Inspection on 04/04/05 for Melbreck

This inspection was carried out on 4th April 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 but made no statutory requirements on the home.

Other inspections for this house

Melbreck 14/11/07

Melbreck 20/03/07

Melbreck 22/06/06

Melbreck 25/11/05

Melbreck 17/01/05

Melbreck 01/10/04

Melbreck 04/08/04

Melbreck 28/04/04

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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 Surrey GU10 2ED Lead Inspector Susan McBriarty Unannounced 04 April 2005 10.00 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 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 Stationary 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Melbreck Address Tilford Road Rushmoor Farnham Surrey GU10 2ED 01225 793474 Telephone number Fax number Email 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 Lorna Oliver Care Home 26 Category(ies) of LD learning disability (26) registration, with number PD physical disability (26) of places Melbreck Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. 26 beds providing nursing care for people from the age of 16 years with learning disabilities and associated physical needs. Date of last inspection 17th January 2005 Brief Description of the Service: Melbreck is a substantial detached property catering for service users with learning disabilities and associated physical disabilities aged betwee 16 and 65 years. The home is located in a rural area near Farnham. The accommodation is for 26 service users. The accommodation has 18 single rooms with four double rooms. There is a large garden with an aviary, herb garden, outdoor pool and green house all of which are accessible to service users. Melbreck Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by two inspectors and took place over five hours. The inspection was unannounced and was the first for this year, 2005 2006. Copies of the inspections for 2004 – 2005 are available on the CSCI web site or by contacting the Eashing office A full tour of the premises took place, service users were observed three of the nine staff on duty were spoken to and the homes records including care plans were sampled. No friends or relatives were at the home during this visit. The six service users seen during the inspection were not able to talk about the home, as they did not have the verbal skills. What the service does well: What has improved since the last inspection? What they could do better: The manager has to report all maintenance needs and administrative changes to the home’s Head Office. This had created delays in getting necessary work completed. For example this inspection report notes that there are continued issues regarding the provision of hot water. In some parts of the home the water was cold and in others too hot. In addition changes to organisational documents are also delayed, for example the Statement of Purpose and Melbreck Version 1.10 Page 6 Service User Guide. These have been made a requirement again on this inspection. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Melbreck Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Melbreck Version 1.10 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 standard(s) 1,2,4 The home had an admissions procedure that ensured service users could visit the home and if wished stay for a short period of time. Detailed admission assessments were present. The Statement of Purpose and Service User guide still need to be updated. EVIDENCE: Individual records were kept for each service user and show in detail the assessed needs of each person. The assessments have not been signed by the service users, as they were unable to do so. Neither had the representatives and/or relatives of the service users signed them. The registration certificate of the home states that the home accepts people from the age of sixteen, the Statement of Purpose states nineteen plus; the home needs to ensure this is changed. None of the staff have been trained to work with children and no children are present within the home. The manager stated that the home would only be taking those over the age of nineteen. A copy of the most recent inspection report was not available for service users and their families and friends to see as required. The service users contracts/statement of terms and conditions were kept at the homes Head Office and were not seen. Requirements from the last inspection will be carried over, the CSCI are concerned at how long the home are taking to update the care plans. Melbreck Version 1.10 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 standard(s) 6,7,9,10 Good progress had been made in updating the care plans and providing a consistent approach. Each service user file sampled had a detailed care plan that reflected their needs and how they would be met by staff. The current service users had complex needs and were not able to make in depth decisions regarding their assessments and needs. Risk assessments were seen and were up to date. The care plans did not evidence the involvement of others, such as other professionals, service user representatives or relatives. One of the service users safe environment assessments had not been signed. EVIDENCE: The care plans seen show that all aspects of the service users needs had been assessed and how those needs were to be met. In some instances changes had been made to the care plans, however those changes had been crossed out rather than replacing the document. This action did not affect the outcome. The care plans did evidence that they were being reviewed. However, some of the care plans have not been updated as yet. This work was seen as ongoing, the requirements made at the last inspection remains until this work is completed. Melbreck Version 1.10 Page 10 Risk assessments had been completed on behalf of service users and covered all aspects of their daily lives. However one Waterlow assessment seen had not been signed or dated. In this home the service users had not signed their care plans or risk assessments, as they were unable to do so. However there was no evidence of the plan being drawn up with the involvement of others. The manager stated that she was going on the training course for person centred planning and was in the process of reviewing the use of Waterlow assessments. All records are held confidentially in the office. Melbreck Version 1.10 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 standard(s) ,14, 15, 16, 17 The home had two areas where service users could take part in a variety of activities one in a lounge area and the second in a mobile unit just outside of the home. An education centre was also available for some of the service users; the centre was within a short distance of the home. Transport and staffing was provided by the home for those who attended. Not all staff training had been carried out. The meals were varied and nutritious. The home rules on smoking and the use of alcohol remain unchanged from the last inspection. Some of the rooms have doors that open out onto a balcony, ramps were not provided. EVIDENCE: The home had been working closely with two organisations, one providing advocacy and the other had knowledge and experience in providing activities to people with complex needs. The manager stated that the organisations had completed their review of the services on offer in February 2005 and a meeting had been arranged for week commencing 11th April 2005 to discuss the activity needs of the service users and the staff training needs. The Commission for Social Care Inspection (CSCI) had previously made a requirement to ensure that staff received training to provide the activities on offer. This requirement will remain and the time limit extended because of the date for the meeting. Melbreck Version 1.10 Page 12 A full tour of the home was undertaken and staff members were observed knocking at each door and checking if service users were present. The doors cannot be locked, as this was not considered suitable given the needs of the service users. Staff were observed assisting service users at lunch time, the support being offered was seen to be respectful and provided in a calm atmosphere. The meal was seen to be appetising but was not sampled by the inspectors. The kitchen area was seen and the cook stated that she was developing a menu plan for the service users; she had started work at the home in January 2005. The Statement of Purpose and Service User Guide had not yet been updated; the manager stated that the home’s administrative staffs, which are not based at the home, were still reviewing those documents. The home had employed a physiotherapist who was working 4 days a week. The physiotherapist was re-assessing and updating all the physiotherapy needs of each of the service users. In discussion with her she stated that she was working under the guidance of the organisations Occupational Therapist and the new physiotherapist was overseeing the physiotherapy assistants in the home. There are some restrictions regarding access within the home. Two of the service users rooms and one lounge have balconies available, however none of these areas have ramps enabling the service users to access the balconies safely. No holiday had as yet been planned for this year. The manager is looking at the provision of long weekends. The service users pay for the holidays including accommodation and transport. The home pays for the staff time. A number of the service users have families who visit the home regularly, none of whom were present during this visit. It was pleasing to see that the television sets have been replaced since the last inspection and offer the service users improved provision. One of the lounges had been converted to provide an activity area since the last inspection. The staff had not yet been trained to provide a number of the activities on offer. Training had been provided to staff to use the sensory room. The requirement from the last inspection will remain. Melbreck Version 1.10 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 standard(s) 18, 19 Detailed care plans were in place however more work is required to ensure that they are consistent and have been signed by service users and if this is not possible by the representative or relative. A key worker system was in place. As stated earlier there were still issues regarding the provision of activities from trained staff and it was felt that this would have an effect on meeting the emotional needs of the service users. A requirement from the last inspection that a record be kept separately by the manager of all pressure sores has not been met. EVIDENCE: The care plans sampled detailed the daily needs of the service users and included how those individuals preferred staff to work with them. Access to other professionals was also evidenced. However the service users in this home are not able to sign their own care plans and neither had a representative or relative had signed them. The manager stated that pressure sores and the action taken was recorded on a service users file, this was seen. The manager had not started a file to record when a pressure sore was found, the name of the service user, size, treatment and any other action taken. This was despite being a requirement from the last inspection. Melbreck Version 1.10 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 standard(s) 22 There were three differing complaints procedures available. No complaints had been received. EVIDENCE: The Statement of Purpose, the homes policy and procedure and the three complaints procedures seen show that the home did not have a clear consistent procedure in place. One of the complaints procedures was seen to be very out of date. Melbreck Version 1.10 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 standard(s) 24, 25, 26, 27, 28, 29, 30 The communal areas were clean, however some furnishings require repair or replacement. The home continues to have a problem with the hot water supply with various parts of the home experiencing different problems. The bathroom that was not in use at the last inspection was still out of use and another had mould growth on the wall. Chemicals were not stored safely. EVIDENCE: A full tour of the home took place and each of the rooms was seen. Three of the four shared bedrooms did not have the screens that are necessary to maintain the privacy and dignity of service users, although they were not being shared at the time of the inspection. Two of the shared bedroom spaces posed problems in terms of available space for each service user. The manager stated that the shared rooms were under review. The issues raised during this inspection need to be considered as part of the review process. One of the bathrooms was still not in use although given the number of bathrooms available this had not affected the service users. As there were no immediate plans to re-open the bathroom it must be made clear that the area is not in use. Melbreck Version 1.10 Page 16 On checking the water temperature it was evident that at least one part of the house had specific problems. In more than one room there was no hot water available and in another room the water was too hot. The water temperatures were considered an issue at the last inspection and no progress has been made regarding this problem. The manager has reported the problem and the heating and water provision has been assessed. The home is being considered for the provision of new boilers to resolve the matter. All maintenance requests are made to the Head Office of the organisation. A maintenance person attends the home once a week to undertake small works. Some of the sofas and specialist chairs in the communal areas had torn covers that require replacement or recovering. A new shower has been ordered for the bathroom showing mould growth the re provision was said by the manager to be expected to end the problem with the mould. A Cupboard containing chemicals was found to be unlocked including the main storage cupboard. This was locked immediately. The current service users were unable to reach this cupboard. The bathroom cabinets also contained chemicals and were unlocked. As stated the present service users are unable to reach these, however the home has six vacancies and this situation could change. The requirement from the last inspection to ensure that all chemicals are appropriately stored has not been met. All the single rooms had been personalised. Specialist aids and adaptations were in place to ensure the service users needs were met. The home had a number of vacancies and only one of the four shared rooms was in use. The laundry facilities met the needs of the service users. All the clothing seen had a name tag and each service user had their own laundry basket. Melbreck Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 36 The home has not yet reached the target of 50 of care staff being qualified at NVQ Level 2. Further work is required in this area. The staff files still did not contain the information required. EVIDENCE: Three of the present care staff are qualified to NVQ Level 2. The home provides nine care staff and two Registered Nurses on each day shift and three waking night staff. A qualified member of staff is always on duty. Meetings are held regularly with the staff team. The minutes of the last meeting were held where all members of staff could access and read them. The manager had access to the job descriptions and advised that job descriptions were not held on the personnel files of each staff member. The Criminal Records Bureaux (CRB) checks had been completed and a letter was seen confirming this. The original documents are kept at Head Office. The original CRB checks must be kept on file at the home. In line with CRB guidance the home must record the staff members name and the reference number and date of receipt. The CSCI must see the original documents in order to sign that they have been seen. Job descriptions for each member of staff must also be kept on each personnel file. Melbreck Version 1.10 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Progress has not been made in ensuring that cupboards containing chemicals are kept locked. The parking area in front of the home still does not have any markings to ensure people do not park in what should be a safe evacuation area. Clinical waste provision requires further consideration. EVIDENCE: The bathrooms each have a cupboard containing chemicals, none of the cupboards seen was locked. A large cupboard where cleaning materials were stored was also unlocked. It was locked immediately on being brought to the attention of staff. It remains a requirement that all cupboards containing chemicals be kept locked. All sharps boxes must be dated to ensure that the first day of use is clear. Melbreck Version 1.10 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 2 x 3 x Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 3 3 3 3 Standard No 11 12 13 14 15 Melbreck x x x 2 3 Standard No 31 32 33 34 35 36 Score x 2 3 2 x 3 Version 1.10 Page 20 16 17 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x Melbreck Version 1.10 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. YP1 Standard Regulation 4(1)(a)(b) (c)(2)(3)( a)(b), 5(1)(a)(b) (c)(d)(e) (f)(2)(3) 14(2)(a)( b), 15(1)(a)( b)(c) 18(1)(i) (ii) Requirement The home must have an updated statement of purpose and service user guide. The documant must be kept under review and revised as necessary (Timescale of 17.04.05 not met) The registered provider must ensure that care plans are reviewed and updated as required. (Timescale of 17.04.05 not met) Staff must be appropriately trained to provide service users with activities either presently being provided or planned to be provided on site (Timescale of 20.02.05 not met) The registered provider must ensure that if there are changes to the the smoking and alcohol policy assessments and risk assessments must be provided accordingly. (Timescale of 17.04.05 not met) The registered provider must ensure that the recording and action taken to address pressure areas is also centrally held and service users referred to specialist provision as required. (Timescale of 18.01.05 not met) Version 1.10 Timescale for action 27th May 2005 2. YP6 27th May 2005 3. YP14 24th June 2005 4. YP16 12(1)(a) (3), 13(b) 27th May 2005 5. YP19 12(1)(b) (3), 13(1)(b) 22nd April 2005 Melbreck Page 22 6. 7. YP30,40 YP34 12(a)(3) 13(3)(c) 17(2) Schedule 4 (6)(a)(c) (d)(e)(f) 23(2)(a) (4)(b)(c) (iii) 13(3)(4) (a) 23(2)(j) 8. YP42 9. YP42 10. YP42 11. YP42 13(3) 16(k) 22(1)(2)( 3)(4)(5) (6)(7)(a)( b)(8) 12. YP22 Liquid soap must be present in all the dispensers. (Timescale of 18.01.05 not met) The registered provider must ensure that the original CRB documents are kept at the home until such times are they are seen by CSCI. (also in line with CRB Guidance) The evacuation area from the ground floor lounge to denote no parking areas to ensure adequate means of escape. (Timescale of 18.01.05 not met) The registered provider must ensure that all items relating to COSHH are appropriately stored. (Timescale of 18.01/05 not met) The registered provider must ensure that hot water supplies are on a consistent basis in order to meet service users needs. The registered provider must ensure that all sharp boxes are provided with a clearly marked start date The registered provider must ensure that a complaints procedure that is compliant with the Care Homes Regualtions (amended)2001 is provided 22nd April 2005 27th May 2005 27th May 2005 22nd April 2005 24th June 2005 22nd April 2005 24th June 2005 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 24 Good Practice Recommendations It is recommended that a review take place in order to enable those service users who wish to, have access from their own rooms and the communal room to the balcony area/s. Melbreck Version 1.10 Page 23 Commission for Social Care Inspection 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 Version 1.10 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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!