Inspection on 09/05/06 for Melbourne House

This inspection was carried out on 9th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 16 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 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 Philippa Cutting Key Unannounced Inspection 9th May 2006 09:30 Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 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.V293608.R01.S.doc Version 5.1 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.V293608.R01.S.doc Version 5.1 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.V293608.R01.S.doc Version 5.1 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 10th October 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. 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.V293608.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In the past 13 months nine people have approached the Commission for Social Care Inspection to express their concerns and unease about aspects of the service users’ care and the treatment of staff in Melbourne House. Their comments have all been consistent so in the light of these concerns and therefore, in line with the Commission to seek wider views regarding service provision, other agencies involved with the people living at Melbourne House have been contacted. Their views form part of this report. The majority of people who came forward voluntarily asked to remain anonymous as whistle blowers, as they were scared of repercussions from the registered provider. Those who came forward were or had been carers. They said that they had never been happy about instructions they had been given by the registered provider relating to the care and management of the service users; others had realised that some of the home’s practices were poor after talking with new staff who were experienced in the provision of care for people with a learning disability and saw their alternative approaches to care. Comments and responses suggest that while there is no ill treatment of service users, when certain staff combinations are on duty the prevailing atmosphere is poor and people are devalued. Words such as ‘not caring’, ‘not compassionate’, ‘feeling intimidated’ have been used frequently by those who have spoken out. These terms have been applied to staff as well as service users. Examples of service users being demeaned included that some service users have been told they are fat. It is correct that one person has a health issue that suggests that care needs to be taken regarding weight gain but the impression was that this was not offered as an explanation to the service user. Staff say that the atmosphere in the home was much calmer and more positive with less eruptions when the registered provider absented herself during a PoVA investigation. There are reports that her influence is re-asserting itself since coming back into home, and it is not always to the good of service users or staff. It is a concern that staff leave as they become increasingly dissatisfied with their terms and conditions. This means that goodwill and continuity of care for the service users is lost. What the service does well: Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 6 The current care plans that the manager has put in place are comprehensive and address service users’ needs, taking into account risk and individual preferences etc. What has improved since the last inspection? What they could do better: 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.V293608.R01.S.doc Version 5.1 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.V293608.R01.S.doc Version 5.1 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): Standards were not assessed, as there have been no admissions since present registered provider took over and very few enquiries. EVIDENCE: Service users have been in the home for between 22 - 18 years. No new service users have been admitted. A couple have left because of ill health leading to mobility problems or because the home was unable to manage their behaviour, feeling that it impacted adversely on other service users. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 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 Service users are not able to contribute much to care planning. It has to be based on the staffs knowledge of them - this demands a high level of integrity by staff. EVIDENCE: The present manager (who is not the registered manager & is about to resign) has put good care plans in place - fully documented with risks, goals and outcomes for each person. Most of the service users have problems making decisions, they appear to have become institutionalised as a result of their early life experiences. If asked a question some tend to look to other service users to speak for them when in their group although outside sources say same service users are responsive and active when away from their familiar group. During the inspection it became apparent that service users fund their College activities from their personal allowances, includng a contribution to ingredients for those who attend cookery. This leaves people very short of spending money for other things that they might wish to buy. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 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 the following standard(s): 11,12,13,14,15,16,17 External activities and College reviews are satisactory but a lack of stimulation in the home was observed. Not all staff mix in - some were seen to be attending to tasks rather than getting involved with service users, except at lunch time EVIDENCE: The Commission has received comments that suggest the service users are bored when at home and that the staff are often too busy with chores to spend much time with them. The workshop/shed remains closed due to its unsuitability for its purpose and very little leisure facilities were noted in the home. The TV was on constantly with both programmes and videos. One service user likes to sing along with music - other service users were remarkably tolerant towards this rendition. All service users have activity programmes out of the home. All bar one are out of the house minimum of 4 x week, maximum 10 times. This includes morning, afternoon & evening sesions. Some of these are are at the local College where, the inspector was told, service users tend to stick together as a Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 11 group so do not get benefits of full integration with others. Other service users perceive them as old. The College report that the service users bicker a lot amongst themselves and they wonder if service users are spending too much time there, having become too familiar with the activities. Three people identifed as needing or being more able to manage increased social integration now attend activities such as local clubs or ‘Drop in’ centres unaccompanied as this makes them integrate more & mix with others. The inspector has been told that staff are given the impression by the registered provider that any additional activities for service users need to be free (ie walks as opposed to visiting places) as paying for any extra admission fees would leave them short of money from their personal allowances to pay for College activities. Help with some jobs (vegetable preparation or washing up) is encouraged as an opportunity for service users to have one:one time. The manager would have liked to develop more individual opportunities if she were staying example: service users to help with shopping. FOOD is an issue that has been drawn to the Commission for Social Care Inspection’s attention by various people. Following an initial intervention a year ago, staff said the quality has improved but quantity is still closely monitored. People have said that they have been told off for putting too much on service users’ plates. The inspector was told that buns and biscuits are not bought – occasionally some home made ones are cooked. The inspector noted that no biscuits were offered with morning coffee. Service users are not offered drinks other than at appointed times. One person said she had heard service users saying they were hungry when they went to bed. As during the week some service users are out by day the main meal is taken in the evening. Consequently lunch for those in the home is sandwiches with a choice of filling offered, followed by a yoghurt or fruit. One service user eats a lot of sandwiches. This is his preference, largely due to his difficulties regarding food but a dietician has been consulted and advised staff to supplement with Enlive or Complan etc. The person involved does not appear to present a problem to be concerned about. A record of his food kept. The inspector was told that healthy eating is encouraged. Service users do not appear to be underweight and records say they are weighed regularly. The Commission has been told that certain service users have been told they are fat so could not have certain food. This has caused them distress. However it is acknowledged that one person does have a cardiac problem so the home tries to watch her diet but this does not appear to be reason for comments made by the registered provider. The evening meal was not observed. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 12 The inspector was told that service users had not been allowed their Easter Eggs. When asked about this, the Manager said service users had had a lot of chocolate eggs (10 for some) so staff had apportioned them, as some would have eaten all in one go. Inspector noted some still had Eggs remaining but also saw service users being given their chocolate so this approach seems reasonable & acceptable. The petty cash budget for food seemed frugal. The carer who shops has £400 per month approximately for groceries for 7 service users 2 staff. Fruit & vegetables milk and bread are delivered separately, but the shopper has had money left over. The Manager commented that the meat provided is often not enough and has to be ‘padded out’ with extra vegetables – for instance one large chicken is provided for Sunday lunch with left overs kept for sandwiches & packed lunches the following week. COOKING is a regular College activity one evening a week. Prior to the managers employment service users attending cookery had a cup of tea before going to College then ate a meal at 8.0 pm ish at College, after they had cooked it. The service users pay a contribution towards the ingredients used from their own finances. The present manager felt the gap between a sandwich lunch and the College evening meal was too long so she now gives people a light meal of egg or beans on toast etc. to keep people going. If at home, tea is at 5.0pm with last drinks at 8.0pm. The Commission will discuss with the DASC if service users funding their own meals accords with their contracts. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 13 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 This is an ageing service user group who are now experiencing increasing physical ailments. Anyone with mobility problems cannot be accommodated satisfactorily in the building. Physical health problems are taken seriously with a supportive GP. The way in which service users are supported for their personal and psychlogical care depends on who is on duty. EVIDENCE: Service users’ physical problems being addressed. Some with mental health problems are being monitored regularly by professionals. The present manager has led by good example regarding personal care. It was noted that a person usually employed as ancilliary is rotad in as a second carer during the registered provider’s holiday. No records relating to training or experience were seen. It was suggested this person has learnt practice from the example provided by the registered provider. The Manager has seen approaches to problems that she has felt were not good. This person has been rota’d on shift with new or less experienced carers. This is of concern to the inspector as service users’ care could be compromised. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 14 Medication is via a monitored dose system and is administered by staff on behalf of all service users. It is stored in locked cupboard in dining room and the current MAR sheets were seen to be correct and completed except for one missing entry by registered provider. Staff are currently undertaking a certifcated course in safe handling of medication via Bude & Holsworthy - but with experienced staff leaving, knowledge will be lost. Ageing is pertinent to current SUs - management of illness and death will probably depend on mobility issues as only one ground floor room with stairs to first floor. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 15 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 Service users do as they are told. In general they have little concept of complaining although their behaviour may reveal unhappiness. Service users without an interested person who keeps in touch with them need an advocate. An external appointee should be arranged to manage service users’ benefits. EVIDENCE: The inspector felt that the service users who were present did not properly understand a question about complaints. The manager has prepared a list of questions to help staff seek the views of the service users about their levels of contentment (& for Quality Assurance purposes). Some people are able to express a view when asked. The home’s complaints procedure is listed in the statement of purpose – a new document was provided but not inspected until after the inspection. The inspector felt that service users were unlikely to understand the document’s purpose. It was learned that one family has complained about the state of their relatives room. It has been agreed that the service user will be moving to newly decorated room when it is ready. There was evidence that staff have undertaken PoVA training through an external company and that staff have seen a ‘Whistle Blowing’ video. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 16 The inspector has received comments that certain service users always ask if the registered provider will be on duty. It has been observed that they become subdued if they hear she will be. The comments have also been made by more than one person that some staff copy the registered provider’s approach to problems, which can exacerbate issues rather than defuse them. Other staff have learnt from the example of the previous manager and this current one and have adopted a softer approach to distract if a service user’s behaviour becomes difficult. All service users need help with their finance. There is a record of the contributions they are required to make to their external activities. The inspector was told that birthday & Christmas presents for service users are bought out of their own savings. The current expenditure pledged on behalf of service users leaves them with about £8.00 spending money from their personal allowance of £19.94 per week. The service users books tallied with the amounts in their individual envelopes & logged in the register but some money bagged up in filing cabinet for pocket money whilst the registered provider was away was noted. A further bag of money (unlabelled) was seen. When asked, the Manager had no idea what this was for - she has not been given any budgatory reponsibilities. Shopping is done by another member of staff. A cheque for £35.00 made out to a service user that had been sent to him in January 2006 and not been paid in was found. The Manager had no knowledge of this although she knew a letter had been had been sent to service user and was dealt with by the registered provider. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 17 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): 24,25,26,26728,30 Home is shabby – it is in need of extensive renovation which is taking place slowly via the handyman. Some rooms have been re-decorated. The back portion of home is almost unusable. EVIDENCE: Home had to cope without water due to SWWA work on mains supply during inspection. The inspector toured the premises and made the following observations: GROUND FLOOR Room 1 - headboard loose on bed, half off. The remainder of the ground floor bedrooms are unused apart from the office that is temporarily located downstairs. The old kitchen storage area is padlocked and out of use. Kitchen stores are being kept in an internal room. UPSTAIRS Room 5 - empty – being used as storage. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 18 Room 6 - in a poor state, broken drawer fronts on chest of drawers & the wardrobe was missing one door. Damp marks by window, hole in walls. Personal effects in room. Family have complained about the state of the room. Room 7 - Double, personalised by service users, satisfactory décor but there is no privacy. One person is due to move to a separate room as other person disturbs her. Room 8 – slight odour but under control. Propad mattress, sheet, Kylie, 2 cotton blankets, duvet cover, no duvet, blanket on the bed. The Manager said this was the service user’s choice as, due to problems he often prefers to spend part of the night in his chair. The commode in the room, contained pale yellow liquid. There was an ordinary armchair with a Kylie protector on the seat. This person sits in a raised chair in the sitting room (own purchase). Room 9 - Kylie on bed, ok Room 10 - no towel rail, only fixings. Room 11 empty Old office - stripped for redecoration. It appeared to be taking priority over the redecoration needed in bedrooms to enable service users to move. The moves are taking place by agreement so all will have single rooms eventually when work is completed. The Manager commented that the handyman reponsible for redecoration sometimes comes in between 4.0pm until 3.0 am to work. On one occasion staff found floor boards up in one room when the service user returned from College so that person had to wait before going to bed. BATHROOMS very shabby- clean but need modernising. Ground floor room has a hoist so it appears to be used more. The floor was awash underneath a blue non slip runner. No heating (small room) is provided for use in winter so damp pervades. Thick dust was seen on the ventaxia cover which could constitute a fire hazard, a hole was noted in the wall, mould seen, the bath seat is stained by unguents used for one service user, untidy shelves. The light over mirror flickered and would not come on – it works from the main switch with the central light. Ground floor WC - no wash hand basin so service users cannot wash their hands. If they do not go into bathroom next door to do this, they have to pass through the kitchen without washing. It seems unlikely that they then go upstairs to their own rooms to wash. First floor bathroom- no rails or bath aids, aged cork bath mat, loose mats on floor. WC no rails, wash hand basin but no soap or towels. COMMUNAL SPACE Sofas very low and dark. Springs can be felt through the covers. One person said Wed like new chairs, these have been here as long as I have - thats 24 years Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 19 There is continued evidence of the dining room doubling as part office space. One service user was seen to use the dining room for recreational use during the afternoon. The sun room is available for the service users when the weather is suitable. KITCHEN new units and equipment in place. LAUNDRY All laundry has to be taken through kitchen to wash area. The Manager said it was bagged and taken through when food is not being prepared. Two people are regularly incontinent of urine by night. Staff wear aprons & gloves when handling dirty washing. The washing is mainly done at night to take advantage of cheaper rate power. The equipment appeared to satisfactory -a domestic washing machine & large dryer but with outside line used when possible. The home would benefit from a procedure to demonstrate that clean & dirty laundry are not mixed up. The ventaxia is hard to reach to clean (behind dryer). EXTERNALLY there are level seating/patio areas available for use. These are accessed by steep steps. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 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 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 feel undermined and devalued by registered provider. Recruitment and training are not afforded enough attention. EVIDENCE: The registered provider has refused to nominate the present manager as registered manager, she wishes to retain role for herself. Not all staff have a job description, most have new contracts (via Peninsular) in place. The inspector was told that there was an issue here - staff wanted to take contracts away to study before signing but were told they could only take them away after they were signed. Induction records are variable. Evidence of the new, about to be mandatory, induction programme was not seen but the registered provider was away so could not be asked if this had been addressed. The inspector was told that there hae been times when there has only been one member of staff on duty. This is unsafe practice. The Manager has never had a job description, so she does not know what her boundaries and responsibilities are. She felt she had instigated a lot of enquiries re training and courses etc but does not have a say about what will be implemented or arranged. She has no budgetory scope. She has not had any supervision sessions with the registered provider. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 21 The pay structure is unequal – there were examples of longer serving staff receiving more than the manager. Junior staff are on minimal rates but are used a lot. There is no enhanced pay for weekends or night work. Staff feel responsible & concerned for the service users but said they felt undermined, intimidated, devalued by the registered provider so give up and leave. Certifcates following succcessful training are not being passed on to staff so their achievements are not recognised nor rewarded by a pay rise. All have done First Aid, Moving & Handling & PoVA recently. Staff team - when rotas were prepared by the previous manager & the present one, staff were given regular hours in advance so they could plan the rest of their time - all were happy with this. Since the registered provider has been back she has re-rotad the system so that peoples hours have been cut and/or changed etc. The Manager felt some unwise combinations had been put in place (two inexperienced people on together). The registered provider has advised the Commission that she is looking into a LDAF course for staff for this September. Recruitment - most recent employees have had two written references taken up - CRB & PoVA first checks being done. The Manager instigated documented supervision for staff. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42 The comments from staff & indications by service users that they feel intimidated and frightened of the registered provider indicate that the management approach is not open and inclusive. EVIDENCE: The registered provider holds a Registered Manager’s Award. Her CV suggests that much of her previous involvement in care, prior to buying Melbourne House, has been more with mental health problems rather than learning disability. It has to be of concern that a consistent comment made by the people who have spoken to the Commission is that there is a more positive and welcoming atmosphere in the home when the registered provider is not present. This was the case when the registered provider was absent for two periods of about two months in 2005 due to different circumstances. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 23 SWWA was working on water main and had notified houses in the area that the water would be cut off. The registered provider had forgotten to pass this information onto staff so they were unprepared & ran out of water the first day of the work. They also ran out on second day of inspection. At inspectors suggestion staff rang SWWA and said the premises were a Care Home. SWWA responded by quickly delivering water to home – they said they would have made these arrangements in advance if they had been made aware that it was a care home. Service users records, the diary & communication books are kept in the dining room where staff sit to complete them. Staff records are locked in the office but the Manager did have access to a key. Financial areas of home were not inspected as the manager does not have this information and the registered provider was not present. The accident and fire records were inspected. COSHH & Electricity maintenance certifcates were not seen. Sight of these will be required to ensure that any refurbishment work is being carried out to a satisfactrory standard. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 2 ENVIRONMENT Standard No Score 24 1 25 2 26 2 27 1 28 2 29 X 30 2 STAFFING Standard No Score 31 2 32 2 33 1 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 1 3 X LIFESTYLES Standard No Score 11 2 12 3 13 2 14 1 15 2 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 1 1 X 3 3 X Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 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 YA17 Regulation 17(2)Schedule 2 16(2)(i) 25(3)(b)(c) 12(4)(a) Requirement Timescale for action 30/06/06 2 YA18 3 YA23 13(6) 20(3) The record of the food provided for service users and the expenditure on food must be assessed by a qualified dietician to verify the quantity and quality of food provided. The registered person shall 04/06/06 make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users. The registered person shall 30/06/06 make arrangements, by training staff or by other means, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. This requirement relates to the apportionment of service users’ money. The registered provider should seek to ensure so far as practicable that persons working at the care home do not act as the agent of a service user. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 26 4 YA24 23(2)(b) 5 YA26 16(2)(c) 6 YA28 23(2)(g) The registered person shall having regard to the needs and numbers of service users ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally & internally The registered person shall provide in rooms occupied by service users adequate furniture, bedding & other furnishings, including curtains and floor coverings, and equipment suitable to the needs of service users and screens where necessary. 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. This requirement is on going. The registered person shall after consultation with the Environmental Health Authority make suitable arrangements for maintaining satisfactory standards of hygiene in the care home. 30/06/06 30/06/06 04/06/06 7 YA30 16(2)(j) 30/06/06 8. YA31 YA32 YA38 12 (5)(a)(b) This relates to the provision of hand washing facilities in the WCs and the passage of laundry through the kitchen & its subsequent handling. The registered person shall, in 04/06/06 relation to the conduct of the care home maintain good personal and professional relationships with service users and staff ; and encourage and assist staff to maintain good personal and professional relationships with DS0000009192.V293608.R01.S.doc Version 5.1 Page 27 Melbourne House service users. 9 YA32 18(1)(a) The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered person shall not employ a person to work at the care home unless he has qualifications suitable to the work he is to perform and the skills and experience necessary for such work. The registered person shall ensure that persons working in the care home are appropriately supervised. This must be continued following the resignation of present manager Staff views as to the conduct of care home. This regulation applies to any matter relating to the conduct of the care home so far as it may affect the health or welfare of the service users. 04/06/06 10 YA32 19()5)(b) 04/06/06 11 YA36 18(2) 30/06/06 12 YA36 YA38 21(1)(2) 04/06/06 13 YA39 24 (1)(b) 24(2) The registered person shall make arrangements to enable staff to inform the registered person & the Commission of their views about any matter to which this regulation applies. The registered person shall 30/06/06 establish and maintain a system for improving the quality of care provided at the care home and The registered person shall supply to the Commission with a report in respect of improving the quality of care. DS0000009192.V293608.R01.S.doc Version 5.1 Page 28 Melbourne House 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 YA37 Good Practice Recommendations A suitably qualified person should be appointed as the registered manager for the home with the registered provider retaining her role as responsible individual. Melbourne House DS0000009192.V293608.R01.S.doc Version 5.1 Page 29 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.V293608.R01.S.doc Version 5.1 Page 30 - 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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