Inspection on 20/03/07 for Melbreck

This inspection was carried out on 20th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Melbreck 14/11/07

Melbreck 22/06/06

Melbreck 25/11/05

Melbreck 04/04/05

Melbreck 17/01/05

Melbreck 01/10/04

Melbreck 04/08/04

Melbreck 28/04/04

Similar services:

Southfields

Thorndene

Insight - Eastchurch

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Melbreck Tilford Road Rushmoor Farnham Surrey GU10 2ED Lead Inspector Mary Williamson Unannounced Inspection 20 March 2007 11:00 th Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 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 Melbreck DS0000017623.V330009.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 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. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Melbreck Address Tilford Road Rushmoor Farnham Surrey GU10 2ED 01252 793474 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) melbreck@robinia.co.uk Robinia Care Limited Lorna Oliver Care Home 26 Category(ies) of Learning disability (26), Physical disability (26) registration, with number of places Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twenty six (26) beds providing nursing care for people from the age of 19 years with learning disabilities (LD) and physical disabilities (PD). 22nd June 2006 Date of last inspection Brief Description of the Service: Melbreck is a substantial detached property catering for service users with learning disabilities and associated physical disabilities aged between 16 and 65 years. The home is located in a rural area near Farnham. The accommodation is for 26 service users. The accommodation has 22 single rooms with two double rooms. There is a large garden with an herb garden, outdoor pool and green house all of which are accessible to service users. The fees charged range from £948.45 to £2370.77 per week. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first site visit of a key inspection and was unannounced. The inspection took place over four hours. Mary Williamson, Regulation Inspector, carried out the inspection. The Registered Manager Lorna Oliver represented the establishment. A tour of the premises was undertaken and a number of records relating to the care of the service users and the management of the home were examined. It was possible to meet most of the service users. As the majority of the service users have non- verbal communication there was limited feedback only through signs and gestures with the help of the staff. All the service appeared well cared for and there was good interaction between them and staff. Discussions were held with staff both in groups and individually. They all had a good understanding of the care needs of the service users they care for. The kitchen was visited and the chef spoken to. He demonstrated a good awareness of the service users nutritional needs. The standard of record keeping is satisfactory and records sampled included needs assessments, care plans, medication recording charts, staff duty rotas, staff employment files and service users financial records. The Commission for Social Care Inspection would like to thank the service users, manager and the staff for their help and hospitality during the inspection. What the service does well: The home offers a good standard of accommodation mainly in single rooms with ample communal space provided. The standard of care is good and all the service users appeared well cared for. The arrangements to meet individual health care needs are satisfactory and the manager stated that the service users are well supported by their GP. Leisure activities are offered on and off site and all service users have a timetable of activities in place. Staff recruitment and training is ongoing and those documents relating to employment and training appeared to be in order. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 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 Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have access to appropriate information in order to help them make an informed decision about living in the home. Needs assessments and contracts of occupancy are in place. EVIDENCE: The home has a statement of purpose and service user guide in place, which has been updated since the last inspection. This provided prospective service users and their relatives with sufficient information to help them make an informed choice about living in the home. The manager explained how she undertakes a pre admission needs assessment on all prospective service users. She also stated that there is a new service user expected to be admitted next month, and four visits have been arranged to the home in order to establish the suitability of the placement and to purchase new equipment including an electronic bed. Three needs assessments were randomly sampled and were informative and comprehensive. Contracts of occupancy are in place which outline the care provided, the accommodation offered, the fees payable and by whom. These are signed and dated. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual care plans outline the care to be provided and by whom. Service users are supported to make decisions and risk assessments are in place. EVIDENCE: Individual care plans are in place which have been written with information obtained from the needs assessment, input from the service user whenever possible, information obtained from relatives, and any other relevant medical reports. Three care plans were randomly sampled and these are well maintained, and reviewed on a regular basis. A review of care was in progress during the inspection, coordinated by the care manager and attended by the service and relatives. Service users make basic decisions about their lives with support from staff. Most of the service users in the home have non-verbal communication, and staff communicate with them through signs and gestures. All the service users have a key worker, and they have a good understanding of the assessed needs of the service users they care for. One staff member was able to explain how he would recognise through facial expression if a service user was happy or Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 Page 10 uncomfortable. Another member of staff stated that he contributes to daily evaluation of care and records care provided. Risk assessments are in place for all identified risks and are included in the care plans. These are reviewed and updated regularly. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements in place for personal development and leisure activities meet the individual and collective needs of service users. The menu is varied and meets the nutritional needs of service users. EVIDENCE: Individual time- tables of daily activity are in place. These include activities provided by the organisations own day centre which a number of service users attend on selected days. The home also has a therapy unit situated at the rear of the property, which is managed by an activities coordinator where some service users attend. Activities include drama, music, cookery, art and craft, cookery and relaxation in the “white room”. Service users access the local community and trips out to local attractions and shopping trips are organised. Family links are maintained and visitors are encouraged to visit the home at any reasonable time. Families are also encouraged to attend care reviews and participate in care planning. The manager stated that an Easter egg hunt and an Easter party had been planned for the following week. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 Page 12 Special day trips replaced a holiday this year, which the organisation funded. The manager stated this decision was made during reviews of care due to the complex needs of service users. The local Church facilitates a Holy Communion Service in the home every two months, which service users attend if they choose to do so. The chef is new in post and is currently reviewing the menus with input from service users with support from staff. Two main dishes are offered for lunch and the evening meal. Special diets and needs are catered for. Several service users require help with feeding, which was observed to be undertaken in a sensitive and caring manner. The kitchen was visited and was clean and orderly. The appropriate records required for health, safety and hygiene were in place and well maintained. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements in place to meet the health, emotional and physical needs of service users are satisfactory. The medication procedures protect the service users. EVIDENCE: All the service users are registered with a local GP who visits the home every two weeks. Service users may also visit the GP surgery by appointment. The district nurses will also visit on request. The chiropodist will visit the home every six weeks and the optician will also provide two yearly eye tests. The manager stated there is also access to the continence advisor, and the dietician who also advises on nutrition and peg feeds. Dental care is provided by a practice in Guildford and also provide a dental hygienist and staff training. The organisation employs a physiotherapist who was visiting the home during the inspection. She advises on specialist equipment and monitors the use of specialist chairs and seating. The home also has physiotherapy assistant who works in the home full time. The home has a policy in place for the administration of medication. Medication practices were sampled for lounge one and two. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 Page 14 Beacon Hill Pharmacy supplies the medication to the home mainly in blister pack format. The medication recording charts were seen and these are well maintained. There is an audit trail of all medication entering and leaving the home. All medication is stored correctly and only qualified staff administer medication. There are no service users in the home capable of self administration of medication. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure and the abuse awareness procedure in place protect the service users in the home. EVIDENCE: The home has a complaints procedure in place, which forms part of the service users guide. All service users and relatives have access to this procedure. There have been no complaints since the last inspection. There is an abuse awareness policy in place and all staff working in the home have undertaken training in this policy during their period of induction. There is also a copy of Surreys Multi Agencies Policies and Procedures on Safeguarding Vulnerable Adults in place, and the manager confirmed that she has enrolled in updating training in these procedures. There are currently two Vulnerable Adults investigations being undertaken, and the home is following the appropriate course of action. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable, safe, clean, and homely environment, which meets their individual, communal, and mobility needs. EVIDENCE: The home is clean and comfortable providing service users with and homely environment to live in. Communal space is arranged over several lounges and dining rooms, which have been furnished to a good standard. Individual bedrooms are well -decorated according individual taste and have been personalised to reflect individual personalities and interests. There are ample toilet and bathrooms situated throughout the home, which have been adapted to meet the assessed mobility needs of the service users. These include overhead hoists, shower trolleys, raised toilet seats and specially adapted toilet surrounds. The home has two shaft lifts and one stair lift. One shaft lift was out of order on the day of the inspection but the lift engineer was on site repairing this. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 Page 17 There are ramps in place to access a well-maintained mature garden with a sensory garden, raised flower- beds, and patio areas. The home is clean and hygienic with no trace of mal odour. The carpets on the first floor corridor are badly stained and during a discussion with the manager she had identified this and was trying to secure funding from the organisation to replace these. There is a control of infection policy in place and several wash hand basins available to staff for hand washing. The laundry is well equipped and arrangements are in place for the weekly collection of clinical waste. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by a competent staff team in sufficient numbers to meet their needs. The homes recruitment practices are good. EVIDENCE: The staff duty rota was seen and the number and skill mix of staff was sufficient to meet the assessed needs of the service users. The home also employs a number of ancillary staff. The recruitment procedures in the home are good. Three staff recruitment files were randomly sampled. These are well maintained and contain all the required employment documentation including two written references and a CRB (Criminal Records Bureau) Disclosure reference number. The manager explained the training programme in place. All staff undertake induction training, evidence of which was seen on file. Several staff confirmed training they had undertaken during discussion including manual handling, food hygiene, fire safety, intensive interaction, epilepsy awareness, and COSHH. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 Page 19 NVQ training is ongoing with two staff holding an NVQ level 2, eight staff with an NVQ level 3 and several other staff currently undertaking this training. The manager is an NVQ Assessor and an Internal Verifier. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users benefit from a well run home where their health, safety and welfare is promoted. EVIDENCE: The home is well manager by an experienced manager who is also a qualified nurse. She has worked within the organisation for several years and has a good understanding of the provision of care to the service users in her care. She has management support from a team of qualified nurses ensuring the home is appropriately managed at all times with an on call system in place. There is also admin support in the home one day per week. Quality assurance is monitored by service user questionnaires, which are completed by relatives on their behalf. By regulation 26 visits, and feedback from visitors and reviews of care. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 Page 21 Health and safety is promoted and all staff have regular training in COSHH procedures. Risk assessments are in place for all identified risks to include safe working practice. Fire safety records were seen and confirm weekly checks of fire alarms. There is a contract in place for the maintenance of fire fighting equipment and emergency lighting. All staff receive fire safety training yearly. The procedure for recording and reporting of accidents is satisfactory. Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 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 Standard No Score 1 3 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 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 YA24 Regulation 23(2)(d) Requirement The registered person must ensure that all parts of the care home are kept clean and reasonably decorated. This must include replacing the carpets on the first floor corridor, which have become badly stained through were and tear. Timescale for action 20/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Burgner House 4630 Kingsgate Cascade Way Oxford Business Park South Cowley Oxford, OX4 2SU 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 Melbreck DS0000017623.V330009.R01.S.doc Version 5.2 Page 25 - 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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