CARE HOMES FOR OLDER PEOPLE
Melbourne House Care Home Aspley Lane Aspley Nottingham NG8 5RU Lead Inspector
Karmon Hawley Unannounced Inspection 20th October 2005 10:00 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.V260096.R01.S.doc Version 5.0 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.V260096.R01.S.doc Version 5.0 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 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.V260096.R01.S.doc Version 5.0 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 20th May 2005 Date of last inspection Brief Description of the Service: Melbourne House is a purpose built two-storey building for up to 38 older people with 2 beds registered for people with terminal illness. There are three lounges and a large dining 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 with a small garden area which is accessible to service users. Melbourne House is also close to local amenities in Aspley, which is on the main bus route into the city of Nottingham. Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place in one day and was performed by one inspector. The main method of inspection was case tracking, this is a method of sampling the records of three randomly selected service users to ascertain if the needs of service users are appropriately assessed and identified needs are being catered for by the home to maintain optimum health and wellbeing of the service user. Three service users and two relatives were spoken with during the inspection so as to give the inspector an insight into the conditions and standards within the home. All were satisfied with the care received and the standards within the home. The manager, nurse in charge and two staff members were spoken with. Staff were able to discuss core values and principles of care and their job role in meeting service users needs. Staff were helpful and polite to the inspector. The manager discussed that a variation application is currently being considered with regards to including 3-4 beds for service users with dementia types illnesses and 3-4 beds for service users less than 65 years of age. The manager had not received the previous inspection report and therefore was unaware of the full requirements set, however due to feedback that had been given on the day she had worked towards complying with many of the requirements that had been set. Due to this consideration has been given with regards to the requirements set and the timescales given at this inspection. What the service does well: What has improved since the last inspection?
There have been several improvements made since the last inspection. The most noticeable being the morale and attitude of the staff, which offered a pleasant, and welcoming atmosphere for service users and visitors.
Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 Page 6 All activities undertaken are now recorded demonstrating that service users are offered these and given the opportunity to continue with past hobbies and interests. The fire alarm testing is now carried out on a weekly basis promoting service user, staff and visitor safety. Improvements have been made with regards to care plans ensuring needs are addressed however further development is still required to fully meet service users needs. Additional training has been arranged and some delivered to develop staff knowledge and skills, however further attention is still required to meet mandatory requirements. Infection control measures have been improved with the purchase of more linen baskets ensuring laundry is not placed on the floor thus enhancing infection control. All staff except two who are not working at present now have criminal records bureau checks in place ensuring added protection of service users. 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 Care Home DS0000026453.V260096.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 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 the following standard(s): EVIDENCE: Not assessed during this inspection. Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 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 the following standard(s): 7,9 Whilst plans of care are in place these did not fully reflect complex needs and were not personalised, thus detracting from health, personal and social needs being fully addressed. Medications procedures and policies require updating and readdressing to ensure service users are fully protected. EVIDENCE: Three service users care files were observed which reflected that assessments with regards to the activities of daily living, pressure areas and nutrition are undertaken to form the basis of the plan of care. There was evidence available to demonstrate that service users and relatives had been involved in the care planning processes and reviews. The manager stated that care plans are currently being updated; therefore reviews were not available in one file examined. Care plans in place were mainly of a computerised pre prepared nature and did not reflect individual care. Also in one file examined where a complex need had been identified a plan of care was not in place. Risk assessment were in place with regards to pressure areas and the aids to be used however with regards to other risks identified such as aggression and risk of falls no risk assessments were in place. Progress notes were kept however
Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 Page 10 in one case file examined, which highlighted a problem, had not been addressed and resolved. Medications checked on the day of inspection were satisfactory and corresponded with the prescription chart, however there were gaps in signing for medication that had been omitted and administered. The medication policy requires updating as to reflect current practices. A new contract is currently being considered with regards to the disposal of medication in order to remain up to date with current legislation. Due to this not yet being in place empty oxygen cylinders were stored in the treatment room, there was no sign on the door stating this and to ensure caution. Although the manager stated that drugs are checked into the building there was no evidence available to substantiate this. Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 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 the following standard(s): 14,15 Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing and balanced diet in pleasing surroundings. EVIDENCE: Service users are enabled to make choices with regards to their daily lives, this was apparent during the inspection, talking with service users, staff and relatives and evidenced within plans of care. Service users spoken with stated that they are able to choose what they do throughout the day and staff listen to their needs, and assist them at all times if required. If able service users maintain control of finances, however there are facilities available to assist this if needed. Although advocates are not used at present they have been used in the past and staff were aware of how these may be accessed should the need arise again. Service users are able to bring in personal possession to make their rooms more homely and one service users and two relatives substantiated this. Mail is received unopened or it is given to relatives if considered necessary. A telephone is available for service users use in the office and there are telephone points in each room should a service user require and individual line installed. On observation the kitchen was extremely clean, tidy and well organised. All cleaning plans and temperature testing were recorded and up to date. The
Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 Page 12 menu demonstrated that choice was available and a wholesome and appealing diet offered. Service users when spoken with stated that food was at a good standard and they had a choice at meals. Service users are assisted with meals as required in a dignified manner and special diets are also catered for. All service users undergo a nutritional risk assessment to ensure needs are met with this regards. Staff training certificates identified that the main cook’s food hygiene certificate is now out of date. Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 Page 13 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 the following standard(s): 18 Despite staff being able to discuss adult protection issues and appropriate polices in place service users may remain vulnerable due to the lack of official staff training. EVIDENCE: Relevant policies and procedures were in place with regards to adult protection and staff when spoken with were able to discuss these issues to a satisfactory standard, however no official staff training has been delivered to staff. Service users and relatives spoken with were satisfied with the standards of care and expressed no concerns. Two staff members although not working at present still require criminal records bureau checks. Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 Page 14 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 the following standard(s): EVIDENCE: Not assessed during this inspection. Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 The number and skill mix of staff meet service users needs, however consideration of staff opinions are to be considered to ensure quality time is offered to service users at busy times. Whilst service users are in safe hands, this may be compromised due to additional training required and the improvement of the induction programme. EVIDENCE: The staff rota was observed and demonstrated that sufficient staff are employed at present, however staff when spoken with expressed that it was on occasion hard work in the mornings when attending to service users as one staff member is allocated to the dining room whilst service users are having breakfast. The manager when spoken with was aware of this and is willing to look into this further and address these issues. Two staff currently have attained their National Vocational Qualification (NVQ) level two in care and a 10 further staff have recently undertaken numeracy and literacy tests in advance of commencing induction of their NVQ next month. Staff training updates in manual handling and fire has been delivered and training with regards to first aid and dementia have been arranged. The home currently follows a basic induction programme, although the manager is looking to improving this to meet with requirements.
Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35 Service users live in a home, which is run and managed by a person of good character who is able to discharge her responsibilities and remain up to date in her practices. Service users financial interests are safeguarded, however further consideration to this system may prove beneficial. EVIDENCE: The manager is a registered nurse and remains up to date in her practices by attending various courses and training events. She has been employed by the in the home for ten years, five of which have been as the manager. She was able to demonstrate competence of her job role and knowledge and understanding of the service users within her care. She has completed an introduction to managing and is now looking into funding with regards to the National Vocational Qualification Registered Managers Award.
Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 Page 17 Personal allowances are received from the Adult Residential Services and are accessed by the manager or the administrator only. In their absence a float of money is used which then is repaid as necessary. There was no money kept at present as the manager had been on annual leave and therefore money had not been received, whilst waiting for it to come the manager stated that the residents’ fund is being used, and again money will be replaced. The manger stated that money is kept in a locked filing cabinet and receipts are kept and transactions are recorded, and signed by two staff members, these were not observed. The manager or proprietor is not responsible for any individual’s money. Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 Page 18 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 3 28 2 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 2 X X X Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15(1) Requirement The responsible individual is required to ensure care plans are personalised and address complex needs to ensure a relevant plan of care is in place to fully meet service users needs. This is an outstanding requirement and must be addressed. Appropriate risk assessments are required to be in place to address the risk and management to fully protect service users. This is an outstanding requirement and must be addressed. The responsible individual is required to ensure a contract with regards to the safe disposal of medicines is obtained. The responsible individual is required to ensure that the medicines policy is updated and practices with regards to the safe storage of oxygen and administration of medication is addressed. The responsible individual is required to ensure evidence is
DS0000026453.V260096.R01.S.doc Timescale for action 30/11/05 2 OP7 13(4,c) 30/11/05 3 OP9 13(2) 30/11/05 4 OP9 13(2) 30/11/05 5 OP15 16(2,i,j) 10/12/05 Melbourne House Care Home Version 5.0 Page 20 6 OP18 13(6) 7 OP28 18(1,c,i) 8 OP31 10(1) 9 OP33 24(2) 10 OP38 17(3,a) schedule 4 available to demonstrate staff are fully trained to ensure food safety. The responsible individual is required to ensure the outstanding criminal record bureau checks are obtained and staff undergo training with regards to adult protection. This is an outstanding requirement and must be addressed. The responsible individual is required to ensure the induction programme meets the required standards. The registered manager is required to have sufficient time to carry out managerial responsibilities. This is an outstanding requirement and needs to be addressed. Quality assurance data is to be available for inspection. This is an outstanding requirement and must be addressed. Records with regards to maintaining health and safety of service users are to be maintained and available for inspection. The responsible individual is required to forward to the commission evidence of the highlighted maintenance check. 20/10/05 20/12/05 30/11/05 20/12/05 20/11/05 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 OP9 Good Practice Recommendations To reconsider the use of shared bottles of lactulose solution to fully protect service users.
DS0000026453.V260096.R01.S.doc Version 5.0 Page 21 Melbourne House Care Home 2 3 OP27 OP35 To consider staff opinions with regards to staffing levels at busy periods of the day. To reconsider the procedure with regards to personal allowances to ensure that service users individual money is available at all times for their use and demonstrate the safe keeping of this Melbourne House Care Home DS0000026453.V260096.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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