Inspection on 01/05/07 for Melbourne House Nursing Home

This inspection was carried out on 1st May 2007.

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 Nursing Home 14/03/09

Melbourne House Nursing Home 07/05/08

Melbourne House Nursing Home 21/11/07

Melbourne House Nursing Home 05/06/06

Melbourne House Nursing Home 20/10/05

Melbourne House Nursing Home 20/05/05

Melbourne House Nursing Home 18/01/05

Melbourne House Nursing Home 18/08/04

Melbourne House Nursing Home 30/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Melbourne House Care Home Aspley Lane Aspley Nottingham NG8 5RU Lead Inspector Linda Hirst Key Unannounced Inspection 1st May 2007 09:45 X10015.doc Version 1.40 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 Care Home DS0000026453.V335552.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 Older People. 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 Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Melbourne House Care Home Address Aspley Lane Aspley Nottingham NG8 5RU 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) 0115 9294787 F/P 0115 9294787 Eastgate Limited Mrs Janice Ann Cooper-Brown Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39), Terminally ill (2) of places Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the total number of beds a maximum of 2 beds may be used for the category of TI Within the total number of beds 1 bed can be used for a named service user aged 44 years 26th September 2006 Date of last inspection Brief Description of the Service: Melbourne House is a purpose built two storey building providing care for up to 38 older people with one named person who is outside the category of registration. There are 3 lounges, a conservatory and a large dinning room providing ample communal space. There are four double bedrooms, two of which have no privacy screening available at present. There is a lift to the second floor and the building is wheelchair accessible. The home is set within its own grounds, which are accessible to residents but not secure for those who would be at risk if they tried to leave the building. The service is close to local amenities in Aspley, which is on the main bus route into the City of Nottingham. Relatives interviewed said they were given a brochure about the home, but had not seen an inspection report. The manager said this is available in the office on request. She was told she must be more proactive in making the last report and the Summary available to all residents and relatives so they are aware of the outcome of the inspections which have been done. The minimum fees are currently £335 and the maximum are £499 per week. There is an extra charge for en suite bedrooms. Newspapers and hairdressing are not included in the fee. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for service users and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This inspection involved one inspector; it was unannounced and took place over 13.5 daytime hours, including lunchtime. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. Two of the people living at the home speak languages other than English and one person was “case tracked” to check that staff understood and provided for their cultural, religious and communication needs. Some of the people who live at this home cannot clearly express their views on the care they receive. Therefore some judgements in this report are from observation of staff and resident interactions Two members of staff and one set of relatives were spoken to as part of this inspection. In addition the views of two other residents who were not part of the “case tracking” were sought to form an opinion about the quality of the service. Documents were read as part of this visit and medication was inspected to form an opinion about the health and safety of residents at the home. A partial tour of the building was undertaken, all communal areas were seen and a sample of bedrooms to make sure that the environment is safe and homely. A review of all the information we have received about the home since the last inspection was considered in planning this visit and this helped decide what areas were looked at. 78 questionnaires were sent to the manager for distribution to residents and their relatives before this inspection to give them the chance to air their views and speak to an inspector directly. None were returned, other ways of distributing these surveys will be adopted for future inspections to get a better response rate. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The service user guide could be made available to people in different formats and it must include a copy of the summary of the last inspection to give residents and their relatives up to date information about the service which they can understand. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 7 The initial assessments could include more personal and social history with information about the cultural and religious needs of the residents to help the staff understand and support people better. The care plans could be more detailed about the personal, social, cultural and religious needs of the residents to ensure that staff give people the care they need. Residents or their relatives could be involved in planning the care they receive so that they give their views on how they want to be helped. It would also be better if care staff read the care plans rather than relying on verbal information which might not be accurate. The use of bed rails could be safer if the proper bumpers were used to prevent injuries to residents. The arrangements for managing the medication for residents could be much safer to make sure that unnecessary risks are avoided and people get their medication as prescribed by their Doctor. Some staff could treat residents with more respect for their dignity and the manager could make sure they know the policy and philosophy of the home to avoid poor practice. All staff should be aware of the religion, cultural needs and the first language of residents from minority ethnic groups in order to meet their needs in an appropriate way. The manager could make sure there is information about the specialist communication needs of people whose first language is not English and identify how staff will communicate effectively with these residents. The service could develop the range of activities provided which are appropriate to the needs of less able residents in order to meet their social needs. The residents’ preferences with regard to their routines should be documented in their care plans so the staff can uphold their choices. The staff could use more appropriate language about those who need assistance to eat and could help people in a more supportive way. The daily menu could be displayed in the home so that residents know what is available and can make informed choices at meal times. The senior staff could go on training about the local abuse procedures so that they know what to do if someone makes an allegation of abuse and can protect residents properly. The company policy should be changed to make sure it is in line with local procedures. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 8 All of the staff need to understand that they should tell the manager if they see people responding in a poor way to residents to make sure they are protected from harm or abuse. Maintenance issues could be dealt with more quickly to provide safer and more comfortable surroundings for residents. The conservatory could be used more if heating were provided to keep it at a comfortable temperature for residents. Privacy screening in all of the double bedrooms could be used to protect residents’ privacy and dignity. Odour control in some parts of the home could be significantly improved in order to provide a cleaner and more pleasant environment for residents. The way staff are organised could be better to make sure residents do not have to wait too long for help to be provided. The service could operate better when the manager is not there to check that people are being supported in the right way. The owner could write a list of the actions he will take to address the issues relatives raised in their questionnaires to make sure the home is being run in the best interests of the people living there. The manager must tell the Commission about all events which adversely affect the health and wellbeing of residents so the service can be monitored. The supervision of staff could be better and their work practice could be assessed and monitored in depth to make sure they are supporting residents properly. 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 Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are assessed before they are admitted to the home to make sure their identified needs can be met, but the assessment is not holistic enough. Some areas of need are not covered in enough detail to enable staff to understand new residents and help settle them in their new home. EVIDENCE: The last person to be admitted to the home was “case tracked” to make sure she had been properly assessed before she was admitted to ensure her needs could be met. The person was self funding and there is a pre admission assessment on the file, although there seems to be conflicting information from the relative who said the ward discharged her before the manager could assess her. The evidence would suggest that she was assessed before she came to the home to make sure her needs could be met. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 11 The person’s relative said that the move would be difficult for the resident to accept as it represents a significant change in lifestyle. This information is not recorded in her care plan. The resident is spending most of the time in her room at present and is not eating well. The person concerned has some memory loss and it would have been helpful to have more information on her personal history to enable the staff to better understand her personal circumstances and help her settle in. There is a service user guide and a statement of purpose, these documents are written in English, and no other formats are currently available which may make them inaccessible to people whose first language is not English. One relative said she did not need information on the service, as she was already familiar with it. The last inspection report was not in evidence in the home, and the manager said this was available on request. The staff who were interviewed said they don’t have anything to do with admissions and they could not answer questions about how this process worked. They said the manager goes out to assess people, and they are informed about new people verbally at handover. They try and make people welcome by settling them in with a drink, unpacking their clothes with them, showing them round and chatting to relatives. They said it could be difficult if the resident does not want to be there but they try to make them happy and comfortable. Intermediate care is not provided at the home and this standard is not applicable. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are not addressed in a way which is consistent, safe and respectful, this places them at risk of harm. EVIDENCE: The care plans seen were of variable quality, some clearly detailing needs, and taking account of residents’ privacy, dignity and choices. Others were very basic, especially around the needs of people with Dementia and those around cultural and religious needs were particularly poor. This could lead to significant areas of residents’ need being inappropriately responded to by staff. There was no evidence of residents or relatives being involved in the development of care plans (other than signatures for the use of bed rails) and relatives and residents who were interviewed said they did not know anything Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 13 about care plans and had not seen them. It is their input which helps to “flesh out” care plans and help staff to understand the needs of residents. The staff who were interviewed said they did not have enough time to read through care plans, and relied instead on verbal handovers. If staff are not reading the care plans it is difficult to see how they could know how the manager and trained staff want them to respond to particular areas of resident need. This, along with the absence of regular staff supervision (See OP36) leads to the risk of staff responding in the way they feel is best, (See OP10) which may not lead to a positive service for residents. The arrangements for supporting residents with their health care were inspected to make sure that their safety and wellbeing is promoted and protected. There is good evidence in files of input from a variety of Health Care professionals, including the District Nurse, Continence Nurse, Speech and Language Therapist, Dietician and the Falls Prevention team. This suggests that the service is proactive in referring people on for specialist assessment and treatment to ensure they remain well and healthy. There is evidence around the home of the provision of different kinds of pressure relieving cushions and mattresses to prevent or help manage pressure sores and provide residents with comfort and relief. There is quite a high use of bed rails within the home, in all of the cases seen there was a risk assessment undertaken before bed rails were used, but appropriate bumpers had not been used in all cases. This is against guidance from the Department of Health which exists to make sure that residents are safe from injury when bed rails are used. The risk assessments are signed by the relatives, but it is unclear how much information they have been given about the risks involved both in the use of bed rails and by failing to use appropriate bumpers. One resident who was interviewed said her health is well looked after and she said she sees the Doctor when she needs to. A relative said that the staff have worked really hard with her mother to try and get her to eat, and there is evidence that the manager has made a referral to the Dietician to try and make sure she gets adequate nutrition. The staff who were interviewed said that the health care support provided to residents is good. The unqualified staff said they don’t do any nursing tasks; the trained staff do this to ensure the resident is safe. They will inform the trained staff though if they notice anything untoward, such as skin tears or pressure areas so that these can be recorded, assessed and treated if necessary. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 14 A medication round was observed and the nurse on duty was observed to repeatedly leave the trolleys open and unattended whilst administering medicines to residents in other areas of the home. She then left a ring binder of medication in blister packs completely unattended in the dining room whilst she assisted a Doctor who was visiting with his “round”. There were no staff present in the room, only residents. This is extremely dangerous practice; residents could easily take medication which has not been prescribed for them which places them at risk of potential harm. This matter was brought to the attention of the manager who took action the same day to ensure that the trolleys were locked whilst the nurse took medication to residents in other parts of the home. The Medication Administration Record showed evidence of several gaps which had not been explained by staff, and in one case the evidence from records and examination of the blister packs indicated that a person’s medication had been missed with no explanation given. This could place the person at some risk of ill health. There was also evidence that there was a tablet which should be treated as a Controlled Drug was unaccounted for meaning that guidance had not been properly followed. Residents said that the staff bring them their tablets with a drink and make sure they take them. The relative who was interviewed said that the staff give her mother medication as she could not manage this herself. She has not witnessed this being done so couldn’t say how it is managed. The staff who were interviewed were not responsible for medication. They said they think the practice is safe, but wouldn’t really know. During the course of this inspection an observation of staff and residents was done to consider the impact of the interactions between them and how this affected the care received. Two staff were seen responding in a very inappropriate way towards residents (mocking, swearing, arguing, and ignoring). This caused some distress for particular residents and the matters were brought to the attention of the manager during the first day of the inspection. These matters were responded to immediately and an investigation and disciplinary proceedings were started. The policy on residents’ privacy and dignity could not be found so it is not possible to determine how the staff are expected to respond to residents in these respects. There is no evidence that the staff have had any specific training on privacy and dignity issues, and those interviewed confirmed this. The staff who were interviewed however, did give good examples of how they ensure residents are treated with dignity and respect for privacy in their day to day practice. One resident said the manager always has a smile for her and she said she gets treated well, she said she can “get along with most of the staff.” Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 15 One relative said she thinks her mum is treated well, although her mum is fearful of asking for any help. The relative did not think this was for any particular reason. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an inconsistent service in this area delivered to residents. Some have their lifestyle choices recorded and respected, but the less able residents are not supported to make choices about their lifestyle and the social, cultural and recreational activities provided do not address their needs. EVIDENCE: Residents’ social needs and interests were not fully recorded and in the case of some people with short term memory loss, the names of key people and events in their lives were not recorded to enable staff to understand who people are thinking of and referring to. As stated in OP3 and OP7 the cultural and religious needs of people are not well recognised or recorded. The staff and manager were not aware what one resident’s first language was, and the manager had to check the file to tell me her religion. The staff said they find it very difficult to understand what she really wants and they rely on her family to tell them. There is no information on her file about her religious beliefs, dietary needs or any rituals around death and dying. Unfortunately the person’s own Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 17 views could not be sought using an interpreting service as she was asleep through the day. A new activities organiser has been employed to work with the residents and to develop activities to keep them occupied and entertained. This was an area of concern raised by several families in the last quality assurance audit. One person commented that there should be, “more activities instead of them sleeping or sitting staring into space.” During this inspection, residents were seen having games of cards, dominoes and BINGO, though these activities were aimed at the more able residents. One resident said she likes to paint and there were pictures she had painted in her bedroom which she recognised and seemed pleased with. Another said she used to enjoy knitting but her health needs were such that this was now impossible to do and she said she did get bored at times. She said she doesn’t get out much, although she wishes she did as she likes the fresh air. She would love to go on trips but doesn’t know if any will be arranged. The manager said that family and friends could come whenever they like, and the relative interviewed confirmed this. Several relatives raised concerns about the reception they receive from staff when they visit the home in the last quality assurance questionnaire. Specific comments were made about staff not being helpful, making relatives feel like a nuisance and about relatives not being offered a drink if the manager was not on duty. There is evidence in the staff minutes and from interviews with staff to suggest that the manager has raised this issue and made expectations clear. Some people who sent in questionnaires said they were always welcomed, and the manager is trying to get a more consistent approach. Resident choices are recorded in some care plans as likes and dislikes, but key information about preferred rising, retiring and bathing times are not recorded. Some male staff are employed but there is no record of the preferences of the resident in terms of the gender of the staff who help them with personal care. Staff interviewed said this can be an issue at times, but they will try and accommodate the wishes of residents. One resident said she gets up about 7, sometimes she wakes up herself, other times staff wake her. She goes to bed around 9ish. She sometimes sits up to watch TV. She has a bath once a week, she didn’t think she could have one every day if she wanted to. The staff who were interviewed said that some people like to get up early and go to bed early. They said they go into residents’ rooms and if they are asleep, they will go back later as some people like a lie in. They said most people have a bath once or twice a week with strip washes between. Lunch was observed and the meal looked and smelled appetising and some residents had a specially blended diet. There are no special diets provided for Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 18 people from Minority Ethnic Groups, and although the manager said that dietary preferences had been discussed with the “case tracked” resident’s family, there was no record of this. The relatives had said on their quality assurance questionnaire that the person liked “spicy food,” but there is no evidence that this is being provided by the service. A number of residents required assistance to eat, and during the course of this inspection three members of staff referred to people as “feeders,” in front of other residents. This is dehumanising and disrespectful language and the matter must be addressed. Two members of staff who were assisting people to eat had a very positive approach and engaged the residents, gauging when they were ready for more food and talking to them. However, another member of staff was observed almost force feeding a resident which caused significant distress to the person concerned. She was challenged quite appropriately by other members of staff who then offered reassurance to the person. This matter was referred to the manager to address and report back on, the outcome of this investigation is awaited. The residents said they do not know what is for dinner in advance, and although they are asked for their choices every day, there is no displayed menu to remind them of the meals available. Several relatives commented that a displayed menu would be helpful. Residents and relatives who were interviewed said that the food is good, but three residents said they were thirsty through the day and the frequency of drinks was also raised as an issue on the relative questionnaires. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ concerns and complaints are responded to and investigated appropriately, but the lack of awareness of staff responsibilities in terms of safeguarding adults and whistleblowing on poor practice places residents at risk of potential harm and abuse. EVIDENCE: Complaints were inspected, since the last key inspection there have been four concerns and two complaints made about the service by relatives. Two of these were investigated by Social Services, two were referred to the provider, one prompted a random unannounced inspection of the home and one remains unresolved as the Commission have not received a response from the provider. This was raised with the provider on the day of the inspection, who said he had not received the documentation and he offered assurances that he would do an investigation and send a copy of the outcome to ensure that the complaint issues had been properly addressed. The record of complaints provided evidence that concerns are being recorded, investigated and outcome letters are being sent to inform complainants of action to be taken. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 20 There is a complaints procedure for the home which is displayed outside the office, but many residents and relatives may not use this area of the building regularly. None of the residents or relatives spoken with had made any complaints but they said they would go to the manager and would feel confident that she would address the issues of concern. One staff member said she had received a complaint and had tried to reassure the person making the complaint, she had recognised that the complainant was worried and concerned and in fact the person concerned apologised to her and said she had complained to reassure her mother. She said she made sure she recorded precisely the relatives’ wishes in the care plan. The other staff member said she would report any concerns straight to the manager. There are copies of the Nottinghamshire Committee for the Protection of Vulnerable Adults procedures at the home, and staff said they have recently done a two hour training on Abuse issues to ensure they know about the types and signs of abuse. However, the policy of the home is not in line with the Safeguarding Adults Procedures and needs amending to ensure that staff do not compromise investigations being done by other agencies. Further, more comprehensive training on the safeguarding adults procedures is needed for senior staff so they are clear about their responsibilities to report abuse and protect residents. The staff who were interviewed demonstrated an understanding of abuse. However, although both staff said they would speak to the person concerned if they saw them behaving in an inappropriate way towards residents, only one said she would go on to report the matter to the manager, regardless of the consequences. The other said she probably wouldn’t because that would be “snitching.” There was also another instance during this inspection where a member of staff did not tell the manager the truth about how a staff member behaved, despite evidence to the contrary. There are therefore concerns about the willingness of staff to “whistleblow” on poor practice and this compromises the manger’s ability to protect the residents from harm and abuse. The matter needs to be addressed and resolved. Residents interviewed said they feel safe at the home. A relative said she is happy with the way she has seen staff respond to her mum, but as she is never in the communal areas she cannot speak about how staff interact with other residents. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally fit for purpose but the maintenance, lack of heating in the conservatory, arrangements for privacy screening and the control of odour all negatively affect the level of comfort for residents at the service. EVIDENCE: Several of the relatives commented on the last quality assurance questionnaires about the long wait for even minor maintenance issues. Staff who were interviewed confirmed that delays can be frustrating because the maintenance man is shared with other homes in the company. One person commented that her mother had waited for over nine months for her own shelves to be put up in her bedroom which is an unacceptably long delay. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 22 There was no evidence in the maintenance book that this matter has been resolved. There are three lounges at the home and a conservatory which is not used as it is too cold as there is no heating installed in the room. One relative commented about the temperature in the conservatory in her Quality Assurance questionnaire, “the conservatory not suitable on hot day and is cold in winter.” All areas of the home which residents have access to must be maintained at a comfortable temperature for them. There are 31 single bedrooms and four double bedrooms but only two have privacy screens to maintain residents’ dignity. Residents can bring in items from home, and some bedrooms are well personalised with personal belongings to help the residents settle. All parts of the home were clean and tidy on the day of the inspection and appropriate hygiene practices were being followed to make sure residents and staff are safe. However, there was a pronounced odour in the lounges nearest the office and residents and several relatives commented on the unpleasant odour around the lounges. Relatives also commented in interview and in the quality assurance questionnaires about the cleanliness of the bedrooms and how the standard of cleaning was not acceptable. There is evidence in the minutes of a staff meeting held after the last quality assurance that this issue was raised with staff with a view to improving the cleanliness of the home. Staff who were interviewed said that the home is kept as clean as they can but they said the cleaners are only on shift in the morning, so any spills, accidents etc have to be cleaned up by the care staff. They said there is sometimes an odour, it is almost impossible not to have this, but they said they do the best they can. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment procedures are robust and protect residents from people who may abuse them but the approach of staff is not consistent and in some cases this leads to poor outcomes for residents. EVIDENCE: The staff rota was inspected to check there are enough staff on duty to meet the dependency needs of the residents. There was conflicting information about whether there were enough staff on duty, the staff and the relative said the number of staff seem appropriate to support people with their needs. However, a resident who was interviewed said she sometimes has to wait for “quite a while” for staff to assist her. The service has almost achieved the target of 50 of staff trained to NVQ National Vocational Qualification 2 to ensure a suitably qualified workforce. This target should be achieved within the next year. The evidence on staff files indicates that a great deal of training has been provided since the last key inspection and this is to be commended. However, it is clear from this inspection (OP9, OP10, OP12, OP18) that there are key areas in which staff Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 24 need support and training to ensure they are providing a high quality of service to all of the residents in their care. There have been examples during this inspection of both very good, enabling practice and very poor practice and the service must work hard to ensure that all staff have the correct approach and are suitably competent and qualified to undertake their role in resident care. This evidence was borne out by comments in the quality assurance questionnaires, one person commented, “not all staff speak to you when you visit, you sometimes seem to be in the way and a nuisance.” Others said the staff were always very kind and helpful, and one resident who was interviewed said the staff were “alright.” The staff files were inspected to make sure that they had all of the information and documentation to ensure that residents are properly protected from people who may harm or abuse them. The files were very well kept and contained all of the information and documents needed by Law in order to safeguard vulnerable people. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is a caring and approachable person but there are not adequate systems in place to ensure that the home runs smoothly when she is not there which leads to poor practice and a negative culture amongst some staff. This impacts significantly on residents and their visitors and this means the home is not run in the best interests of the people living there. EVIDENCE: The manager is a qualified nurse and there is evidence from training records that she is continuing to update own knowledge with a view to providing good Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 26 care to residents. She was praised by the staff, residents and relatives who all said she was kind, approachable and supportive. However, it is clear from the observations during this inspection and from the quality assurance questionnaires that there are problems she needs to manage and address (OP7, OP9, OP10, OP12, OP15, OP18, OP19, OP24, OP27, OP30). There is evidence that there is a difference in the quality of service provided when she is not there, relatives commented, “the dining room only seems available when matron is on duty. When matron is not on duty we mostly have to ask for a drink.” Another said, “Not all staff speak to you when you visit.” There is no formal supervision at the moment, and this combined with the reluctance of some staff to whistleblow on poor care practice means that the manager cannot adequately protect residents from potential harm and abuse. The manager urgently needs to address the attitudes of some staff and how the service is conducted in her absence. The last quality assurance questionnaires were sent to relatives in December 2006 to get their views on the care being provided. Fourteen families responded, and with the exception of two whose comments included “I always get a very pleasant reception,” and “Very good food, on the whole very good,” all of the others raised issues of concern. The same areas were raised consistently and these were; the quality of care when the manager is not around, the attitudes of staff to relatives, maintenance issues, the smell of urine, dusty bedrooms, relatives not being welcomed by staff and offered a drink, staff not talking to residents and occupying them enough, relatives being kept better informed. The manager has so far not developed an action plan, but there is evidence that the issues to do with welcoming and involving relatives and the cleanliness of the home were raised with staff in a meeting in January 2007. The manager and proprietor must ensure that an action plan is drawn up as soon as possible to address the issues of concern which were raised and provide a service which acts in the best interests of residents. Staff who were interviewed said that they were aware of relative questionnaires but had not yet had full feedback on the issues. Neither the resident not the relative interviewed had completed a questionnaire. There is no evidence that the manager has been sending in notifications about incidents affecting the health and wellbeing of residents to enable proper monitoring of the service to the Commission as required. The manager said these have been e mailed but they have not been received, a new form has been sent to the manager for this purpose. The arrangements in respect of residents’ finances were checked to ensure their interests are being protected. The records all tallied with the amounts held on the premises and there were receipts for expenditure indicating the arrangements are well organised. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 27 The records of Health and Safety servicing and checks were inspected these were all up to date and well recorded. The staff have all completed their statutory training courses and they confirmed that their health and safety is promoted and protected by the provision of training and equipment. Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 2 X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 2 X 3 1 X 3 Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 5(1)(d), 5(2) Requirement Timescale for action 14/06/07 2. OP7 15(1) 3. OP7 15 2. OP7 13(4c) The Service User Guide must be given to all service users and it must contain a copy of the summary of the last inspection report to offer residents and their relatives up to date information about the service. Care plans must explain in detail 30/06/07 the health, personal social and cultural and religious needs of the residents to ensure that people receive the holistic care they need. Timescales of 5/8/06 and 7/11/06 not met. Residents (or their relatives) 14/06/07 must be involved in the development of their care plan to ensure they are properly consulted about the care they receive. Bed rails must be used with 14/06/07 appropriate bumpers to protect residents from the risk of injury. The management of medication must improve as follows: • The Medication Version 5.2 3. OP9 19 (1) 01/05/07 Melbourne House Care Home DS0000026453.V335552.R01.S.doc Page 30 • • Administration Record must be fully completed, if any medication is not given there must be an explanation for the omission. This is to ensure that residents get their medication as prescribed by their Doctor. There must be an accurate record of all Controlled drugs (or those to be treated as Controlled Drugs) to ensure that these are being administered safely and according to the residents’ prescription. Medication must be administered from the Blister packs to avoid error and to ensure that the medication remaining and the Medication Administration Record tallies. This is an immediate requirement. Timescales of 5/6/06 and 7/11/06 not met. 01/05/07 Staff must respond to residents in an appropriate way and with respect for their dignity Staff must not use disrespectful language about residents and their needs. 4. OP10 12 • • 5. OP12 17(1)(a), Sch 3 (3) (l), 12(4)(b) This is an immediate requirement The manager must 30/06/07 • provide details of the specialist communication needs of people whose first language is not English and identify the methods DS0000026453.V335552.R01.S.doc Version 5.2 Page 31 Melbourne House Care Home 6. OP12 7. OP15 8. OP16 9. OP18 10. OP18 11. OP19 12. OP20 13. OP24 of communication that will be used with each individual. • Ensure that all staff are aware of the religion, cultural needs and the first language of residents from minority ethnic groups in order to meet their needs in an appropriate way. 16(2)(m & Activities which are appropriate n) to the needs of less able residents should be developed in order to meet their social needs. 12 Those who need assistance to eat must, in all cases be supported in a positive and enabling way taking account of safety and residents’ personal dignity. 22 The provider must investigate the complaint made to the Commission and provide a copy of the investigation and outcome to ensure appropriate action has been taken. 13(6) The manager and senior staff must attend training on the Safeguarding Adults procedures to ensure they know about their reporting responsibilities in terms of protecting residents. 13(6) Action must be taken to address the staff culture of refusal around whistleblowing poor practice to ensure that residents are protected from harm and abuse. 23(2) Maintenance issues must be progressed more quickly to ensure the home is safe for residents to use. 23(2)(p) Heating must be provided in the conservatory to enable residents and their visitors to use it in comfort and safety. 12(4)(a), Privacy screens must be 23(2)(e & provided in all double bedrooms DS0000026453.V335552.R01.S.doc 31/07/07 14/06/07 14/06/07 01/08/07 14/06/07 14/06/07 30/06/07 14/06/07 Page 32 Melbourne House Care Home Version 5.2 f) 14. OP26 16(2)(k) 15. OP30 18 to maintain the dignity of residents. The home must be kept free of offensive odours to ensure a clean and comfortable environment for residents. Support, information/training must be provided on Safe practice regarding medication • Privacy, Dignity and Respect • The religious and cultural needs of relevant Minority Ethnic groups • Whistleblowing To ensure the staff are competent and understand their role and the needs of residents. • 14/06/07 01/08/07 16. OP32 10(1) 17. OP33 24(1)(b) & (2) 18. OP33 37 19. OP36 18(2)(a) The manager and provider must take steps to address the quality of the service provided when the manager is not on duty to ensure residents are safe and well looked after. The provider must develop an action plan to address the issues raised in the last quality assurance audit and make a report on the quality assurance available to the residents at the home. This is to demonstrate that the home is being run in the best interests of residents. All incidents which fall within this Regulation must be notified in writing to the Commission without delay to enable monitoring of the service provided to residents. All staff must be appropriately supervised to ensure that they are responding appropriately to residents. 14/06/07 01/07/07 14/06/07 30/06/07 Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 33 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 OP3 Good Practice Recommendations Initial assessments should incorporate personal histories; significant life events and cultural and religious needs to enable staff to better understand and support residents on admission. Care staff should read the assessments and care plans to ensure that they are clear about how they should respond to residents and meet their needs. Develop a policy on privacy, dignity and respect and provide training in this so that the staff are clear about the philosophy of care at the home. The residents’ preferences with regard to their routines should be documented in their care plans. The daily menu should be displayed in the home so that residents know what is available and can make informed choices at meal times. The complaints procedure should be more prominently displayed in the home so that residents and relatives can have easy access to it and understand how to complain. The policy on safeguarding adults should be amended to make sure it is in line with local Safeguarding procedures and that staff are not compromising investigations by other agencies. Review the deployment of staff and the staffing levels to ensure there are enough staff to ensure residents do not have to wait for long periods for help and support. Staff should have formal, recorded supervision six times a year covering the areas specified in Standard 36 to ensure their work performance is to the standard required. 2. 3. 4. 5. 6. 7. OP7 OP10 OP14 OP15 OP16 OP18 8. 9. OP27 OP36 Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. Extracts may not be used or reproduced without the express permission of CSCI Melbourne House Care Home DS0000026453.V335552.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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