed regarding this. The inspector was told that a new bath/shower room is planned but this will be in an internal room. Care will need to be taken to ensure that there is adequate ventilation & heating. Shower rooms can generate more water vapour/steam than a bathroom which could thereby create dampness in the home. A ground floor WC had mould around the window, which was stuck up with paint so that it could not be opened. It had no light shade. A freezer with a rusting top was noted in the pantry, which also had a dirty window. Rooms 3 & 4 are accessed via the kitchen rather than a passage. Room 4 an inner room - contained various items that were being stored. They included a stained mattress that needed to be disposed of rather than stored. The kitchen is currently undergoing the renewal of units and equipment. The communal space consists of a sitting room, dining room where service users can eat at small tables for groups of four or so and a small sun lounge. These rooms appeared to be satisfactory in their décor. Melbourne House Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 Staffing appears to be a contentious issue . Staff comments made following the inspection did not bear out the evidence presented at the inspection. EVIDENCE: There was little opportunity to speak to staff on this occasion. The inspector was concerned to be told that the manager was sick when he had in fact resigned the previous day. The registered person said that all staff were given job descriptions and that a thorough recruitment process was followed. A number of staff approached the inspector after the inspection and their comments did not bear out all these claims. There was some documentation relating to supervision but a concern was that work contracts did not specify the number of hours for which a person was being employed. Following the inspection, it came to the inspector’s attention that a number of staff left in the following weeks. Melbourne House Version 1.10 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,40,41,43 The limited experience of the service users means that they need a lot of help to make judgements and decisions about their lives. EVIDENCE: The service users have lived at Melbourne House on average for 20 years. Some of them have little experience of other life styles and most said they were content. It was not possible to identify in the brief contact with them what other aspirations they might have. Again comments made to the inspector subsequent to the inspection has caused concern. Melbourne House Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Score 1 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 3 x 2 Standard No 11 12 13 14 15 Melbourne House x 3 x 3 3 Standard No 31 32 33 34 35 36 Score 2 2 2 2 2 2 Version 1.10 Page 19 16 17 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 3 x 2 Melbourne House Version 1.10 Page 20 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 Regulation Requirement Due to the investiagtion that is going on into the comments made following this inspection, no statutory requirements are being made at this point but these may be made once investagtion is complete. Timescale for action 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. Refer to Standard 1 Good Practice Recommendations The stateent of purpose and service users guide needs to be expanded to describe more fully the facilites and access. Melbourne House Version 1.10 Page 21 Commission for Social Care Inspection 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 Version 1.10 Page 22 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!