Inspection on 25/11/05 for Melbreck

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Melbreck 14/11/07

Melbreck 20/03/07

Melbreck 22/06/06

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 Susan McBriarty Unannounced Inspection 25th November 2005 11:15 Melbreck DS0000017623.V268994.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 Melbreck DS0000017623.V268994.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. Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Melbreck Address Tilford Road Rushmoor Farnham Surrey GU10 2ED 01225 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) Robinia Care Limited To be confirmed Care Home 26 Category(ies) of Learning disability (26), Physical disability (26) registration, with number of places Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 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). 15th September 2005 Date of last inspection Brief Description of the Service: Melbreck is a substantial detached property catering for service users with learning disabilities and associated learning disabilities aged between 19 and 65 years. The home is located in a rural area near Farnham. The accommodation is for 26 service users, has 18 single rooms with four double rooms. There is a large garden with a little used aviary, herb garden outdoor pool and green house all of which are accessible to service users. Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection the third during 2005-2006. An enforcement notice was served in July 2005 and a compliance inspection took place on the 28th August 2005 in addition to the unannounced inspections. The enforcement notice had been complied with. The Commission for Social Care Inspection is reviewing the Surrey homes owned and managed by the Robinia Care Group plc as part of a protection of vulnerable adults concern. The review is not yet complete and a report will be provided under separate cover once the review has been concluded. During this inspection the residents were observed having lunch and a number of documents were sampled including care plans, financial information, minutes of residents meetings and staff supervision details. The residents of the home have complex needs and it was not possible to gain their views of the home without considerable support and planning. What the service does well: What has improved since the last inspection? All but one of the previous requirements had been met or was in the process of completion. The majority of care plans were seen to have begun a regular cycle of review and updating as required. Some were over the six-month date but not significantly so. The organisation had started residents meetings and two had taken place since June 2005 in addition an independent advocacy group was planned although specific residents still needed to be identified to attend. Lunch was observed and the deployment of staff had improved ensuring that residents were not waiting for their meal and that appropriate support was readily available. Melbreck DS0000017623.V268994.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. Melbreck DS0000017623.V268994.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 Melbreck DS0000017623.V268994.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): 3,5 Some improvement regarding communication with residents was noted and members of staff had received training to begin to provide them with the necessary skills. Further work is required to ensure that each resident has a contract or statement of terms and conditions. EVIDENCE: The home provides for residents with complex needs including nursing. Members of staff had recently received training in ‘intensive interaction’ a course that enabled them to consider various methods of communication. Observations made during the inspection noted that the members of staff had improved their interaction with residents for example talking to individuals during lunch. The majority of residents at the home were white British and mostly male, the staff team were of mixed gender (mostly female) and ethnicity. The organisation had recently developed a residents group and two of the residents from this home had attended. Please also see Standard 8 of this report. Residents do not as yet have a contract or statement of terms and conditions setting out the fees and services provided by the home. The manager reported that statements of terms and conditions are due to be completed shortly. A requirement was made to ensure that they are completed in a timely manner. Melbreck DS0000017623.V268994.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): 8 Specified residents had recently been offered the opportunity to take part in residents meetings and an advocacy group was in the early stages of being formed. Both these options should improve communication between the residents and the organisation. EVIDENCE: Two residents meetings had been held within the past six months and the minutes of those meetings were seen during the inspection. The minutes had been produced with pictorial and plain English version combined. Two of the residents from the home had attended the meeting and the manager reported that they appeared to enjoy attending and taking part. The attendees were from homes in Surrey and Hampshire. It was noted that residents were concerned about paying for transport on a regular basis when they had not used the service. In another example the residents had discussed the issue of paying for lunch when they go out from the organisation’s day centre. The minutes did not identify responses from the organisation to the questions raised by residents. Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 10 The manager reported that the advocacy group engaged by the organisation had asked the home to consider representatives to take part in a resident advocacy meeting. The manager stated that the advocacy group would assess any individual nominated in order that they might be clear about their communication and support needs. Members of staff from the home would not attend the meeting maintaining the independence of the scheme. At the time of the inspection no decision had been made regarding the nominees. Both the residents meetings and the advocacy group were seen by the CSCI as improvements as they offer residents the opportunity to discuss their views about the services offered within the home as well as an arena for the organisation to respond effectively to the queries raised. A number of previous requirements had been made regarding the reviewing and updating of care plans (Standard Six). A number were sampled during the inspection to confirm progress made by the home. The home had continued to use the same system as previously the manager stated that this was due to the complex needs of the residents and the need for detailed information. The internal structure of the files had been improved and the samples were found to be easier to access and understand. A number of the files sampled evidenced reviews and updates taking place in October and November 2005 within the six months required. The remainder were due for review but were not significantly over the six month period. Melbreck DS0000017623.V268994.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): 11,12,13 The residents have complex needs and the members of staff within the home and the organisation had begun to make external links improving the knowledge and skills of the staff team. EVIDENCE: As part of the concerns raised through the protection of vulnerable adults investigations the home had improved contacts with nominated Care Managers from various local authorities. The manager reported that each of the residents now had a named Care Manager and that they were attending the reviews of the residents. The manager reported that personal financial profiles had been completed for each of the residents some of these had been signed and returned by the nominees of local authorities. The profile notes the income of residents, how much they pay toward the cost of their care and the level of support required to manage their finances. A finance record was sampled and found to be correct. Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 12 Services were also being provided by specialist activity services, an advocacy group and links with the specialist health provision had also improved. The home had recently employed a driver and the manager hoped that in the future a more flexible approach enabling increased activities in the evenings and at weekends might be made available. The manager also reported that the organisation interviewed a number of people as drivers and the successful candidates were awaiting satisfactory employment checks before they could begin work. An improved number of drivers might also enable additional opportunities for activities. Residents at the home require staff support in all areas of their lives; this impacts on the level of privacy available to them. Melbreck DS0000017623.V268994.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): 21 Further work is required to ensure that the residents’ wishes or best interests are taken into account following their death. EVIDENCE: In discussion with the manager it was noted that residents best interests or preferred options following their death had not been taken into account. The CSCI noted that given the time of year and that it was close to Christmas that this matter is attended to in the New Year. A requirement was made that the home makes suitable enquiries and record and document the outcome in order to ensure that wherever possible the best interests or wishes of the residents are recorded in their care plans. The manager was referred to specialist information and advice regarding particular aspects of this process in order to ensure that the correct information was available should it become necessary. Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 14 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): 23 Further work is required by the organisation to ensure that the policy and procedure regarding the protection of vulnerable adults was clear and met with the local guidelines. EVIDENCE: The Commission had made the organisation aware through the inspection process that the policy and procedure for the protection of vulnerable adults must be made clear and met with local guidelines. As yet this work had not been completed in order to ensure consistency across the inspections a requirement was made that the organisation review and update the policy and procedure regarding the protection of vulnerable adults. Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 15 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 These standards were assessed during the inspection of the 4th April 2005. Although the standards were not re-assessed during the inspection of the 25th November 2005 a requirement and a recommendation were made to ensure the home remains comfortable and accessible to specified residents. EVIDENCE: These standards had been assessed previously during the Inspection of the 4th April 2005 they were not assessed during the inspection of the 25th November 2005. The requirements made at the inspection had either been met or where receiving attention. For example the boiler had been replaced and the manager stated that funding had been agreed to replace some of the furniture. Some of the specialist chairs in use were showing signs of considerable wear; the manager reported that the chairs remained suitable for the purpose although unsightly. It was recommended that the manager consider how these chairs might be re-upholstered given the assessed needs of those specified residents. Those individual bedrooms that have access to balcony areas had not been provided with ramps to ensure access to all areas of the building as required. A Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 16 requirement was made to provide ramps in all those areas where residents should have access. Building work within the home had led to one of the double bedrooms being made into two single bedrooms. The work had not been completed at the time of the inspection. This might offer an additional bedroom within the home, a variation of registration would be required should the organisation wish to consider that option. Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 17 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 Regular supervision was provided to members of staff the home must remain mindful of dates and times for supervision to ensure that they are able to remain on target and the meet the standard of at least six sessions per year. Further work is required to ensure that training in equal opportunities/diversity is provided and to consider ongoing training regarding communication. EVIDENCE: A number of supervision records were sampled and although supervision was being provided the home might have difficulty in meeting the standard of at least six sessions per year; four sessions were generally evidenced. It was required that dates and times be agreed with members of staff in order that the home meets the target. Members of staff received regular training in all mandatory training including health and safety, lifting and handling and first aid. Training needs were discussed and recorded through supervision sessions. The manager was unable to confirm whether training in equal opportunities/diversity was provided. A requirement was made that the manager investigates this need and inform the CSCI of the outcome. A specialist service had been engaged by the organisation to provide members of staff with training regarding methods of communication. The manager reported that the training was due to end in March 2006, it was not confirmed Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 18 as to what training might be available after that date. A requirement is made that the organisation review the training provision to ensure that the communication needs of the residents can be met in a consistent manner over the long term and that staff turnover be considered within that review process. Members of the day staff continued to finish their duty at 7pm, the manager reported that staff can and do work flexibly to provide evening and weekend activities. Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 19 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 Further work is required to ensure that any action plan from the quality assurance process is known to the home. EVIDENCE: A copy of the organisations national quality assurance audit was held within the home. The manager was unable to confirm whether an action plan was in place. A requirement was made that a copy of any action plan be forwarded to the CSCI. As noted previously some of the residents are now attending residents meetings in which the services provided by the home can be discussed. Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 20 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 X 3 X 2 Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X 3 X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 2 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Melbreck Score X X X 2 Standard No 37 38 39 40 41 42 43 Score X X 2 X X X X DS0000017623.V268994.R01.S.doc Version 5.0 Page 21 YES 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 YA5 Regulation 5(1)(b)(c) Requirement Timescale for action 31/12/05 2 YA8 3 YA21 4 YA23 5 6 YA24 YA35 7 Melbreck YA35 The registered person must ensure that each service user is provided with a statement of terms and conditions. 24(3) The registered person must ensure that service users are provided with feedback regarding issues raised in the residents meetings. 15(1)(2) The registered person must ensure that, wherever possible, the wishes or best interests of the service users following their death are recorded and documented. 13(6) The registered person must ensure that the organisations protection of vulnerable adults policy and procedure are reviewed and meet local guidelines. 13(4)(a) The registered person must review the lack of ramps within specified individual bedrooms. 18(2)(a) The registered person must review the dates for supervision to ensure they meet the standard of at least six sessions per year. 18(1)(a)(c) The registered person must DS0000017623.V268994.R01.S.doc 31/12/05 31/01/06 31/12/05 31/12/05 31/12/05 31/12/05 Page 22 Version 5.0 8 YA35 9 YA39 review the training to ensure that equal opportunities/diversity are included. 18(1)(a)(c) The registered person must review the planned specialist communication training and inform the CSCI of how they intend to continue to meet this need. 24 The registered person must provide the home with a copy of any action plan from the quality assurance audit. 31/12/05 31/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA24 Good Practice Recommendations It is recommended that the home investigate the option of re-upholstering the specified service users specialist chairs. Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Melbreck DS0000017623.V268994.R01.S.doc Version 5.0 Page 24 - 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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