Inspection on 21/11/07 for Melbourne House Nursing Home

This inspection was carried out on 21st November 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Melbourne House Nursing Home 14/03/09

Melbourne House Nursing Home 07/05/08

Melbourne House Nursing Home 01/05/07

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 Susan Lewis Karmon Hawley Unannounced Inspection 21st November 2007 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.V354586.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.V354586.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 0115 9294787 javid0612@yahoo.co.uk 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.V354586.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within the total number of beds 1 bed can be used for a named service user aged 44 years 1st May 2007 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 dining 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. The service is close to local amenities in Aspley, which is on the main bus route into the City of Nottingham. 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.V354586.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 two inspectors; it was unannounced and included the lunchtime period. The main method of inspection used is called ‘case tracking’ which involved selecting four 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. Three 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. We were unable to effectively understand and communicate with some of the people living at the home, therefore some judgements in this report are drawn from our observation of staff and resident interactions. Two hours were spent observing the care given to a small group of people. All observations were followed up by discussions with staff and examination of records. Three members of staff and two sets of relatives were spoken with as part of this inspection. In addition the views of seven 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. The registration document was reviewed as part of this inspection to ensure it was correct. No amendments were necessary at this inspection. The Annual Quality Assurance Assessment was not received in time to include any information in this inspection report. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Further training has taken place and more is booked including safeguarding adults training for all staff. Prospective residents are now given information about the home to inform their decision before moving in. Relatives said that they are consulted in the creation of care plans to ensure that they meet the needs of the individual. Where residents need help to eat their meals staff assist in an appropriate manner. The provider has now investigated an outstanding complaint and provided the Commission with the information it needed to show what action if any has been taken. The registered manager has undergone safeguarding adults training to ensure she understands her responsibility in protecting residents from abuse. Staff now have a better understanding of their responsibility to report poor and dangerous practice and so protect residents. Supervision is taking place that addresses staff approach to their work and improve the quality of care for residents. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 7 What they could do better: There have been some development in regards to care planning , however a the quality of reviews and monitoring place residents at risk. Care plans must provide detail of how the staff are to provide care and how the resident wants that care to be provided. Reviews must involve residents, where possible and relatives to ensure the care remains up to date. Medication practice remains poor and again places residents at risk of not receiving their prescribed medication. There must be improvements in monitoring of records and staff who administer medication to ensure practice meets the required standard. Some staff still refer to residents in a derogatory manner and there is a general lack respect. Staff must use more appropriate language when referring to residents. Residents spend long periods of time inactive and many complained of being bored, although there are some organised activities these are insufficient to occupy all residents to provide a quality life. A range of activities must be developed which are appropriate to the needs of less able residents in order to meet their social needs. Residents who have different nutritional needs whether this is through dietary choices or through religious choices are not having them met appropriately. There is a lack of understanding regarding what constitutes a healthy and balanced vegan diet. Meals must be developed that meet all residents nutritional and cultural dietary needs. Maintenance problems within the service continue to be slow to be resolved and this means some residents cannot have their personal choices met regarding their care plan. Maintenance issues should be dealt with more quickly to provide safer and more comfortable surroundings for residents. Privacy is not maintained in shared bedrooms, as screening is not available. Privacy screening in all of the double bedrooms must be used to protect residents’ privacy and dignity. The conservatory was noted as being cold at the inspection in May 2007, as it had no heating, it continues to have no heating, and is therefore unusable. The commission is considering a condition of registration so that this part of the building is not used as part of the registered service. Many of the requirements made at this inspection have been outstanding for sometime and the Commission is looking at taking enforcement action against Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 8 the provider. However it is also the registered manager’s responsibility to ensure that the home is run well and with so many concerns regarding the service the Commission may also consider the manager’s fitness to be a manager. The registered manager and provider must ensure that requirements set at each inspection are acted upon in to meet the date set. Although quality surveys have started to be sent to service users there is no evidence that the collated information is passed to the registered manager to make improvements in the service. The registered provider should write a list of the actions that need to be taken and when they will be done to address the issues that are raised 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.V354586.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.V354586.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): 3 and 6 Quality in this outcome area is good. Each resident is provided with a statement of terms and conditions prior to moving to the home. Admissions are not made to the home until a full needs assessment has been undertake This judgement has been made using available evidence including a visit to this service. EVIDENCE: No intermediate care is provided in this service. Four care plans were viewed for the purpose of this inspection including someone who was admitted to the home recently. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 11 In discussion with relatives they said that they had been given plenty of information regarding the home and this helped them make the decision for their loved one to move to the home. A requirement was made at the last inspection to ensure that all residents and their relatives are given up to date information about the service. This requirement is met. Relatives also said that staff had helped their loved one settle in and were very kind. Staff were observed with this resident interacting in a positive manner and ensuring that they were reassured when they were concerned about something. Families also confirmed that the manager visited their loved prior to coming to the home to carry out an assessment. Staff spoken with said that they weren’t sure of the admissions process but they knew the manager visited the resident before coming to the home and then it was the carers job to help settle them in with one of the nursing staff. Melbourne House Care Home DS0000026453.V354586.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. Most residents have care plans although they are often out of date, reviews take place but do not always reflect changing needs. Medication records are not up to date; there are gaps in recording and information. The current practice and lack of adequate recording puts residents at risk. Some staff continue to address residents inappropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were viewed to ensure that the requirements made at the last inspection were met. The first requirement was that care plans must explain in detail the health, personal social and cultural and religious needs of the residents to ensure that people receive the holistic care they need. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 13 Evidence in diary notes showed that care provided to residents was not always reflected in care plans. Such as when a resident had a catheter fitted but there was no mention of this in the care plan. A resident who had been admitted for respite care earlier in the year had not had their assessment updated during this current period of respite and the diary notes showed that the care needs had changed. Care plans are not always up to date. The care plans for a resident who had diabetes stated that they could self medicate but the manager said this was no longer the case. Also this plan did not identify specialist needs such as foot and nail care, which are very important for people with diabetes. A further requirement set at the last inspection was that bed rails must be used with appropriate bumpers to protect residents from the risk of injury. Risk assessments were in place for bedrails but not always fully completed to explain what adverse outcomes there may be for the residents if they were to be used. Two accident records were seen that showed that residents had caught a limb in a bedrail showing that bumpers were not routinely used immediately after the last inspection to minimise the risk of limbs being trapped. However evidence was seen that bumpers were in use for some residents. This requirement is partially met. Care plans and diary notes showed that residents were not being routinely weighed despite this being in their care plans as being important to monitor their nutritional intake. Residents who had culturally specific needs did have some information in care plans and it showed how nutritional needs were to be met. Care plans did reflect residents’ preferences showing how they preferred to receive their care and how they wanted to spend their day. Staff spoken with were also aware of residents cultural and religious needs. Despite risk assessments taking place such as pressure care and infection control there were not always care plans in place to show how an identified risk was to be met. Residents spoken with said that they see a doctor when they need one and that ‘staff help me when I need help’. A requirement was made at the last inspection regarding residents (or their relatives) being involved in the development of their care plan to ensure they are properly consulted about the care they receive. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 14 Only one resident and relatives spoken with confirmed that they had been consulted when staff created the care plan. Most other residents were unable to recall if this happened. Staff spoken with said that when care plans are reviewed that residents are involved but this is not always recorded. All residents spoken with said that they are happy with the care they receive. Staff said that they find care plans useful and read them to find out how residents needs are to be met. Although important that staff read care plans the evidence from diary notes showed that care plans were often out of date and so staff may be providing inappropriate care. Fourteen medication administration records were viewed and gaps were noted in all records as well as errors of omission in giving important medication and hand written entries were not signed and countersigned to minimise the risk of errors when transferring information to the medication administration records. There were two residents who had needed to wait for prescriptions to be filled or other circumstances and so had not received their medication for seven days. There was an audit system in place to prevent gaps in records, which made it easy to follow what had been administered and where errors had occurred, however this did not address the fact that nursing staff were not signing for it. The controlled medication records observed were correct and evidenced that this part of the requirement set at the last inspection visit had been met. Where residents had specialist health needs these were not always being met and staff were not always aware of what the side effects were of medication, even though the information had been provided by the hospital. One resident was prone to hypertension due to their medication, there was no evidence this was being monitored. This had the potential to place the resident at risk. A care plan identified that a resident some times refused medication which could lead to problems with health however there was no plan or risk assessment in place to identify what action staff should take should an emergency occur. Following the inspection visit the provider forwarded an action plan in regard to the measures to be taken to address these outstanding issues. During the course of the day staff were observed with residents and visitors. Most residents were treated with respect and spoken to in a pleasant manner. Visitors spoken with said that staff made them feel welcome. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 15 However one member of staff referred to residents at lunchtime who needed assistance with meals as ‘feeders’. This is demeaning and does not show respect. This was raised at the last inspection and an immediate requirement was issued. This was brought to the manager’s attention again. The manager said she had addressed this with staff and they knew that they must not refer to residents in such terms. Staff spoken with said they were instructed how to address residents in induction and during supervision. The registered person must ensure that this is complied with. Melbourne House Care Home DS0000026453.V354586.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 and 15 Quality in this outcome area is poor. Activities are not always provided that are adequate and stimulating and residents have become compliant with the routine of the home. Residents are able to have personal possessions in their room. The food in the home is of good quality, well presented but it is cot clear that they always meet the dietary needs of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A requirement was made to provide details of the specialist communication needs of people whose first language is not English and identify the methods of communication that will be used with each individual. Care plans did identify any cultural needs such as communication and residents were seen able to play culturally appropriate music. This requirement is now met. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 17 A second requirement was made to 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. Staff spoken with understood the cultural needs of residents and were able to give examples of how they supported residents to maintain their cultural identity. This requirement is now met. A third requirement was made to provide activities, which are appropriate to the needs of less able residents to meet their social needs. There is an activities organiser who works part time and there was an activities trolley near the lounge areas that staff spoken with said they could use when they had time, however residents spoken with said that they did not see much of the staff, this is further discussed in standard 27. The manager also said that relatives had access to this trolley if they wanted to entertain residents. However during the course of the inspection no one was seen accessing it. Relatives spoken were not aware they could use it if they wanted to. A period of observation took place between 12.20pm and 1.20pm in the dining room and 2.50pm and 3.45pm in the lounge. Most of the contact residents had during the lunchtime was around the meal and residents were mostly passive and did not engage with those around them or their environment except when their meal arrived. During the second period of observation residents were either watching television, but the picture was cloudy and no staff came to change it, or were sleeping. Most residents spoken with talked about how bored they were most saying there was nothing to do other than watch television but said this was OK. This requirement is not considered met. Residents said that they could have visitors anytime, which they liked and relatives confirmed that they were able to visit any time and were made welcome. Residents bedrooms were personalised and those spoken with confirmed that they had been able to bring in personal items when they came to the home. The midday meal was observed and all the residents who were confined to chairs and needed assistance with eating their meal were placed at one end of the dining room. Staff were observed assisting them sensitively and ensuring that they had finished each spoonful before giving more. Each member of staff showed warmth and kindness to the residents they were assisting. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 18 A choice was provided for both the main course and pudding and residents were asked what they wanted. Residents spoken with said that they enjoyed the meals and had plenty as well as drinks throughout the day. A resident who was provided with culturally appropriate meals on set days was waiting for it to arrive and a carer asked if they wanted ‘Your own food or our food’. Although the deputy manager said this was to give the person choice in fact this way of asking further marginalised the person and showed lack of understanding in supporting the person’s cultural needs. It was also noted in the person’s care plan that they were vegan but in reading the food diary it was not clear that this was always being adhered to. The person was being given potatoes and vegetables with gravy on days that the culturally appropriate diet was not available. It was not clear whether the gravy was suitable for vegans. It was also observed during the mealtime that a member of staff was asking residents what they wanted for lunch and then shouting across the dining room to the kitchen what people wanted. This is not appropriate and residents could be seen to flinch. Melbourne House Care Home DS0000026453.V354586.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 and 18 Quality in this outcome area is adequate. Residents and relatives understand how to make a complaint. All relevant staff demonstrate an awareness of the content of the policy and know what immediate action to take and when and who to refer any incident on to. Safeguarding adult training is not given the priority in new starters induction it should be to ensure residents are protected at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a detailed complaints policy and relatives spoken with were aware of it and said that they felt confident to talk to the manager regarding complaints. The complaints records were viewed and none had been received since the last inspection. The Commission had received one complaint since the previous inspection visit in regard to a room that was being used for respite care, this is addressed further in standard 19. Staff spoken with said that if a resident complained to them they would ask the person in charge of the shift to speak to the resident or take it to the manager. Residents spoken with said they knew who to complain to and felt sure it would be dealt with. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 20 A complaint that remained unresolved at the last inspection was discussed with the manager but as it concerned her she was unaware of all the details other than she believed the proprietor had looked into the matter and believes did resolve it. Information was requested from the proprietor to confirm what was the outcome of his investigation and action had been taken if any. This was provided by email and had been looked into by the proprietor and resolved. At the last inspection a requirement was made for the manager to attend training on safeguarding adults. The training manager confirmed that the manager had attended this training. This requirement is met. The training manager provided information to show what training was carried out for staff to ensure they were fully aware of their responsibilities in regard to protecting residents. The training manager explained what was covered on induction however staff were to attend a more detailed safeguarding adults training later. In discussion with the training manager she mentioned that during some inductions the safeguarding adult information is either only briefly covered or dropped altogether due to time constraints in needing to get other areas such as moving and handling dealt with. This is a concern because if staff do not understand what safeguarding adults is there is potential for residents to be at risk. A new member of staff may not attend safeguarding adults training for several months after they have started. A requirement was made at the last inspection to address the staff culture of refusal around whistle blowing poor practice to ensure that residents are protected from harm and abuse. Staff spoken with said they knew what the whistle blowing policy was and when given different scenarios around poor practice were able to describe what action they would take including if it was the manager at fault. Relatives asked if they felt their loved one was safe in the home said that they did. Melbourne House Care Home DS0000026453.V354586.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, 24 and 26 Quality in this outcome area is poor. The home is generally clean and tidy. There are sufficient bathrooms and toilets but some are not in good working order or are being used as stores. Maintenance continues to be progressed slowly limiting residents choice in how their care needs are met. Residents are also limited to what space they can use due to some areas being cold. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A partial tour of the building took place and a number of selected bedrooms were seen. The service offers three lounges and a conservatory. At the last inspection the conservatory was not used as it was cold and that heating should be provided Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 22 to enable residents to use it. There was no evidence that this had been done as the area continues to be cold and residents spoken with said that they mainly stayed in one bit of the home, as it was cold elsewhere. This requirement is not met therefore the Commission is considering adding a condition of registration for this part of the building not to be used as part of the registered service. A further requirement was made to ensure that maintenance issues are progressed more quickly to ensure the home is safe for residents to use. During the tour it was noted that the only shower was leaking and could not be used. It had been reported two weeks prior to the inspection with no indication when this was likely to be resolved. This room was now being used for storage of old mattresses. Other bathrooms around the home were also being used as storage for old equipment. It was also noted in care plans residents had expressed a preference for showers and so were being denied their preferred method of maintaining their personal hygiene. On the day of the inspection the manager was observed trying to contact a plumber to resolve this matter. During the tour of the building the room in regard to the complaint was viewed. The window was frosted glass, which consequently meant that the resident in this room could not look out. Other bedrooms on this side of the building had not got frosted glass in place. On discussing this with the staff they were not able to explain why frosted glass was in use in this room. Although the grounds are accessible they are not secure and there is potential that a resident may leave the building and walk out to the main road unnoticed. Staff spoken with said that they felt that the home was usually well maintained and felt the manager tried to get things sorted out as quickly as possible. Residents spoken with did not raise any concerns regarding maintenance. A requirement was made to ensure privacy screens were available in double rooms. During the tour of the service no screens were seen in double rooms. This requirement is not met. A requirement was made to keep the home free from offensive odours. Staff spoken with mostly felt that the home was clean although they reported that when they were very busy it sometimes got difficult to keep on top of both the cleaning and making sure residents were cared for. No odours were present on the day and relatives spoken with said they had not noticed any bad smells. This requirement is met. There are a number of residents with different infectious illnesses such as MRSA and Clostridium difficile (C Diff). Staff spoken with had a good understanding of infection control and what was ‘barrier nursing’. One resident Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 23 who had C Diff was confined to their bedroom and was being barrier nursed; however the door to the bedroom was open. In this persons care plan it mentioned they did not want their door closed. Good practice is that in such cases doors are kept closed. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 24 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. Residents are generally happy but feel that there are not enough staff to help them. The service recognises the importance of training, and delivers where possible a programme that meets any statutory requirements. The service has a robust recruitment procedure, which protects residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff spoken with said they felt that usually enough staff were on duty to meet the needs of residents. There are currently 37 residents 19 of who are nursing category. Usually there are 5 carers and 1 nurse on at peak times. All of the residents spoken with said that they did not feel there were enough staff on duty. Residents said ‘It’s not bad here. I want to go for a smoke but the staff are too busy to take me’. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 25 ‘Staff are very nice but very busy and you don’t see very much of them’. ‘Night staff are very busy and you have to wait literally hours for help. It happens in the day but it is much worse at night’. ‘I’m happy and settled. You don’t see staff very often, we are left to ourselves most of the time’. During the observation in the lounge two staff were seen coming in and out of the lounge asking if residents needed anything and bringing hot drinks around. Most of staff contact with residents was focussed on a task such as taking them to the toilet or bringing drinks very little was on sitting and talking to residents or spending any quality time with them. There is a wide gap between the staff view of what it is like in the home and the experience for residents. Over 50 of staff have attained their National Vocational Qualification 2 to ensure a suitably qualified workforce. A training matrix showed what training staff have attended and what they needed to attend. Most staff need to update their mandatory training such as Moving and Handling, Infection Control and Fire. However evidence of staff being booked on courses was provided to show that this is being dealt with. A comment that was made in the inspection in May 2007, that ‘despite this training it is not always evident that staff are maintaining the high levels of care expected in a care home’, remains relevant at this inspection. It was clear from staff supervision records that management are trying to address this to ensure that all residents receive a good quality service. Staff recruitment records were checked to ensure that robust practices were in place to protect residents from people who should not be working with vulnerable adults. All records were in place and were in good order. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 26 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, 33, 35 and 36 Quality in this outcome area is poor. The manager is a qualified nurse and has the necessary experience to run the home however she does not always ensure staff follow the services policies and procedures in working with residents. The service is not run in the best interest of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is a qualified nurse and currently undergoing a variety of training to ensure she remains up to date with changes occurring in legislation in the care sector. Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 27 Staff spoke positively about the registered manager saying that she was supportive and caring. One staff member felt ‘she gave her all’. However it is the registered manager and provider’s responsibility to ensure that all outstanding requirements are met and that the home is run to the Care Home Regulations, this is currently not happening with some requirements remaining unmet from previous inspections. The Commission is now considering taking Statutory Enforcement because of continued breaches of regulations and is also assessing the fitness of the registered persons due the number of unmet requirements. A requirement was made at the last inspection to ensure that the manager and provider took steps to address the quality of the service provided when the registered manager is not on duty to ensure residents are safe and well looked after. Although some improvements have been noted since the last inspection it is clear that the registered manager has not been able to ensure that all staff are clear about what is an acceptable way of speaking about residents. (See standard OP 10). Despite the manager instructing staff not to refer to residents who need assistance to eat their meals as ‘feeders’ one member of staff continues to do this. This requirement is not met In discussion with staff they were unaware of any quality assurance that takes place in the home. The registered manager reported that the next questionnaires are due to be sent out shortly. The provider deals these with centrally at the head office and comments are highlighted for the manager to deal with. There is still no evidence that this home is run in the best interest of residents, it was required at the last inspection to create an action plan to address issues that had been raised as a result of the last quality assurance questionnaires. There was no evidence that this had been done. Supervision of staff has started with the training manager but not the registered manager, notes for these meetings were seen. Staff spoken with confirmed they had received supervision from the training manager. In checking the accident and incident falls for the service against those received by the Commission it was clear that we are still not receiving them despite this being a requirement at the last inspection. The manager assured the inspector that she was sending them and showed copies of those sent. A discussion took place on how to ensure that copies were received and the manager will ensure that this happens. As there were no concerns raised regarding health and safety this standard was not checked during this inspection. Melbourne House Care Home DS0000026453.V354586.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 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 2 2 1 X X X 1 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X X 3 X X Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 29 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 Care plans must explain in detail 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, 7/11/06 and 30/06/07 not met). Statutory enforcement action is being considered Care plans must be kept up to date and reflect the change in needs of residents to maintain their safety. Bed rails must be used with appropriate bumpers to protect residents from the risk of injury. (This is an outstanding requirement and the timescale of 14/06/07 is not met) Residents weights must be monitored and recorded for the purpose of monitoring their nutritional intake particularly where this has been highlighted in their care plan. All prescribed medication must DS0000026453.V354586.R01.S.doc Timescale for action 21/11/07 2 OP7 15(2)(b) 25/02/08 3. OP7 13(4c) 21/11/07 4 OP8 17(1)(a) Schedule 3 14/02/08 5 OP9 13(2) 14/02/08 Page 30 Melbourne House Care Home Version 5.2 6. OP9 7. OP12 be administered as prescribed for example injections to ensure that residents health and wellbeing is sustained. 19 (1) The Medication Administration 14/02/08 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. 16(2)(m & Activities, which are appropriate 11/01/08 n) to the needs of less able residents, should be developed in order to meet their social needs. (This is an outstanding requirement and the timescale of 30/07/07 is not met) 12(4) 23(2) Meals must be provided that meet the cultural and religious needs of residents. Maintenance issues must be progressed more quickly to ensure the home is fit for purpose and meet residents care needs are met as they identified in their plans of care. The manager must ensure that the identified staff member responds to residents in an appropriate way and with respect for their dignity The registered persons must involve residents in the quality monitoring of the service to ensure that their views and opinions are taken into account and the service is run in their best interest. 25/02/08 25/02/08 8 9. OP15 OP19 10 OP31 9(1) 14/02/08 11 OP33 24(1) (a)(b) (2)(3) 25/02/08 Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 31 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 OP10 Good Practice Recommendations 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. Ensure that safeguarding adults information during induction is given equal status to other information on the induction and is not missed out. When the identified room with frosted glass is to be used this should be discussed with prospective service users to ensure that they are enabled to make an informed choice. The grounds could be made secure to minimise the risk of residents leaving the home unnoticed. Where a resident chooses not to have their door closed where barrier nursing is required look at all possible alternatives to minimise the risk of infection spreading. 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. 2. 3. OP14 OP15 4 5 6 7 8 OP18 OP19 OP19 OP26 OP27 Melbourne House Care Home DS0000026453.V354586.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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.V354586.R01.S.doc Version 5.2 Page 33 - 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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