Inspection on 03/05/05 for Mellor House

This inspection was carried out on 3rd May 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mellor House 31/05/07

Mellor House 26/09/06

Mellor House 25/05/06

Mellor House 14/12/05

Mellor House 19/10/04

Mellor House 04/04/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Mellor House 80 Station Road Westcliff on Sea Essex SS0 7RQ Lead Inspector Sarah Meddle Unannounced 03.05.05 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. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Mellor House Address 80 Station Road Westcliff on Sea Essex SS0 7RQ 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) 01702 437350 01702 437350 Royal Mencap Society Position Vacant CRH 8 Category(ies) of LD & PD registration, with number of places Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Care home. Learning disability - 8. Physical disability - 8. Not exceeding eight persons to be accommodated aged between 18 and 65 years of age. Date of last inspection 19th October 2004 Brief Description of the Service: Mellor House is a purpose-built home providing 24 hour residential care for up to eight adults with profound complex physical and learning disabilities. The home is situated within a residential area of Westcliff on Sea and is close to the towns of Southend and Leigh on Sea. There are good public transport links to the area and a railway station is within close walking distance to the home. Springboard Housing Association owns the home, and MENCAP provide the care. There are eight spacious single bedrooms with handwashing facilities all located on the ground floor. Assisted bathrooms are located within easy location to the bedrooms. There is a large lounge and dining room available. The kitchen is large and wheelchair accessible. A number of areas within the home are in need of refurbishment and this includes the lounge, hallway and kitchen. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home has experienced a significant period of change in recent years due to the lack of permanent management. This was partly resolved in January 2005, with the appointment of a permanent Manager; Ms Mabel Quest. The CSCI await an application for her to be registered as Manager of the home. Whilst many areas of record management (for example care plans, daily records etc,) have not changed since the last inspection, staff morale was stated to have improved. Staff supervision was reported to take place regularly and staff spoken with stated that they found this useful. There are some ongoing issues within the staff team and it is hoped that this will be resolved. Residents (service users) changing needs have been identified and acted upon with professional opinions being sought where necessary. Relationships with residents families was reported by the Manager to have improved and it was pleasing to note that the home has secured the services of an independent advocate. The inspection was unannounced and took place when two service users and two staff were available. The Manager joined the inspection at 11am. The inspection was carried out throughout the morning and lunch time period. What the service does well: What has improved since the last inspection? Appointment of permanent Manager. Reduced use of agency staff/stable core team of staff. Communication with service users significant family members. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 Page 6 Use of Advocacy services. What they could do better: 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. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 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 Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 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, 3, 5 The home demonstrated it effectively meets the needs of individuals at the home by the actions taken, however written material maintained is not adequate to support this. EVIDENCE: The home provides prospective service users with a service user guide and statement of purpose. No new service users have been admitted since the last inspection. Full assessments are carried out prior to admission and all parties are involved in this process and includes the service user, family members, social worker. Whilst these do not fully address those identified in the National Minimum Standards, future assessments for new admissions are reflective. Independent advocates have not been involved in this process but the home has now secured the services of an advocate. Due to the nature of service users complex disabilities the home has not been able to fully identify service user aspirations but their daily activities and normal living principles are addressed. Some items in the care plans were not dated, nor was there evidence of reviews. Unusual changing patterns of behaviour identified in two service users has been managed by the homes’ contact with health care professionals. The staff group did not fully meet the ethnic and religious background of the service users. Revised contracts reflecting the NMS for Adults were not in place despite this being an issue at previous inspections. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 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, 9 and 10. The home identified that the needs of the service users are addressed. The written evidence the home maintains is not reflective of the service delivered. EVIDENCE: Service users are involved in the devising of the individual care plan. These reflect their likes dislikes and daily living activities. Photographs of the service users enjoying and taking part in activities to illustrate the care plan further is positive. The care plans need to show the dates devised and any reviews. It was disappointing to note that the care plans did not reflect recent changes in care needs of service users. Personal goals are not identified and this is partly due to the complex needs and communication difficulties of the service users. These did not reflect goals and aspirations reflecting normal life principles. Daily notes making on the welfare of the service user and how they have spent their day was not always completed (such as a stay in hospital) or other relevant information was scant. However, on other occasions, comments were informative and detailed. Risk assessments are included but these are basic and lack significance, dates and review. The Manager stated she was aware of this and that staff have recently received training in carrying out risk assessments. In the near future revised risk assessments will be in place, carried out involving the key worker responsible for each service user. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 Page 10 Information held on service users is stored appropriately. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 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) 11, 12, 15, 16 and 17. The home provides service users with the opportunity to develop independence relevant to the restrictiveness of their disabilities. Activities available are appropriate and the organisation provides sufficient staff at weekends to meet individuals needs as a number of service users visit their families. Their was a lack of inventiveness around meals provided. EVIDENCE: Service users needs are addressed individually, for example one service user was taken for a haircut and one service user remained at home with 1:1 staff support during the inspection. Activities are available such as outings to the pub and local theatre. A number of service users attend formal day services, which enables them to partake in activities with their peers. No service users are involved in paid work. Family members have a strong presence in the home and actively support the service users. An independent advocate has been offered to ensure an objective view to support the service users rights is available. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 Page 12 Where practical service users personal rights within the home are supported and respected. At weekends the staffing levels are maintained to support 1:1 activities to take place, which is positive to note. Service users are supplied with adequate food stocks. It was discussed that the menus presented identified that the menu was repetitive and not varied. The Manager stated that this was reflective of service user likes. Alternative selections and special diets were not highlighted despite the form providing space on the form for this to be completed. The kitchen cupboards and worktops are in a poor state of repair and the cooker and hob was in need of a deep cleanse. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 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 and 20. Service users personal and healthcare support is well managed. Written information maintained by the home is not reflective of the full service delivered. Relevant paperwork was not always maintained. EVIDENCE: Care documentation highlights service users personal care needs. It was encouraging to note that service users changing needs had been noticed and acted upon. It was disappointing that care records did not adequately reflect this. Food charts had not been consistently completed which was particularly poor practice for one service user whose intake was being monitored for health care professionals information. Policies are in place to support any service users wishing to manage their own medications. Currently no service users do. Medication Administration Records (MAR) are well maintained. It was noted that it had been a problem with staff not signing for medication in the past but it was positive to note that staff are now effectively carrying out the task. Medication risk assessments and protocols were not dated or reviewed. Each service user medication record did not have a photograph for identification purposes. The medication fridge did not have a lock. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 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 and 23. The organisation responds positively to complaints about the service. A recent complaint highlighted the need for the home to communicate with families better. EVIDENCE: Robust policies are in place to protect service users from harm or abuse. Service users were unable to communicate whether they felt safe. A recent complaint regarding medication has been resolved. No complaints have been received by the CSCI. Not all staff had up to date training on identifying and reporting procedures of suspected abuse. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 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 and 30 The home provides sufficient space and facilities to meet service user needs. The lounge is bright and spacious and provides a view of the sea for those not using wheelchairs. Many areas of the home require upgrading, replacing and cleaning. EVIDENCE: Service users at Mellor House are provided with spacious bedrooms, bathrooms and corridors wide enough for self-propelling a wheelchair for example. There is a large lounge room, which currently is in poor condition requiring an overall refurbishment including furnishings; curtains carpet and settee/chairs. Whilst many service users have their own wheelchairs, there is inadequate seating for staff and visitors to sit with them. There did not appear to be much in the way of specialist seating and most service users should not remain in their wheelchairs for long periods. This is a matter the home should investigate further. It was concerning to note that domestic hours have been cut meaning that care staff are carrying out this task. Through discussion it was noted on occasion that effective cleaning is not always possible when a number of service users remain at home or appointments need to be kept out of the home. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 Page 16 There was an unpleasant odour in the main hall and lounge (one area smelt of urine) – the carpet in this area needs replacing as attempts at cleaning it have been unsuccessful and it remains in an unsatisfactory condition. The drawers and cupboard doors in the kitchen are water swollen and falling apart and the cooker and hob was in need of a deep clean. One bedrooms chest of drawers had come loose and looked unsightly. Some bedrooms would benefit from redecoration. The Manager stated that money has been allocated to upgrade the living room and kitchen around July 2005. The CSCI await further details as to when improvements will be implemented. The garden was unkempt and inaccessible on the day of inspection. Since the last inspection, the homes vehicle has been serviced and is awaiting road tax. Currently there is only one member of staff able to drive it but this is extended to service users family members whom the home will insure. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 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) 31, 32, 33, 34, 35 and 36. Staff appeared competent. The Manager reported good staff morale and working relationships. Training opportunities were good but records were not adequately maintained to evidence this. The organisations recruitment checks were not effective. EVIDENCE: Job descriptions are available detailing staff roles and responsibilities. A high number of staff are undertaking the NVQ Level 3. Staff on duty were unsure who else on the staff team held relevant qualifications. A number of staff have worked at the home for some time. Two on duty had worked for over two years at Mellor House. The staff rota had dates missing and on occasions there were two rota’s for the same week with different hours worked. It was commented that there has been a significant reduction in the use of agency staff. The organisation has not ensured that appropriate references are taken up. On one staff file it was noted that a candidate provided two referees home addresses and mobile phone numbers, rather than the services details for example the name and phone number of the home. Instructions detailed by the Home Office on employment hours should be followed to enable students to follow their studies effectively. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 Page 18 Original certificates of CRB checks were not retained in the home. Staff receive adequate supervision and stated that they found it beneficial. Staff stated that they had recently received training in manual handling and medication, however there were no records or certificates to evidence this. The Manager stated that other training is due to be booked for June and July. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 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 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) 37, 40, 41, 42 and 43. The Manager is new in post she has managed other care homes in the past. Further inspections will hopefully introduce improvements in written record keeping relating to care service delivery. The best interests of service users appears to be safeguarded. EVIDENCE: The Manager has many years experience of managing care homes for people with enduring mental health issues. Because of other issues to be dealt with such as staffing and building relationships with service users families, relevant records relating to care have not been prioritised. Some records required by regulation were well maintained for example; accident forms which also showed appropriate action was taken. As previously discussed, records relating to care delivered to service users is poor. The organisation maintains effective policies and procedures. Gas, electrical and portable appliance testing certificates were in good order, as were documents relating to Legionella checks and risk assessment. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 Page 20 The CSCI were not informed of significant events such as heating breakdown (and of any contingency plans), hospital admissions and the absence of the Manager over 28 days. Changes to staffing levels such as cancellation of domestic hours, had not been discussed with the CSCI prior to any decision being made. Quality assurance monitoring had not been carried. 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 3 2 3 x 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 x x 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 3 2 3 2 Standard No Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Score Version 1.20 Page 21 LIFESTYLES Standard No 11 12 13 14 15 16 17 Score 3 3 x x 3 3 2 31 32 33 34 35 36 3 2 2 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x x 3 2 2 2 Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 Page 22 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 YA 6 Regulation 17 (1) (a) and Schedule 3 Requirement Maintain adequate records in respect of each service user including care plan risk assessments and daily notes and provide a photograph on each file. (Previous timescale of 19.10.04 and previous two inspections, not met) Provide wholesome and nutritious food which is varied and reflected in the nutrition record for service users. Identify any special diets. Provide suitable premises which are of sound construction externally and internally, clean, reasonably decorated and the grounds appropriately maintained. (Previous timescale of 28.02.05 not met). Provide an accurate record of staff working in the home and whether the rota was actually worked Ensure effective recruitment checks are carried out - this to include adequate reference information and original CRB certificates. Ensure records required by regulation are adequately Timescale for action Immediate 2. YA17 16 (2) Immediate 3. YA24, YA26, YA28 and YA30. 23 (2) (b) (c) (d) and (o) 01 July 2005 4. YA33 5. YA34 17 (2) and Schedule 4 19 and Schedule 2 17 (2) and Immediate Immediate 6. YA41 Immediate Page 23 Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 7. 8. YA 42 YA 43 and YA 39 Schedules 3 and 4 37 35 maintained. Inform the CSCI of any notifiable incidents. Ensure adequate systems are in place for monitoring the quality of service at the home. A report of the findings to be available and a copy sent to the CSCI. (Previous timescale of 28.02.05 not met). Immediate 01 August 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. 2. 3. 4. 5. 6. Refer to Standard YA2 and YA9 YA5 YA20 YA32 YA36 YA3 Good Practice Recommendations Ensure assessments are clear and relevant documents regularly reviewed in a timely fashion. Provide service users with contracts that reflect NMS for Adults. Ensure the medication fridge is lockable. 50 of care staff to NVQ 3 by 2005. Ensure certificates of training attended is available for each staff. Ensure service users are provided with effective and comfortable specialist seating for the living room and /or bedroom. Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Mellor House I06 I56 S15510 Mellor V223931 030505 Stage 4.doc Version 1.20 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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