Inspection on 19/06/06 for Mellish House Residential Home

This inspection was carried out on 19th June 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Mellish House Residential Home 18/07/07

Mellish House Residential Home 22/11/05

Mellish House Residential Home 28/01/05

Mellish House Residential Home 11/05/04

Mellish House Residential Home 20/01/04

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

CARE HOMES FOR OLDER PEOPLE Mellish House Residential Home Kings Hill Great Cornard Sudbury Suffolk CO10 0EH Lead Inspector John Goodship Unannounced Inspection 19th June 2006 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mellish House Residential Home Address Kings Hill Great Cornard Sudbury Suffolk CO10 0EH 01787 372792 01787 377953 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) Stour Sudbury Limited Suzanne Elizabeth McKeon Care Home 34 Category(ies) of Dementia - over 65 years of age (34) registration, with number of places Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2005 Brief Description of the Service: Mellish House provides care for 34 older people who have dementia. The home is located in a residential area of Great Cornard on the outskirts of the market town of Sudbury. There is a Public House close by, and the town of Sudbury provides a range of shops and eating-places. The home shares grounds with another registered care home, which is also owned by Stour Sudbury Ltd. Mellish House is a purpose built home arranged on two floors. There is a passenger lift and stairs to the first floor, and ramped access to an enclosed garden. All thirty-four single rooms, which are located on both floors, have a wash hand basin and ensuite lavatory. Each floor has a dining room, lounge and two communal bathrooms and lavatories. Mellish House Residential Home DS0000024446.V299125.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 key inspection of 2006. Its aim was to check that action was continuing to be taken to implement the requirements of the previous inspection report of November 2005, and to inspect all the key standards as listed overleaf under each Outcome Group. The visit took place over 6.5 hours during the day. The manager was present throughout, and the provider’s regional representative was present for part of the visit. The inspector examined care records and staff files, toured the building, spoke to care staff and other staff and interviewed two care staff, and spoke to several residents and observed others in the communal areas, the dining rooms and walking around the home. No survey forms were returned by or on behalf of residents, nor were any relatives’ comment cards received. However the inspector was able to speak to two relatives who came to take a resident out for lunch. What the service does well: On the day of the visit it was clear that visiting relatives were welcomed to the home and greeted in a friendly manner. Residents can choose to move around the home to where they wanted to be freely within a very relaxed atmosphere. Information from relatives and other professionals as to how residents would liked to be cared for was set in out in detail. This included resident’s likes and dislikes. The home employs a part time activity co-ordinator, who has created a varied programme of activities and games, with full recording of participation in each resident’s file. Staff were observed to show a caring and respectful attitude to residents. Mellish House Residential Home DS0000024446.V299125.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. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4. Standard 6 is not applicable to this service. Quality in this outcome area is adequate. Although most relevant standards are met, residents will not be certain that staff are competent to care for their specialist needs until training programmes are completed for the majority of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care plans were examined. All contained pre-admission assessments. Residents, or their advocates, were given a contract which set out the terms of residency. A copy of the contract was signed by both parties. Training was underway for some staff to provide the specialist competence essential for the specialist care required by the residents. This is covered under outcome group “Staffing”. The training of staff needed to be completed before it would be possible to fully meet Standard 4. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 9,10. Quality in this outcome area is adequate. Residents cannot be sure that all their care needs will be assessed and that staff will be guided to support those needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans for those residents who lived on the ground floor contained a care plan summary, which was helpful at-a-glance information for all carers. None had yet been completed for those on the first floor, although the manager was anxious to complete these summaries as soon as possible. Two of the care plans did not contain a photograph of the person. Health needs were recorded in the plans, with risk assessments, nutrition monitoring using the M.U.S.T. system, records of visits by the district nurse and GP visits. Care plans included information on the behavioural aspects of residents, but little evidence of guidance for staff in dealing with episodes safely and with the dignity of the resident intact. There was little indication in the assessments and care plans that each person had their own individuality with their preferences, Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 10 skills, strengths and needs. Plans were good at identifying what residents could not do, without describing ways of making use of their remaining abilities. Some of this approach was evident in the records of the activities co-ordinator, but not generally. A few entries merely reported All care given. This was not a professionally adequate record of the care given, nor of any activities which the resident had undertaken. Using the manager’s training in Dementia Care Mapping, and increasing the level of staff training in the knowledge and skills of person-centred planning, would enable the home to plan and deliver a quality of care aimed specifically at people with dementia. It was noted that all entries were up-to-date. Reviews were recorded as being held, and a relative confirmed that they were invited to attend. This relative expressed their opinion that the care given to their relative was excellent. They were always clean. They took the reisdent out twice a week for lunch. None of the care plans sampled included information on the resident’s wishes at the time of death. Staff were aware of the need to treat residents with respect and to consider dignity when delivering personal care. A sample of MAR charts was examined. All signatures were in place, and tallied with the tablets remaining in the drug trolley. It had been noted at a previous inspection that the medication cupboard was rather warm. On this inspection, the temperature showed 28 degrees C. Many medicines require to be stored at below 25 degrees C. It was noted that the ceiling fan was not working properly. The manager stated that they would ask the maintenance man to repair it to see if this brought the temperature down. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. Fuller care plans and record keeping will provide better evidence that residents can expect all aspects of their preferred lifestyle are met. Residents can be confident that visitors will be welcomed and be kept in touch with their progress. The availability of activities is being enlarged with proposals for outside trips. Residents’ nutritional needs are monitored and the catering service meets the dietary needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It had been noted in previous reports that the home employed an enthusiastic and creative activities co-ordinator. Whilst they were not on duty on this occasion, there was evidence that they completed full records of the activities undertaken by each resident and these were inspected. During the inspection, staff were engaged in some one-to-one activities, reading the newspaper, playing dominoes, and after lunch a group game downstairs. However, with the limited english language ability of some care staff, it was difficult to assess whether some staff had the necessary communication skills to maximise each persons ability to be understood, to understand and to make choices. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 12 Visitors were welcomed in the home, and the monthly provider visits reported on their comments. All seemed to appreciate the care given. The inspector spoke to two relatives who were very happy with the care of their relative, whom they visited twice a week, and usually took out to lunch. There had been a complaint earlier in the year which, although unfounded, revealed some shortfall in communications with a family. The home had held a fete in the garden the previous Saturday which the manager thought had been successful in attendance and had raised a significant sum for the residents amenities fund. The manager had booked a local wheelchair accessible transport for a date in July and in August in order to take six residents out on a trip. This would be a positive activity if it takes place. The dining rooms, one on each floor, were clean with re-covered chairs. However the plain tablecloths gave the rooms a dull appearance, and the downstairs room was quite dark. There were noticeboards in the two main lounges with that days menu choices, although some residents did not know what was for lunch. The kitchen was clean and met the environmental health standards. Records for the fridge temperatures were seen, and the record of dangerous equipment. The cook was aware of the new legislation relating to food hazard controls. Care plans recorded residents who required special diets. Residents ate their lunch in a mostly calm atmosphere, although one carer was heard to order a resident to sit down in a loud voice. Staff were available to support those who needed help, either with cutting up food, or with eating it. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18. Quality in this outcome area is good. Residents can be assured that their concerns and complaints will be handled quickly. Arrangements can be made for legal representation or for power of attorney if necessary. Residents are protected by the training in adult proptection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints log was inspected. There were three concerns reported which had been sorted out by the manager to the satisfaction of the resident or relative. It was noted that there was a notice on the board regarding the providers whistle-blowing policy. It displayed prominently the phone number of the responsible senior officer in the organisation who staff should ring in confidence. Two staff files which were examined contained a record of the training sessions on adult protection which staff had received. These were repeated annually. Also kept in the files were the test questionnaires completed by staff at the end of each training session. One relative stated that they were the legal representative of their relative with power of attorney. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. Residents are able to benefit from a continuous programme of upgrading which sometimes takes time to be actioned by the provider. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All rooms now had the names of each occupant in large print against a background which reflected an interest of theirs. The walls of rooms were decorated in deeper colours than other surfaces to allow residents to differentiate. The front door had a keypad entry system which required all visitors and residents to be let in and out by staff. In the laundry there was a tumble dryer cleaning check list signed to show that for instance the lint tray had been cleaned out. This had been identified at an earlier inspection as a fire hazard. Residents clothes were sorted in Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 15 pigeonholes. Some of the white items were decidedly grey in appearance, indicating imperfect cleaning or time for replacement. The manager and the regional representative said that the carpet in the downstairs hallway and corridor was included in the current years plan for replacement. This was not a guarantee that the replacement would happen if a more urgent need arose. The inspector was able to discuss with the housekeeper the methods used to maintain the cleanliness and atmosphere of the home. She was aware of those residents who needed surveillance of rooms for staining and odours. Control measures were in place and in only one room was a faint unpleasant odour detected. One room had been refloored with laminate but retained a personalised feel. One relative asked if all the floors could be laminate, but this would not necessarily be the choice of the resident, nor have the support of the CSCI. The manager was aware that maintaining the hygiene of the home had to be accompanied by analysis of the cause of the problem. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is adequate. Residents are supported by the appropriate numbers of staff who are recruited and initially trained with procedures to protect the safety of residents. However, residents cannot yet be sure that all care staff are trained to care for their specialist needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had one current vacancy for a full-time day carer. This was covered internally and no agency staff were being used. There were five carers on during the day, with the deputy manager and manager as additional to this. At night there were three waking staff on duty. The home employs a number of foreign staff mainly from Poland, which they recruit through an agency. Two relatives said that they had no problems with communicating with the foreign staff, but they were difficult to understand when they answered the phone. The inspector spoke separately to three carers whose first language was not English. They had some difficulty understanding some of the questions put to them, although the answers they gave showed that they did understand some of the care needs of the residents for whom they were keyworkers. Their entries in the daily record showed that their written English was better than their conversational English. One carer, who had the most difficulty understanding questions, said that they were going to English language lessons. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 17 The manager reported that when they conducted training sessions, time was given to check that these staff understood the information being put across. They were encouraged to ask if they did not understand. This was confirmed by a carer whose first language was not English. They said that they were encouraged by the trainer to ask if they were unsure of the meaning of words. Staff were tested at the end of training sessions to check understanding. These tests were held on file. Recruitment and ID documentation for recently appointed staff was all in order. Training records showed that staff undertook the mandatory courses with regular refreshers. These included, moving and handling, fire, food hygiene, first aid, health and safety and adult protection. In addition staff received a short introduction to Dementia Care. Some staff were working through the Dementia training pack produced by the Alzheimer’s Society with video and training manual covering topics at NVQ Level 2. It would take further time before the majority of care staff had completed an in-depth course in the care of people with dementia. The one day Dementia Awareness course is a good introduction but must be followed by further knowledge and skills training. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. Quality in this outcome area is good. Residents can be assured that the home has systems to monitor the care given. Residents’ health, safety and welfare are promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was registered by the Commission in 2003 and had been working in the home for some years prior to that. She had gained the NVQ Level 4 in care and management. The provider representative visited the home each month as part of the provider’s quality assurance programme. An informative report was written for the manager and copied to the CSCI. This included all the matters required by Regulation 26 with action points to be followed up. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 19 Staff meetings were held, the last one being four days prior to the inspection. The provider representative explained that they had set up an opportunity for their activities co-ordinators to meet and share experiences of what worked, and to share best practice. The effect of this was apparent from previous inspections and from the records made by the Co-ordinator. There had been a visit from the local council environmental health officer (EHO) in February 2006, which had identified some minor works needed to the kitchen. These had been completed as was evident on inspection. A return visit by the EHO had found all items now met their requirements. The home has procedures in place to prevent and tackle the topic of unpleasant odours. This was clear from the discussiobn with the housekeeper and manager and the tour of the home. There was no unpleasant odour in the building generally. The manager took the inspector to one room where particular difficulties had been experienced. Strategies to improve the hygiene of this room, and to try to identify the reason for the resident’s behaviour were discussed. The home did not hold any money on behalf of residents. All residents, or their representatives, were invoiced for fees and extras such as hairdressing. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP4 OP30 Regulation 12(1) Requirement The registered person must ensure that care staff are appropriately trained to provide the specialist dementia care expected of the home. The registered person must ensure that the temperature of the drug storeroom is maintained below 25°C. Care plans must reflect best practice in the assessment of needs of the residents, with proper recognition of abilities, wishes and preferences, with clear guidance for staff on how those needs must be met. Care plans must include information on the wishes of a resident at the time of death. Timescale for action 01/11/06 2 OP9 13(2) 19/06/06 3 OP7 15(1) and (2) 19/06/06 4 OP11 12(4), 15(1) and (2) 19/06/06 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 Good Practice Recommendations DS0000024446.V299125.R01.S.doc Version 5.2 Page 22 Mellish House Residential Home 1 Standard OP12 The registered person should ensure that all records of activities undertaken by each resident are fully documented, with the records made by the activities coordinator as the example. Mellish House Residential Home DS0000024446.V299125.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. 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