Inspection on 07/05/08 for Melbourne House Nursing Home

This inspection was carried out on 7th May 2008.

CSCI found this care home to be providing an Adequate service.

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 21/11/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Melbourne House Care Home Aspley Lane Aspley Nottingham NG8 5RU Lead Inspector Karmon Hawley / Lee West Unannounced Inspection 7th May 2008 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Melbourne House Care Home DS0000026453.V364060.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.V364060.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 Vacant 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.V364060.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 21st November 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 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.V364060.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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. 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. One hour was spent observing the care given to a small group of people. All observations were followed up by discussions with staff and examination of records. Four members of staff and one set of relatives were spoken with as part of this inspection. In addition the views of seven people using the service 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 from the provider and the general public 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. The category (TI) terminal illness is no longer in use; therefore this has been drawn to the attention of the Commissions Registration Team who will amend the certificate. The Annual Quality Assurance Assessment was received in time to include information in this inspection report. Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Plans of care are now more person centred reflecting the personal preferences and needs of people using the service to ensure that these are met. Care plans are now kept up to date and reflect the change in needs of people using the service to maintain continuity of care and their safety. Appropriate risk assessments are now in place for highlighted risks to ensure that people using the service are fully protected. The medication policies and procedures have been improved upon to ensure that working practices protects people using the service. Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 7 The weights of people using the service are now monitored and recorded, thus ensuring that their health care needs are met. The activity programme has continued to develop working towards ensuring that the needs of people that are less able are met. Maintenance issues are now addressed more quickly ensuring that the home is fit for purpose and meets the needs of people living in the home. The gathering of views and opinions of people living in the home has improved working towards offering people more say in the running of the service. Safeguarding adults information is given equal status to other information during the induction period to ensure that new members of staff are aware of their roles and responsibilities in safeguarding the people using the service. The frosted glass has been replaced in the identified bedroom to ensure that people using service that occupy this room are enabled to enjoy the view. The daily menu is now on display so that people using the service are able to see what is available so they can make informed choices. What they could do better: People whose needs are not reflected by the registration categories and the content of the statement of purpose, must not be admitted to the home in order to ensure their assessed needs can be met. The issues we raised concerning the conduct of a minority of staff must be investigated and sent to us, along with the action taken to ensure people who live at the service are properly supported by all staff. It must be ensured that people who live at the service are treated with dignity and respect and have their needs attended to promptly and with consideration. All complaints received must be recorded correctly to ensure that these are investigated and resolved according to the service’s policies and procedures and to the complainant’s satisfaction. People using the service must be liaised with further so that they feel comfortable and reassured in the knowledge that they can express any concerns however small to staff and that these will not be classed as ‘telling tales’ but will be taken seriously and acted upon. The security of the home must be reviewed to ensure that people using the service are safe from intruders and if they should wander safe from the risk of leaving the home unescorted. Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 8 The care home must be clear of offensive odour to ensure that people using the service live in a comfortable environment. It must be ensured that staff who are employed with only a POVA 1st in place are supervised until a satisfactory criminal record bureau check is received to ensure that people using the service are protected from unsuitable people being employed. It must be ensured that staff practices are monitored following training to ensure that they maintain good practices at all times so that people using the service are safe and their needs are met. The registered persons must further involve people using the service 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. 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.V364060.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.V364060.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 adequate. This judgement has been made using available evidence including a visit to this service. People who may wish to use the service know that their needs will be assessed and that the staff can meet these before they move into the home, however if they are admitted in an emergency there is a risk that the staff may not be able to fully meet their needs if they do not gain enough information. The service does not offer intermediate care. EVIDENCE: Prior to the visit a person had been admitted to the home who was not in the service’s registration category. The deputy manager had contacted the CSCI to discuss this issue the day before we visited the home. The registered nurse who had arranged the admission as an emergency stated that they had not been fully informed of the person’s needs at the time of referral and that they were not fully aware of the restrictions that were imposed upon the service. A requirement was set in regards to admitting people into the home that are not within the service’s registration category to ensure that peoples’ needs can be fully met in appropriate surroundings. Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 11 The deputy manager usually visits prospective people in the community to carry out a preadmission assessment before they move into the home. There was evidence of these assessments taking place within those case files seen. People may also visit the home and spend time there before making a decision to move in. Three relatives were looking around the home on the day of the visit who stated that they had been given enough information to make a decision about the suitability of the home. They had looked around the home and were aware that a pre admission assessment would be carried out to make sure that the staff could meet their relative’s needs. The service does not offer intermediate care. Melbourne House Care Home DS0000026453.V364060.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 adequate. This judgement has been made using available evidence including a visit to this service. Plans of care and risk assessments have improved thus working towards ensuring that the needs of people using the service are met. Medication management has improved ensuring that people using the service are protected by the policies and procedures in place. Despite staff undertaking training in manual handling this is not always followed and leaves people using the service at a degree of risk of injury. People using the service are not always treated with respect. EVIDENCE: There was evidence available within those files observed to show that further development has taken place, as plans of care were more person centred and had moved away from being task focussed. This ensures that people using the service receive individual care according to their personal needs and preferences and shows us that the service has complied with the requirement set at the previous visit. Plans of care were in place for all identified needs and there was evidence of plans being updated to reflect changing needs as required. Changes have been Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 13 made in regard to those people requiring specialist services such as foot care for people with diabetes mellitus, thus ensuring that their needs are fully met. Appropriate risk assessments were in place for all identified risks, such as falls, the safe use of bedrails and diabetes mellitus, to ensure that people remain safe and demonstrating compliance with the requirement set at the previous visit. There was evidence that people’s weights were being monitored as stated within the plan of care to ensure that they maintain a healthy weight, thus complying with the requirement set at the previous visit. Staff spoken with were able to discuss people individual needs and how they support them in meeting these. People using the service offered the following comments: ‘the staff are generally very good, however I have not had a shower for over a week, which annoys me,’ ‘I have not had a bath for over two weeks and I am not sure if I will get one this week,’ ‘the staff are very good, they help me when I need it and my needs are met’ and ‘the staff are lovely to me, I only have to ask if I need anything,’ One relative spoken said he sometimes has food down his chin but it is to be expected, the staff are really nice, I am kept informed, there is a family atmosphere and I can relax when I go home knowing that he is looked after. There was evidence within those plans of care seen to demonstrate that people using the service are supported in gaining access to specialist services such as the doctor, optician, dietician, district nurse and continence assessor. During the tour of the home, relevant equipment for the maintenance of healthy skin was seen to be available. Two people using the service spoken with stated that, ‘I can see the doctor at any time that I need to’ and ‘I can see the doctor if I am ill, the staff usually arrange this for me.’ Although staff have received training in manual handling practices, there were two incidents when we observed poor practice taking place. Whilst one person was being assisted to move to attend their appointment with the district nurse staff did not use any lifting aids but used an underarm lifting technique, which is unadvisable due to the damage, it can cause to the shoulders of the person being moved. In the afternoon of the visit carers were again observed moving a person from their wheelchair using the underarm lift. This was further discussed with the deputy manager and the training coordinator, they both confirmed that this area would be addressed and that all staff had attended training and that relevant manual handling equipment was available for staff to use to ensure that staff practices are maintained. To ensure that people using the service are protected by the homes medication policies and procedures, these were observed. The administration of morning medication was being carried out and the registered nurse was administering medication in accordance with the correct procedures. There were no gaps on Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 14 the medication record charts demonstrating that all medication had been administered as prescribed. There were two records, which showed that medication had been omitted for two weeks, these were recorded and there was evidence within the plan of care as to why these had been omitted. These findings demonstrate that compliance with the requirements set at the previous visit have been complied with. The auditing process continues, to ensure that accurate records of medications received in to the building, administered and destroy or returned are kept. One resident, who had declined medication for pain earlier in the day asked for some and the registered nurse gave this in accordance with the code of practice and the home’s procedures, completing the medication administration sheet after the resident had received the medication. To ensure that the people using the service are treated with the respect and dignity that they deserve we observed the staff practices. There were incidents when both good and poor practice was observed. Whilst care staff were attending to a persons manual handling needs, they approached the person with gloves on, when asked why, she said ‘I have put them on because I am going to handle a resident,’ this could be seen as detracting from ones dignity. Two carers involved in one of the manual handling tasks discussed above were also observed to be a little abrupt with the person using the service saying in a loud voice, ‘come on, the district nurse wants us to take you to your room.’ We also observed the same two carers to move a lady in a layback chair from where she was sitting to another area of the lounge, without talking to her and explaining what was happening. When people using the service were moved to the dining room for lunch, this was carried out with dignity and people were seated for lunch. The poor practices were discussed with the deputy manager and the training manager to enable further development to take place in this area. People using the service said that staff generally respected their dignity, however two people spoken with said that ‘at times some people can be very unkind’ ‘some staff are good and polite, some are not but I just ignore it’ and ‘staff are usually very good.’ Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. People using the service are enabled to partake in activites, which enhances the lifestyle experienced in the home. Additional interaction with people using the service would enhance their wellbeing. The rights and choices of people using the service are compromised due to the current arrangements in regard to sugar free diets. EVIDENCE: An activity coordinator is employed to assist people using the service to partake in various activites such as dominoes, reminiscences sessions, bingo and motivation classes as they desire. The activites coordinator has also researched information in regard to developing activities that are specifically for people who have dementia care needs, so that they can develop individual person centred activity plans for people using the service. Once this has been completed this will ensure that the requirement set at the previous visit in regard to ensuring that activites which are appropriate to the needs of less able residents are developed will be fully complied with. The activites coordinator discussed how they spend time with those that are less able chatting to them, however she was hopeful that this could be further developed once she had completed arranged training courses. Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 16 There were records of activites that had been undertaken within the care plans of people using the service and whether they had enjoyed them. There were also photographs available to show the events such as the children’s carol concert that had taken place. Three people were observed to sit outside with the activites coordinator enjoying a game of dominoes and when asked they said that they were enjoying themselves. Staff spoken with felt that there was enough going on in the home to entertain people living there. People using the service offered the following comments: ‘my days are very long,’ I am very happy here, everyone looks after me well, I enjoy the bingo,’ ‘the bingo is fun’ and ‘I enjoy the activites, I join in whenever I can.’ During the specialist observation between 1.30pm and 2.30pm we observed both positive and negative findings in regard to the life of people using the service. The observations showed positive outcomes for two of the people observed in regard to their wellbeing, however for the third person there was very little interaction from staff, which affected their sense of wellbeing. The observations demonstrated that the main connecting lounges were used as a through route for staff, they were regularly seen passing through here but interaction with people using the service was minimal during the observation period. Two members of staff did acknowledge people in the room as they were walking by, whereas others avoided eye contact and one member of staff simply sat between two people and ignored them. Good interaction was observed when a registered nurse attended to one person during the observation. To ensure that people using the service are enabled to maintain contact with relevant others there are no restrictions placed upon visiting and visitors may also be received in private. There were several visitors seen to come and go throughout the day. People using the service spoken with said that. ‘I often have people who come to see me, they also take me out, I enjoy it,’ my family are made welcome all the time,’ and ‘my family come to see me, its good that they can, I do miss them but enjoy it when they are here.’ Staff spoken with confirmed that there were no restrictions on visiting. Staff were able to discuss issues in regard to ensuring that they maintain equality and diversity of people using the service. They discussed how people are supported in maintaining their religious beliefs should they wish and also to maintain relationships that are important to them. There was evidence of people’s individual beliefs and preferences being considered within plans of care observed. People using the service felt that they were treated as individuals and offered the following comments: ‘the staff are very good here, they treat me well and look after me like I want’ and ‘staff treat me as a person, you know, we can have a laugh and a joke, they know everything they need to know about me.’ A wholesome and appealing diet is on offer and choices are generally available at each meal. Breakfast and lunch were briefly observed; both meals looked appetising and were plentiful. We spoke with the person working in the kitchen Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 17 on the day of the visit about the nutritional needs of people living in the home. When discussing diabetes mellitus she stated that ‘they all have the same, everything is sugar free so that the diabetics can have the same food as everyone else.’ Whilst this ensures that people who have diabetes mellitus have choices in regard to their diet, it compromises the rights and choices of other people using the service, as they are unaware of this taking place and they are therefore unable to make a decision as to whether they want to have a sugar free diet. People using the service said that they enjoyed their meal on the day of the visit. A requirement was set at the previous visit in regard to, meals must be provided that meet the cultural and religious needs of residents, this is not applicable at present due to the current needs of people living in the home, however must be considered on admission for each individual in the future. Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 18 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. This judgement has been made using available evidence including a visit to this service. People using the service may be assured that complaints will be listened to and acted upon, however they need to be made to feel more comfortable to express any worries that they may have. All complaints received must be documented in the complaints file to ensure that these are logged and investigated appropriately. People using the service are placed at a degree of risk of experiencing abuse due to the attitudes of a minority of staff. EVIDENCE: There have been four complaints received directly to the service since the previous visit, three of which have been appropriately investigated and resolved, demonstrating that the service takes complaints seriously and acts upon them. The fourth complaint is in regard to people using the service having a lack of choice when getting up and going to bed, lunch being prepared at breakfast and some care plans not being prepared or updated. This had not been logged into the complaints book as received, which could affect the complaints procedure being followed appropriately. The commission for social care inspection has also received three complaints in regards to the standards of care, staffing and the standard of food, which were passed to the provider to investigate. There were no records of these complaints being received within the complaints book. The provider has however investigated theses concerns and responded with the outcomes to the Commission for Social Care Inspection. Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 19 Staff spoken with were able to discuss how they would deal with a complaint should one be received. The person using the service who had made a statement about staff being unkind said that they did not feel that they could make a complaint, as it would be like ‘telling tales,’ whereas another person spoken with said that they would approach staff if they were unhappy about anything. During this visit a thematic probe took place, which concentrated upon safeguarding adults. All members of staff have undertaken training in the protection of vulnerable adults to ensure that they are aware of what constitutes abuse and how they may report bad practice. Staff spoken with were able to discuss these issues to a satisfactory standard, however there remains concerns in respect of staff practices when a minority are abrupt or disrespectful to people using the service. Three staff files were examined which showed that they contained all the required documentation by law to ensure that people are protected from unsuitable people being employed, however there was no evidence available to demonstrate that one member of staff was working supervised whilst waiting for their Criminal Record Bureau check (a police check to see if an individual has a police caution or criminal record) to come through. Staff spoken with were able to confirm that they had undertaken the relevant checks before they started working at the home. Relevant policies and procedures are in place and these are updated if instances arise that warrant this and also on an annual basis during the quality review process. The deputy manager and training manager were able to confirm that training in safeguarding adults takes place and that they had themselves attended. Staff undergo supervisions with the training manager where working performance is discussed and developed. People using the service stated that they felt safe living there and although they did not always want to raise concerns they knew who to speak with if they needed to. The deputy manager stated that she ensures that she is available and approachable for people using the service so that she can support them in an appropriate manner and their rights are maintained. She was able to discuss the roles of other organisations and how to make and alert to the necessary authorities. Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 20 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service live in a home that is satisfactorily maintained, however they are not fully protected in regard to the security measures in place. Although the care home is clean and tidy, attention to odour is required to ensure that it is comfortable at all times. EVIDENCE: A maintenance book was observed which showed that maintenance issues are addressed as needed. The deputy manager stated that the timescales that they have to wait has improved and there was evidence seen in the book of this occurring. A brief tour of the home was undertaken and all areas were satisfactorily maintained. The gardens were well maintained and people were working in its upkeep on the day of the visit. Several people using the service were also seen to enjoy sitting outside. Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 21 There are concerns in regard to the security of the home, when we visited we were able to enter the home through a fire door in the dining room that was open, we were not observed to do this and it was several minutes before a staff member approached us. Also throughout the day all of the fire doors were open, alarms were deactivated due to this; it was a hot day and this enabled people to enjoy the fresh air, however there are people who live in the home who are known to wander, as the dining room gave access to the car park with no restriction and the gate at the front of the main building is not difficult to open there is a risk that people may not be observed leaving. There is also a risk that an intruder may enter the building unobserved. The fire door in the conservatory is not linked to an alarm; therefore if a person left the building via this door, again they may not necessarily be observed doing so. A concern was raised in one survey that was returned to the Commission for Social Care Inspection in regard to the availability of hot water. The water temperatures were checked on the day of the visit and these were satisfactory. There was evidence within the maintenance files to demonstrate that work had taken place on the boiler system to remedy problems with hot water delivery. Although the home was clean and tidy there were incidences when a strong, unpleasant odour was in the lounge area, causing discomfort for those in the vicinity. Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service do not feel that there are always sufficient staff available to meet their needs. Staff training is at a high standard, however further steps must be taken to ensure that all staff carry out these practice when tending to people using the service to ensure that their needs are fully met and they are protected. EVIDENCE: The duty rotas examined showed that the level of staff on duty varied at times between, 4,5 and 6 carers being on duty. Shifts that needed additional staff had been highlighted. There were 7 incidences where only four care staff had been on duty in the month of the duty rota examined. The deputy manager agreed that at times they have been short. Minutes in the trained staff meeting stated that staff levels had been deemed as unsafe at times, and if this occurs in the future staff should raise an incident form to alert the management. One member of staff spoken with expressed grave concerns in regard to night staff cover and stated that on one occasion that there had been only two members of staff on duty, which they felt was unsafe as three people using the service wander. This was discussed with the management who had been investigating this issue. Other staff spoken with said, ‘we are short staffed and are so busy, people’s care needs are met but we are very stretched,’ and ‘staff morale is low at the moment.’ People using the service expressed concerns in regard to their hygiene needs and two people stated that they had not had baths or a shower for over a week. There were also Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 23 comments in two surveys returned to the Commission for Social Care Inspection that stated that the staffing levels were at times low and insufficient to meet the needs of the people using the service. Four staff personnel files were examined to ensure that they contained all the required documentation by law to ensure that people are protected from unsuitable people being employed. All files contained the required documentation such as an application, two references and identification. Within one personal file the staff member had been employed with a POVA 1st in place (a check to see if an individual has been placed upon a list if they have abused a vulnerable person) whilst waiting for a criminal bureau check to be returned (a police check to see if an individual has a police caution or conviction) however there was no evidence that this person was being appropriately supervised to ensure that people are protected from unsuitable people until a satisfactory criminal record bureau check had been received. The deputy manager stated that this person had been employed in the past and therefore was aware of the routines, however could not evidence that they were being supervised. To ensure that new staff are aware of their roles and responsibilities on commencing employment they undergo an induction process. The training manager carries out inductions with all new staff and works with them on the first two days, evidence of this was seen in the notes made of each member of staffs session notes. One new member of staff spoken with was able to confirm that the induction process takes place and they were observed to work with the training manager during the visit. To ensure that staff have the required knowledge and skills to care for the people using the service seventeen carers have achieved the National Vocational Qualification level 2 in care (a nationally recognised work and theory based qualification). There was evidence of staff achieving these qualifications in staff files examined. One member of staff was able to confirm that they had gained this qualification. To ensure that staff are aware of the needs of people using the service they undertake a through training programme. The training manager was able to provide evidence of training that the staff had undertaken and further training that has been arranged. There were posters around the office and staff room areas with training for all staff. The training manager also supports personal development of all levels of staff and training in non-compulsory areas are also covered, for example, male catheterization, developing a nutritional team with a registered nurse and carer, to monitor weights and nutritional requirements. Training has also been organised for June in Mental Capacity and developing person centred care plans. Staff spoken with offered the following comments about their training and development ‘ I have learnt loads since I have joined the home and I am a link nurse for the continence advisor,’ ‘I have regular Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 24 supervision sessions and have and training in safeguarding and moving and handling.’ Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The deputy manager is currently making necessary changes to the running to the home to improve the outcomes for people using the service. People using the service are given an opportunity to have a say in how the home is run, however further development of this is needed to ensure that their views and opinions are fully valued and taken into consideration. EVIDENCE: The previous manager has left employment; therefore the deputy manager is undertaking this role until a new manager has been appointed. Along side this there have been many changes within the running of the home to make the necessary improvements. Staff spoken with felt that improvements had been made and that they had been needed, one expressed that the home was a disaster prior to this and staff needed to take responsibility for their actions. All agreed that these changes had made the necessary improvement, however Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 26 due to the changes, staff morale is low at times. The deputy manager has not managed a care home previously, however both managers of the other two homes in the company are supporting her and she stated that she felt supported by them. Staff spoken with stated that the deputy manager was approachable and that things were now getting done. The deputy manager returned the Annual Quality Assurance Assessment to the Commission for Social Care Inspection when we asked for it, providing up to date information on the running of the home and quality issues. To ensure that a quality service is on offer regular audits such as accidents, maintenance, health and safety, and personnel are carried out. There was evidence of these audits taking place within documentation observed. A questionnaire has recently been sent to people using the service in regard to the food and the food delivery. Responses were mixed, some stating that they were happy with the menu and the quality of the food, whereas others were dissatisfied. The deputy manager stated that once these results had been collated these would be discussed with the new cook that the service is currently recruiting and a new menu will be devised. A full survey has not been sent to people using the service since 2006, therefore views gained form people living at the home are limited, and this needs attention especially due to the current discontentment that some people using the service are feeling and to fully comply with the requirement that was set at the previous visit. Due to the current needs of people using the service there are currently no meetings that take place, however the deputy manager stated that she is always available should anyone want to talk with her. Attempts have been made to hold meetings for the relatives of people using the service, however these have so far been unsuccessful; there was evidence seen to show that these had been arranged. The training manager prepares a report for the registered provider, which is sent to the commission on a monthly basis, outlining the running of the home, so that we may monitor the service. The service is not responsible for the money of people using the service and none is kept on the premises, should a cost be incurred then relatives or relevant others are invoiced for this. There was evidence within plans of care in regard to the financial arrangements for those people case tracked. The training manager carries out staff supervision sessions to assist staff in their development. There was evidence of supervisions taking place in documentation examined. Staff spoken with also confirmed that these are taking place and that they were beneficial. The Annual Quality Assurance Assessment outlined the maintenance and servicing that had taken place. The hoist certificate was also checked on the Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 27 day of the visit, which showed that this had been serviced as required. Staff have undertaken training in health and safety and were able to discuss these issues, however there remains concerns due to the current security arrangements. Melbourne House Care Home DS0000026453.V364060.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 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Melbourne House Care Home DS0000026453.V364060.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 *RQN Regulation S24 Care Standards Act 2000 Requirement People whose needs are not reflected by the registration categories and the content of your statement of purpose, must not be admitted to the home in order to ensure their assessed needs can be met. The issues we raised concerning the conduct of a minority of staff must be investigated and sent to us, along with the action taken to ensure people who live at the service are properly supported by all staff. You must ensure that people who live at the service are treated with dignity and respect and have their needs attended to promptly and with consideration. All complaints received must be recorded correctly to ensure that these are investigated and resolved according to the service’s policies and procedures and to the complainant’s satisfaction. Liaise further with people using the service to ensure that they feel that they can approach staff DS0000026453.V364060.R01.S.doc Timescale for action 12/06/08 2 OP10 12(4)(a) 15/06/08 3 OP10 12(4)(a) 15/06/08 4 OP16 12(2) 22(8) 15/06/08 5 OP16 12(5,a) 15/07/08 Melbourne House Care Home Version 5.2 Page 30 6 OP19 13(4,c) 7 OP26 16(2,k) 8. OP27 18(1)(a) 9 OP29 19 (1,b) 10 OP30 18(1,c,I) 18(2) 11. OP33 24(1) (a)(b) (2)(3) with any concerns that they may have. Review the security arrangements of the care home to ensure that people using the service remain safe. The care home must be clear of offensive odour to ensure that people using the service live in a comfortable environment. The holistic needs of the people who live at the service must be reviewed and a calculation produced for staffing levels to meet these needs and ensure the health, safety and wellbeing of the people in your care. It must be ensured that staff who are employed with only a POVA 1st in place are supervised until a satisfactory criminal record bureau check is received to ensure that people using the service are protected from unsuitable people being employed. Following training ensure that staff carry out safe working practices at all times and that there are records of monitoring that has taken place to evidence this and to ensure that people using the service are protected and their needs are met. The registered persons must further involve people using the service 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. 12/06/08 15/06/08 25/07/08 07/05/08 16/07/08 16/07/08 Melbourne House Care Home DS0000026453.V364060.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 OP15 Good Practice Recommendations Ensure that people using the service are aware of the fact that desserts are sugar free so that they can make an informed choice as to whether they wish to have this. Melbourne House Care Home DS0000026453.V364060.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V364060.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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