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Inspection on 20/05/05 for Melbourne House Nursing Home

Also see our care home review for Melbourne House Nursing Home for more information

This inspection was carried out on 20th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The processes for the pre admission assessment are in place and cover the requirements of the standard, there was evidence that assessments are in depth to ascertain service users needs. Despite staff being extremely busy they responded quickly when alarms were sounded and were observed to deal with the situation efficiently. One service users expressed how happy she is in the home and that staff listen to her and another was pleased with the special diet the kitchen staff arrange for her.

What has improved since the last inspection?

The complaints procedure has improved since the last inspection and relevant timescales are now in place for dealing with any complaints efficiently, consequently improving response times for service users. Care plans with regards to consultation should a service user become terminally ill have begun to make improvement and there was evidence of a plan in place within one case file examined, thus resulting in specifically expressed needs being met.

What the care home could do better:

The infrastructure is in place, however further training, staffing, and time is required to implement this sufficiently and develop the processes within thehome. There are various concerns with regards to care planning and assessments, manual handling techniques, staff training and attitudes and record keeping. Therefore several requirements have been set to address these issues.

CARE HOMES FOR OLDER PEOPLE Melbourne House Aspley Lane Aspley Nottingham NG8 5RU Lead Inspector Karmon Hawley Unannounced 20/05/05 10.00 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Melbourne House Address Aspley Lane Aspley Nottingham NG8 5RU 0115 924787 0115 924787 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Eastgate Ltd Janice Ann Cooper-Brown Care Home 39 Category(ies) of OP 39 registration, with number TI 2 of places Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: I named sevice user may be aged 44 years or over Date of last inspection 11th January 2005 Brief Description of the Service: Melbourne House is a purpose built two storey building providing care for up to 38 older people with 2 beds registered for people with terminal illness. There are 3 lounges and a large dinning room providing ample space. The majority of bedrooms are single and a number are ensuite. There is a lift to the second floor and the building is wheelchair accessible. The building is set within its own grounds, which are accessible to service users, it is also close to local amenities in Aspley, which is on the main bus route into the city of Nottingham. Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place in one day, four services users care notes and other relevant records with regards to their care and the environment were examined. Three service users, one visitor and three staff members were spoken with. What the service does well: What has improved since the last inspection? What they could do better: The infrastructure is in place, however further training, staffing, and time is required to implement this sufficiently and develop the processes within the Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 6 home. There are various concerns with regards to care planning and assessments, manual handling techniques, staff training and attitudes and record keeping. Therefore several requirements have been set to address these issues. 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 C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4,5 To enable an informed choice and a suitable placement pre admission assessments are of a good standard. Trial visits are arranged which enhance this process. Whilst staff are able to discuss service users needs, training received is not satisfactory resulting in service users needs not being fully met. EVIDENCE: The manager carries out assessments in the community prior to service users being accepted into the home. Pre admission assessments were in depth and covered the requirements of this standard. There was evidence to demonstrate that all required equipment is obtained prior to service users being admitted. Relevant referrals and nursing determinations were in place. Specialist services are accessed and link nurses within the home facilitate communication. Individual staff training plans are not kept, however there was a main sheet, which identified staff training that has taken place. There were noted deficits in first aid, adult protection, manual handling and health and safety. Prospective service users and relatives are invited to visit the home prior to making a decision and service users may stay for lunch if required. Trial visits can be arranged if requested and the home accepts emergency admissions; the same processes as for arranged admissions followed. Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 Assessment tools in use were not completed consistently thus questioning the validity of these. Complex needs, appropriate monitoring and implementation of requests is not fully addressed thus detracting from care received. Risk assessments do not outline how identified risks are to be managed, consequently service users are at a degree of risk. Respect of service users needs is not fully addressed as two service users spoken with felt there was a lack of consideration of their needs. EVIDENCE: Various assessment tools are in use to assess service users needs with regards to manual handling, nutrition and pressure area care, however these were completed in varying degrees and lacked consistency. There was evidence of National Health Entitlements being received and of specialist services being obtained. Plans of care were based upon the activities of daily living, however identified needs within two care plans examined did not have a plan of care in place. Risk assessments observed were of a complicated nature and did not accurately identify risks and present an appropriate management process of the risk identified. Whist examining care notes it was identified that in one instance these were not up to date with current needs. There was also evidence of a lack of monitoring of health needs with regards to blood pressure Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 10 and glucose monitoring. Daily running records were kept, however in one instance a request for a medication review had not been completed. There was evidence of specialist equipment available and aids with regards to the prevention of pressure sores, however service users raised concerns that they were being lifted under the arms and this was uncomfortable. Staff have recently received training with regards to oral hygiene from a visiting dentist which is also covered in the induction programme along with the philosophy of care. Staff spoken with stated they knock on service users doors prior to entering and they also use signs which state care in progress so people do not enter unless permission given. If service users require a private area this is usually within their own rooms, the conservatory or the office. Service users spoken with did not substantiate this; they discussed lack of care given and consideration to their needs. The manager stated that with regards to death and dying service users and relatives are liaised with to ensure all needs are met. There was evidence of wishes being recorded in those case files examined. Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 Service users enjoy activities available, however further consideration is required to evidence activities have taken place. Service users are enabled to maintain contact with relatives and friend as they wish. EVIDENCE: Two activities coordinators are currently devising a structured programme of activities; these members of staff were not on duty on the day of inspection and no records of activities taken place are kept. However there was evidence that activities had been taking place as resources were available around the home and service users were using these. The only phone available at present for service users use is the one located in the office. Cultural, religious and recreational needs are briefly noted within the plan of care and the manager stated that the Polish father visits the home on a regular basis and other service users go to church with their relatives. Visitors are welcomed into the home and one visitor spoken with substantiated this. Privacy is facilitated if required as discussed in standard10. The visitor’s policy is discussed prior to admission and is displayed in the main entrance. There are currently no community contacts. Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Complaints received are dealt with in a satisfactory manner and staff are able to discuss issues with regards to abuse, however training received is limited thus detracting from service users protection. EVIDENCE: There is a clear, brief and accessible complaints procedure. Three complaints have been received within the last year, there was evidence that these have been appropriately responded to within relevant time scales and consequently resolved. There is an ongoing complaint at present, which is centred around manual handling issues, care standards employed and staff attitudes. This was investigated during this inspection. No personal allowances are kept on the premises. There is a copy of the Nottinghamshire Committee for the Protection of Vulnerable Adults within the home and an additional policy related to the home supplements this. The whistle blowing policy and procedure is displayed in the staff room and staff spoken with were able to discuss these issues, however limited staff have receive official recognised training in this area. Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,23,25,26 The home is well maintained, clean and tidy, with the exception of the laundry room. Specialist equipment is in place, however a review of manual handling equipment will be beneficial, to ensure service users needs are fully met. EVIDENCE: There are three lounges, a conservatory, separate dinning room and the entrance room to provide ample seating within the home. Décor within the home was maintained. Doors with the exception to the main door and laundry door are linked to an alarm system. On the day of the inspection these alarms were set off by a service user who was leaving the home, the staff on duty responded quickly. All heating within the home is supplied under floor or ceiling. Window restrictors are in place. The manager stated that water temperatures are recorded however these were not available for inspection. Adequate domestic staff are employed to maintain hygiene standards, the home was clean and tidy with the exception of the laundry room where dirty clothes had been placed on the floor. Service users rooms were personalised and relevant aids and equipment were noted to be available. Some rooms are ensuite and there are ample washing and toilet facilities available. Manual Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 14 handling equipment was noted to be in place but limited with regards to the type of hoist available. Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 A minority of staff on the day of inspection were rude and dismissive towards the inspector resulting in a poor impression gained, service users and one visitor felt they experience this attitude on a daily basis, however those members of staff spoken with were friendly and knowledgeable. The lack of completed criminal records bureau checks in place could implicate the protection of the service users. EVIDENCE: The manager stated that she on occasion works along side staff as part of the required numbers. Supernumerary time is not specifically allocated to ensure she maintains managerial responsibilities. Staff allocation is aimed at one registered nurse on each shift; four to five care assistants on the morning and afternoon shift and two care assistants at night. Staff rotas were observed and this was evidenced. However a member of staff has spoken with the Commission for Social Care Inspection and stated that staffing numbers currently are not sufficient to fully meet service users needs and if members of staff are off sick shifts are not covered thus increasing pressures of work and responsibilities. On the day of inspection it was noted at particular times that staff were extremely busy. The induction programme, of which there was evidence within staff files, covers the requirements of this standard. The manager stated that she is in the process of commencing appraisals, relevant paperwork for these were observed. Formal supervision sessions are Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 16 not currently held. The manager works with care assistants on a one to one basis whilst delivering care. Staff files were observed and contained the required information and checks with the exception of some longer-term members of staff who are still awaiting criminal records bureau checks. Staff training records demonstrated that not all mandatory training has been covered and some training is now out of date. (Please see standard 4) The manager stated that staff have received the General Social Care Council Code of Conduct, however staff spoken with were unable to substantiate this. Staff were very reluctant to talk to the inspector and were dismissive, however two members of staff were spoken with they expressed they had not realised they had been rude. Following discussions another member of staff who had not been spoken with passed a sarcastic comment apparently aimed at the inspector. This was further discussed with the manager at the end of the inspection and was to be addressed. Staff felt that communication within the home was good and the team get on well together. They stated that all service users are treated with respect and staff are friendly. However another member of staff spoken with substantiated that at times some staff are sarcastic and have a poor attitude, which has been discussed with the manager. The staff spoken with were able to discuss current care needs of service users and core values and principles of care. They did however express that they felt they would benefit from further training in regard to complex issues. Service users and one visitor also expressed concern with regards to staff’s attitudes and one service user stated she was afraid to talk to staff, with consent this was further discussed with the manager after the inspection. It was also felt that there was not sufficient staff available to fully meet needs and service users expressed they find they are waiting for excessive amounts of time for attention. Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,37,38 The manager requires allocated supernumerary time to ensure the home is run in the best interest of service users and their needs are fully met. Some records were not available for inspection, which was a cause for concern as it demonstrates possible risks with regards to the health and safety of service users. EVIDENCE: The manager stated that she works along side other staff and is included in the staffing numbers, no supernumerary hours are officially allocated, she stated that she is able to maintain managerial work, however the lack of documentation in service users case files does not substantiate this. Quality assurance questionnaires are sent to service users on an annual basis, which are received by the proprietor and evaluated, these are then passed to the manager to address any negative issues. The manager states this is done via staff meetings. Copies of these were not available for inspection. The manager stated that service users and relatives are free to approach her should they have any issues they wish to discuss and they often do so. Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 18 All servicing and maintenance records were observed with the exception of the main electrical testing certificate, which was not available, no issues of concern were noted. Fire alarm testing however had not been carried out on a weekly basis and water temperatures were not available. Staff training is lacking in first aid, although a date for this has been arranged, health and safety adult abuse and manual handling. Whilst observing accident records it was noted that a reportable accident had not been reported under RIDDOR Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 1 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 x 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION 3 x 3 x 3 x 3 1 STAFFING Standard No Score 27 1 28 x 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 x x 1 x x x 1 1 Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 20 YES 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 OP4 Regulation 18(1c(i)) Requirement Staff training must be addressed to ensure staff have the necessary skills and knowledge to meet service users needs, this must include issues around staff attitudes and relations with service users and appropriate others. Assessments of service users must be consistent to ensure they obtain all required information, appropriate monitoring and observations must be recorded. Care plans are required to address all identified needs to ensure a relevent plan of care is in place to meet service users needs. Appropriate risk assessments must be in place to identify risk and outline the management of the risk. Manual handling equipment must be reassessed to ensure there is sufficient supplied to meet service users assessed needs and up to date practices are maintained. Records with regards to activities that have been undertaken must Timescale for action 31st July 2005 2. OP7 14 (1) 2nd July 2005 3. OP7 15(1) 2nd July 2005 4. OP7 13 (4c) 2nd July 2005 31st July 2005 5. OP8 13 (5) 6. OP12 16(2n) Immediate Page 21 Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 7. 8. OP26 OP27 13(3) 18 (1) 9. 10. OP29 OP30 19 (1) 18 (4) 11. OP31 10(1) 12. 13. OP33 OP37 24(2) 17(3 a schedule 4) be kept and evidence to demonstrate that service users have been consulted to take part in activities offered. this is an outstanding requirement and must be addressed to avoid enforcement action. Infection control procedures are to be readdressed with regards to the handling of soiled clothing. Staffing levels must be evaluated and evidence available to demonstrate sufficient staff are available to meet service users assessed needs. All staff employed are required to have Criminal Records Disclosure Checks in place. All staff are to be issued with the General Social Care Council Code of Conduct. This is an outstanding requirement and must be addressed to avoid enforcement action. The registered manager is required to have sufficient time allocated to manage the care home with sufficient care, competence and skill. Quality assurance data is to be available for inspection Records with regards to maintaining health and safety of service users are to be maintained and available for inspection. Immediate 6th July 2005 Immediate Immediate 2nd July 2005 31st July 2005 2nd JUly 2005 14. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 22 1. Melbourne House C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Edgeley House Tottle Road Nottingham NG2 1RT Address 4 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 C53 C03 S26453 Melbourne House V229045 180505 Stage 4.doc Version 1.30 Page 24 - 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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