Inspection on 25/11/05 for Melbourne Lodge

This inspection was carried out on 25th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Melbourne Lodge 27/06/07

Melbourne Lodge 30/06/06

Melbourne Lodge 12/05/05

Melbourne Lodge 29/09/04

Melbourne Lodge 21/04/04

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

CARE HOME ADULTS 18-65 Melbourne Lodge 73-75 Greens Lane Hartburn Stockton-on-Tees TS18 5HT Lead Inspector Jackie Herring Unannounced Inspection 25th November 2005 11:00 Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 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 Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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 Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Melbourne Lodge Address 73-75 Greens Lane Hartburn Stockton-on-Tees TS18 5HT 01642 587519 01642 596791 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) Care UK Mental Health Partnership Limited (Arc Healthcare Limited) Mrs Michelle Cox Care Home 18 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (18) of places Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate one named individual over the age of 65 years in the home. 12th May 2005 Date of last inspection Brief Description of the Service: Melbourne Lodge is an 18 bedded care home providing personal care to younger adults with mental health problems. The home is a converted Victorian property, which provides all single room accomodation, fourteen of which have an ensuite facilities. The care home is situated close to Hartburn village, which provides a range of shops, public houses and is on a bus route. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a second unannounced inspection conducted during this inspection year. It took place over one inspection day, nine inspection hours in total and was conducted by two inspectors. A tour of the home took place, a number of records were examined including residents individual records, policies and procedures and training records. Residents, staff and the manager were involved in discussion about life at Melbourne Lodge and visiting professionals were also consulted. A pre inspection record was also completed and returned prior to the inspection and was used in the inspection planning process and some of the detail is also contained within the main body of the report. What the service does well: What has improved since the last inspection? There has been substantial development to the staff training programme and staff are now undertaking a detailed five day training course on Mental Health needs. The staffing levels on night duty have also improved with there now being two waking night staff, which has assisted with the observation levels throughout the home. Progress had been made to the external environment with the rubble in the garden being cleared away. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 Residents care needs are assessed prior to their move and they are provided with information to enable them to make a decision about moving into Melbourne Lodge. There are also good opportunities to spend time in the home prior to admission. EVIDENCE: Three sets of resident’s records were examined during the inspection and three residents were engaged in discussion about life in Melbourne Lodge. They spoke of visiting the home on a few occasions prior to admission and talked of planned visits and overnight stays, which they found very helpful. One resident said, “I came and had a look around with my Social Worker and I liked it straight away and I also came for tea twice and also stayed over one night”. Copies of the assessment documentation were made available, which is a twopart assessment and is detailed and clearly aims to capture individual views of their mental health and daily living needs as well as information from significant individuals. It clearly supports the category of care provided by Melbourne Lodge. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, Each resident has individual care records, which they are involved in. Although a wide range of information is contained within the records, additional information would assist residents and staff to meet some of the specific goals. EVIDENCE: Three sets of resident’s records were examined during the inspection, which were well presented and clear to follow. Three residents were also engaged in discussion about life in Melbourne Lodge. Residents were aware of their care plans and they had up to date care plans in their files. One resident described how their keyworker went through their care plan a few days after admission and confirmed that they had signed their individual plan. It was identified that the actual plans of care were satisfactory, however these could be developed further with more specific, personal detail and information. An example of this is, a resident was described as having problems with behaviour, the care plan stated, “behaviour poor, residents appears to use their behaviour to control others”. There was no detail behind this in respect of how this behaviour is displayed and how it impacts on others. The assessment documentation in one of the files had not been updated in respect of recent changes although care plans were in place for this. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 10 In another file examined, there were issues identified relating to specific personal behaviour, which potentially impacts on other people, there was no detailed written risk assessment in place for this or risk management strategies. Resident involvement was evidenced by records of monthly residents meeting that looked at planning holidays for individuals and Christmas menus and activities. These records are accessible to residents in a file within next to the staff office. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15, 16 Good contact is made with friends and family and there are opportunities for residents to spend time with their families outside of the home. Where more intimate relationships have developed, there is the need for more information for staff and detail within plan of care. EVIDENCE: It was confirmed that residents were able to maintain relationships with family and friends and this was observed on the day of the inspection. Residents were observed going out of the home and one resident was seen to go out with a family member. One resident said that they had chosen not to have visits as they wanted a break from their family, which clearly demonstrated that individual residents needs and choices were respected. It was identified through discussion with the manager and after examining residents records that where more intimate relationships had developed between residents that this could potentially be challenging for staff to deal with and there may be the need for some further training. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 12 Where these relationships had developed, it was recommended that appropriate records should be in place to support this and demonstrate the approach to be taken by the staff. This matter was also confirmed through discussion with a visiting professional, who expressed the same views. During the inspection it was observed that residents had keys to their own bedroom doors, and each room also had it’s own doorbell. Staff throughout the inspection were observed to use the doorbells or knock on the doors. It was also observed that residents were well able to choose where they wanted to spend their time, some residents were observed to spend time in their bedrooms whilst others chose to spend time in their rooms. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Resident’s benefit from a relaxed, flexible approach to care and one that ensure their privacy and dignity is respected and independence promoted. Good arrangements are in place for promotion of resident’s health care needs. Of the medications systems examined, they are appropriate for the residents needs and are managed in a safe manner. EVIDENCE: Residents were involved in discussion about their individual life within Melbourne Lodge. A relaxed and flexible life was demonstrated through discussion with residents and staff, one resident said, “I am really happy here, staff are friendly and helpful, I want to stay forever” and another resident said, “It’s nice and relaxing here”. A staff member also commented, “Melbourne Lodge is just like home from home” they also said when discussing the needs of the residents, “you don’t do too much for them, you prompt and encourage. All of the bedrooms are single bedrooms and resident have their own key for their rooms. During the inspection, residents were consulted about accessing their rooms; of the rooms visited, there was clear evidence of individual preferences and personalities, one resident took pride in discussing their artwork. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 14 It was confirmed through looking at residents records and through discussion with residents and visiting professionals that they were able to access the GP, that there is regular involvement by Community Psychiatric Nurses and other health care professionals such as Consultant Psychiatrist and Social Workers should the need arise. The medication system was discussed with the manager and a small number of records examined which were found to be in order with appropriate storage in place. A new junior member of staff confirmed that they had no involvement with the medication, that this was managed by more experienced senior staff. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Residents are aware of what to do if they have concerns or complaints and good systems are in place to support this. There is the need to ensure that these are fully concluded and satisfactory outcomes detailed. Whilst systems are in place for managing allegations of abuse, the implementation of this is not as robust as it should be. EVIDENCE: The complaints procedure is available within the home, which is accessible to the residents and residents were able to discuss what they would do in the event they had a complaint. The actual procedure for making complaints and supporting documentation was good. Since the last inspection, there had been two complaints. In one of the complaints, it was unclear if this had been fully concluded and if the resident was satisfied with the outcome of this complaint. In the second complaint, a visiting professional said that the manager had been very responsive to the complaint. Protection of Vulnerable Adults procedures are available within the home although the procedure is a corporate one and does not refer to local arrangements, however it was confirmed through discussion with the manager that the Teeswide protocols are available within the home. Staff confirmed that they had received training on abuse and adult protection. It was however identified that there had been some issues within the home that should have been referred through adult protection and this had not occurred. The manager was asked to do this retrospectively. This had also been raised prior to the inspection when an allegation of verbal and emotional abuse was reported through regulation 37 notifications for which no referral had been made. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 30 Overall improvements to the décor, with some refurbishment are needed to ensure residents are provided with a more homely, well-maintained environment. EVIDENCE: The environment at Melbourne Lodge continues to look tired, somewhat dated and in need of refurbishment. A plan of maintenance has been submitted to CSCI following a meeting after the last inspection. The manager has been asked to reconsider some of the timescales within this plan and to bring some of the items, such as refurbishment of a number of windows, which were clearly rotting and were very draughty. There was discussion about the future plans in respect of a proposed extension, however the home as it is currently must be improved and cannot wait until work had commenced on the extension. The corridors, particularly the ceilings were in need of redecoration and the manager confirmed that this was planned for early next year. It was acknowledged that a number of bedrooms had been decorated, two new bedroom carpets had been laid and the work had been completed to bedroom 17. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 17 Inappropriate signage in resident areas, such as first aiders, out of date fire training and labelling of the bathrooms, also continues to be in evidence around the home, which potentially detracts from providing a homely environment. Bathrooms continue to need refurbishment and it was noted on this occasion that grey masking tape had been used to repair bath panels. It was again identified that wallpaper in the dining room continues to be hanging off since earlier this year. The manager was informed that this was unacceptable and needed to be addressed immediately. On the day of the inspection, cobwebs were observed in several areas, dead moths and insects and dust were observed on a number of windowsills and the home did not appear as clean as it could be. The manager stated that there were twenty-five hours for housekeeping a week, however she did say that Melbourne Lodge was a large home. It was confirmed that residents are actively encouraged to complete domestic tasks in respect of their own rooms. Externally, the outhouses continue to be in need of repair or demolished, it is acknowledged that these have been made safe pending potential development plans. The gardens could also be developed further and some of the external repairs are still needed. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 35, 36 A well-trained and experienced staff team supports residents and they have worked hard to ensure that there are 70 of them trained to NVQ level 2 in care or higher. EVIDENCE: Since the last inspection, the training programme had been reviewed and updated and staff were now undertaking more service specific training such as Mental Health Training. Details of this were made available which outlined a very good five-day programme covering a range of mental health issues including a number of mental health disorders as well as challenging behaviour. It was also identified through discussion with a staff member, that they had also completed training in regard to one resident’s particular medical needs. Discussion took place with a new staff member who described a three-day induction, which covered moving and handling, First Aid, Fire Safety and the topic of abuse, which was held away from the home. They also described an induction at Melbourne Lodge, which included orientation to the environment. They also confirmed that they were going to commence their NVQ training after Christmas. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 19 National Vocational Qualifications were detailed within the pre inspection questionnaire, however this was discussed further with the manager and the situation had changed since. The Manager stated that nine of the fourteen care staff had completed NVQ level 2 or above and four of the staff also had NVQ level 3. Staff were very positive about the training within Melbourne Lodge and comments included, “I have never done as much training as I have done in the last four year”. It was also confirmed through interview with the manager that a further three members of staff are to commence NVQ 2 in February. It was confirmed that regular staff supervision takes place, however the manager confirmed that there is no appraisal system in place. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 42 Arrangements to ensure residents’ views are promoted are in place. The additional, new quality system is in the process of being implemented. The maintenance and service records are mostly up to date, however an additional safety check needs to be undertaken to ensure a safe environment. EVIDENCE: Staff described Melbourne Lodge as a well run home, with brilliant staff and a manager who was very encouraging. One resident’s said, “I love it here, I have been in a lot of stressful situation and I have been in hospital, I like the freedom here, it is relaxed and safe”. During discussion with the manager, it was confirmed that monthly resident meetings take place and the minutes of these were made available during the inspection. It was also confirmed that these are accessible to residents in a folder next to the main office. Contained within this folder are the minutes of the meetings, resident’s satisfaction survey results and a copy of the service users guide. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 21 It was also identified through discussion with the manager, through the residents’ minutes and as detailed on the wipe board in the main office that residents had been consulted about holiday venues, with some residents going to France and others going to Scotland. Other quality checks were discussed with the manager and it was confirmed that a new system has been introduced, which herself and the deputy manager are currently implementing. Maintenance and service information was made available within the pre inspection records and found to be in order with the exception of the five-year electrical installation, which remained outstanding since the last inspection. The manager was requested to take immediate action to address this and whilst the inspection was still taking place, it was confirmed that the work would take place the following week. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 X Standard No 22 23 Score 2 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X x 2 2 X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 2 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X 3 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Melbourne Lodge Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score X X 3 X X 2 X DS0000000012.V268905.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13 Requirement Where allegations of abuse or situation of potential abuse are identified, an adult protection referral must be made. The outhouses continue to be in need of repair or demolition. (Previous timescale of 20 July 2004 was not met). A number of windows must be repaired or replaced. (Previous timescale of 30 March 2005 was not met). The programme of redecoration and refurbishment must continue and some of the dates detailed in the plan must be reviewed. The wallpaper hanging down from the dining room wall must be attended to. The bathrooms continue to need updating and broken bath panels must be attended to. The garden must be developed further to ensure that it is safe and accessible to residents. (Previous timescale of 30 March 2004 was not met) The external repairs to the ventilation covers for the cellars and old gas meter cover must be DS0000000012.V268905.R01.S.doc Timescale for action 25/11/05 2. YA24 23 31/03/06 3. YA24 23 31/03/06 4. YA24/YA27 23 25/11/05 l YA28 23 31/01/06 Melbourne Lodge Version 5.0 Page 24 undertaken. (Previous timescale of 30 March 2004 was not met). 6. YA42 13 The five-year electrical installation check must be completed. 25/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard YA6 YA9 YA15 YA22 YA24 YA30 YA30 Good Practice Recommendations Individual plans should be developed further to give specific detailed information about needs and goals and detail how these are to be achieved. Risk assessments and supporting plans of care should be in place for identified personal behaviour activities, with clear control measures and ongoing evaluation. Where more intimate relationships have been developed, these should be detailed in individual plans. Staff may also benefit from further education in respect of this. When complaints have been investigated the outcome and satisfaction with outcome should be recorded. Consideration should be given to the posters and signage around the home, which could if needed be more homely. The housekeeping arrangements should be reviewed to ensure that the home is kept clean. The appraisal system should be developed and introduced. Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Melbourne Lodge DS0000000012.V268905.R01.S.doc Version 5.0 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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