Inspection on 06/08/07 for Melbourne House

This inspection was carried out on 6th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 2 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 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 09/07/2008.

CARE HOME ADULTS 18-65 Melbourne House Chapel Road Foxhole St Austell Cornwall PL26 7UG Lead Inspector Michael Dennis Key Unannounced Inspection 6th August 2007 10:00 Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 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.V340653.R01.S.doc Version 5.2 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.V340653.R01.S.doc Version 5.2 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 Mrs Janet Rosemary Brewer Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 31st August 2006 Brief Description of the Service: 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 seven residents in the 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. 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. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection which took place on the 6th. August 2007 over a 7 hour period. Records were inspected, the premises toured and residents and staff interviewed. 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 show off their bedrooms and talked about the contents ranging from photographs, pictures, ornaments, toys etc. 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 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 who were case tracked ranged from £331.83 to £369.83 per week. What the service does well: Care plans have been maintained and improved. Overall the recording practices at the home are positive. Good audit trails are in place regarding residents expenditure of personal finances. Effort is made to integrate residents into the community via work/college placements and other recreational pursuits. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The improvements made should be consolidated and management must strive to provide the best possible care for all residents. It is particularly important to realise the changing needs of the ever increasing age of the residents accommodated. Health checks, mobility needs, dietary requirements etc. should be kept under constant review. Additional equipment, such as hoists maybe required in the future. The building/renovation work is underway and this should be completed with all expedience to minimise disruption. On completion it is expected that facilities will have improved. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 8 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.V340653.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 5, People who use the 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 would be given the information they would need in order to make an informed choice about living in the home. EVIDENCE: No new residents have been admitted to Melbourne House since the current provider took over. The Statement of Purpose and Service User Guide was inspected and found to be satisfactory and up to date. Evidence of original care assessments was presented and in discussion with the Registered Provider it was evident that she is aware of the process to follow when new people are referred. All seven of the existing residents had signed copies of contracts with the home. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9. People who use the 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. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 11 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. 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. Improvement is noted in this outcome group. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12,13, 14, 15, 16, 17. People who use the 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. Resident’s 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. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 13 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 has it’s 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, one informed us that she had been shopping over the weekend and had also been to the beach. 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. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. People who use the 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. More input from the services that deal with learning difficulties could be broached. 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. There does not appear to be much contact with the adult service for learning disability. As the age profile of residents is increasing this might be a good Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 15 avenue to pursue to ensure that the residents receive all the help available. 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. When hand written entries are made on the Medicine Administration Records (MAR), these should be accompanied by the signature of the author and that of a witness. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. People who use the 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 the inspector. 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 Cornwall Social Services. 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 all 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 home’s Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 17 minibus and provide for the transport needs of residents. The home’s policy and service user guide provides details of this agreement. 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. Various items were chosen at random and the receipts for these items were available and the items were seen in the home. 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. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The 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 residents for on average 20 years. They now all have single rooms. 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 décor is deemed adequate. Residents told us that Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 19 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 is in a poor state but building work is underway to improve this area and in so doing will provide updated accommodation for residents. Previous accommodation in this area was less than satisfactory providing bedrooms with little or no natural light. The alterations will improve this situation. A new bathroom is also to be made available. There are only 7 residents living in the house at present instead of the maximum of 12 that may be accommodated. This has allowed the Registered Providers to separate the living areas from the building works thus minimising health and safety considerations. It was noted at the previous inspection that there were bolts on a final exit fire door by the laundry and the ground floor bathroom. It was a requirement that the bolts be removed and advice sought from either Fire Safety officer at the Brigade or the home’s fire contractor about suitable replacements. We were informed that a fire authority inspection had taken place and that no recommendations were made regarding this area. We require you to forward the fire officers report. Externally the garden was tidy and there were tables & chairs provided where people had been able to sit outside in the fine weather. From the rear of the property the outline of the roof and skylights suggest that these need regular checks to ensure their soundness. 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. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36. People who use the 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 three 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’. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 21 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 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. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41,42. People who use the 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 survey. The methods used for such consultation are one to one discussions, group meetings, paper surveys etc. The information gathered provides the home with it’s quality assurance data. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 23 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. 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. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 2 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 3 3 3 X Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 25 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 YA20 Regulation 13 Requirement Hand written entries to the Medicine Administration Records must be signed by the author and accompanied by the signature of a witness. Bolts currently fixed to final exit doors must be removed and alternative arrangements for securing those doors sought from the Fire Safety Officer or the home’s fire contractor. The above requirement was listed in the previous inspection report. We were informed that an inspection of the premises by the fire authority has been carried out and that no requirements were made in respect of the above mentioned exit doors. You are required to send the report of that inspection to the CSCI. 01/10/07 Timescale for action 01/10/07 2. YA24 23(4) Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard YA18 Good Practice Recommendations 1. Contact & support should be sought from the adult learning disability team to ensure that the residents are able to obtain all the help and benefit which they may need. Melbourne House DS0000009192.V340653.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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