Inspection on 01/11/05 for Melrose

This inspection was carried out on 1st November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Melrose 08/03/06

Melrose 22/03/05

Melrose 10/01/05

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

CARE HOME ADULTS 18-65 Melrose 8 Melrose Avenue Hoylake Wirral CH47 3BU Lead Inspector Peter Cresswell Unannounced Inspection 1st November 2005 09:00 Melrose DS0000018912.V263055.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 Melrose DS0000018912.V263055.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. Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Melrose Address 8 Melrose Avenue Hoylake Wirral CH47 3BU 0151 632 4669 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) louise@pcidercare.com Mr Hendrikus Gerardus De Rooij Mrs Alexandra De Rooij Mr Hendrikus Gerardus De Rooij Care Home 29 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (29) of places Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twenty nine (29) adults with a mental disorder, aged 18 - 64, and may from time to time care for adults with a mental disorder over the age of 64. The total number not to exceed 29. 1 adult with a mental disorder who additionally has a mental handicap may be accommodated. 1 named adult with a mental disorder and physical disablement may be accommodated. 22nd March 2005 2. 3. Date of last inspection Brief Description of the Service: Melrose is located just off the main road in Hoylake, within easy walking distance of a wide range of shops, restaurants, churches, other community facilities and the shore on Deeside. Hoylake is well served by public transport. Melrose was originally built by the local authority for use as a care home for older people and was converted by the present owners to accommodate people with mental health problems. The home has 29 bedrooms on two floors. Many of the rooms are spacious and two of them can be used as flats to aid rehabilitation. There are three lounges; a large, well furnished TV lounge, a medium sized ‘quiet’ room, a very small smoking room plus a dining room. Smoking is only allowed in the smoking lounge. Melrose has a lift but it is not in everyday use and service users are encouraged to use the stairs. There were 23 residents at the time of the inspection. Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced inspection the inspector spoke to a number of residents, staff, the owners (one of whom is also the Registered Manager), the Care Manager and the Residents’ Services Manager. He examined documents including care plans, staffing files and fire safety records. He also toured part of the building, including all of the lounges, some residents’ rooms and the kitchen. What the service does well: 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. Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 6 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 Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 7 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): 2. Residents are only admitted to Melrose if their needs have been adequately assessed, thus ensuring that their needs can be met. EVIDENCE: The Registered Person or the Care Manager assess prospective residents before they are admitted. The file of a recently admitted resident indicated that she had visited the home with a relative before being admitted and had decided to move in after a period of reflection. She had been properly assessed before admission and evidence was on file from other professionals, including a consultant psychiatrist. Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 8 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): 6, 7 and 9. Care plans are detailed and are reviewed regularly, ensuring that up to date information is available to staff responsible for day to day care of the residents. EVIDENCE: There is a detailed care plan for each resident. A member of staff reviews the care plans each month and any changes are entered on to the plan using a computer. The care plans deal with issues such as hygiene, medication, activities, motivation and behaviour. Daily reports (often more than one a day) are made on a dedicated computer program - Care Assist - which does not allow the retrospective alteration of records. Each resident has a folder on the database, which includes the daily report, accident reports, incidents, a photograph and personal details. The program can only be accessed by staff using a password and documents are backed up on a central server. Smoking is restricted to one small and very well used smoking room. Risk assessments are completed and were in place on the files examined during the inspection. The Registered Person has decided that the risk of allowing residents to have kettles in their own room is too great and they are not permitted. No residents told the inspector that they wanted such a facility. Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 9 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): 12, 13, 14, 15, 16, 17. Daily routines in the home are informal. Some activities are provided and most residents follow their own preferences by taking part in everyday activities in the community. The meals in the home offer some choice, flexibility and a nutritious diet for the residents. EVIDENCE: A member of staff has been designated as the home’s Activities Organiser. She provides 20 hours of such work at each of the Registered Person’s homes. Activities include trips, both on a group basis and individually. Two residents were due to go to Blackpool with staff and residents from the Registered Person’s other home later in the week. Another resident told the inspector that she was going shopping with a worker from Impact, a local voluntary organisation staffed mainly by former social workers. The Registered Person said that he was considering stopping using Impact as its staff have not been CRB checked, though they are experienced people. It would be unfortunate to lose such a valuable resource and it is to be hoped that the problem can be resolved. Activities were not recorded in any detail and it was difficult to establish exactly what had been provided in recent months. Most of the residents go out alone and take part in a range of activities in the locality – Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 10 one resident told the inspector that he does voluntary work in a local charity shop. Most of the residents visit local pubs, cafes and restaurants. The Registered Person and staff encourage residents to maintain contact with their families; this was evident from the files examined during the inspection and from conversations with residents. Meals are served at flexible times and there is always a vegetarian choice on the menu. Two residents are vegetarian and enjoy the meals prepared for them. The main meal of the day is usually served at lunchtime, though the evening meal is often also cooked. Tea and coffee tends to be served at fixed times throughout the day and there are no independent drinks-making facilities for residents, though there is a vending machine. Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 11 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): 18, 19, 20. Appropriate specialist mental health care is available to all residents, ensuring that they receive care appropriate to their condition. Medication is well organised and the administration of medication is generally accurately recorded, protecting the interests of the residents, though there were some minor shortcomings. EVIDENCE: Few residents at Melrose require physical personal support. One older person is a resident at the home but does not require this type of support and is placed at the home by reason of mental health issues, not old age. Residents receive all necessary community and specialist health services and most receive support from Community Psychiatric Nurses and psychiatrists. All residents have single bedrooms and can therefore receive guests and visiting professionals in private. No residents retain their own medication and medication is on the whole well organised and administered. The home uses a monitored dosage system (MDS) with most medication dispensed in dedicated blister packs. The inspector checked the medication for three residents and one tablet (not in the MDS) could not be accounted for. Controlled drugs are stored in a suitable controlled drugs (CD) cabinet and their administration is recorded in a bound CD register. However, not all of the entries recording administration were signed by two staff as required by the Royal Pharmaceutical Society’s guidelines. Depot injections are given by visiting Community Psychiatric Nurses and are recorded on the Medication Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 12 Administration Record sheets. Medication requiring refrigeration is stored in a dedicated fridge. The temperature of the fridge is checked but not recorded. Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 13 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): 22, 23. Melrose has a complaints procedure which is available for residents and relatives to use to make their views heard and protect their best interests. EVIDENCE: The home has an appropriate complaints procedure but no complaints have been received since the last inspection. Adult protection policies are available in the home and staff receive training in the protection of vulnerable adults. Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 14 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, 25, 26, 27, 28, 29, 30. Melrose’s clean, appropriately furnished accommodation meets the needs of its residents. There are some minor repairs needed to ensure the continued comfort of the residents. EVIDENCE: Melrose was originally built as a care home for older people. The present owners adapted it to meet the needs of younger people with mental health problems. All areas of the home are accessible and a shaft lift is available if needed though it is not in everyday use and service users are encouraged to use the stairs. The areas of the home inspected on this occasion were well maintained and appropriately furnished. Melrose is within easy walking distance of public transport and other community facilities. The home is clean and adequately decorated with several bedrooms being repainted on the day of the inspection. The one exception to this was the very small, but well used, smoking room which was poorly decorated and shabby. The Registered Person does not encourage smoking and the home has a clear policy of restricting smoking to this lounge. However, many people with mental health histories have long standing smoking habits and a balance needs to be struck between meeting their interests as well as those of non-smoking Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 15 residents and staff. During the inspection there were more residents in the smoking room than in the other two lounges put together. Residents all have single bedrooms with locks and those rooms visited during this inspection were clean and in many cases personalised to reflect the interest and personalities of their occupants. There are sufficient toilets and bathrooms to meet the needs of the residents and they are clean and well decorated. The vinyl flooring in the bathroom on the first floor was lifting and must be replaced or repaired. Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 16 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): 32, 33, 34, 35, 36. The home’s recruitment and training policies ensure that residents have their needs met by competent staff EVIDENCE: The home is adequately staffed and employs catering staff, domestics and a handyperson as well as care staff. In the past staff have worked at both Melrose and the owner’s other home in New Ferry. The Registered Person said that as they began to establish more staff stability it was intended to deploy staff to individual homes. This would help the development of the key worker policy and arrange for more continuity in the care of the residents. The owners have begun to employ additional staff from overseas and workers from Poland, the Philippines and Romania currently work for them. The staff are recruited via a specialist agency which screens them, takes up references and arranges for work permits and immigration clearance where necessary. Management conduct telephone interviews, partly to ensure that staff have sufficient command of English for the post. Recruitment records showed that CRB certificates had been applied for and POVA First checks received for all new starters. Staff awaiting CRB certificates (but with POVA clearance) are closely supervised. All care staff have at least NVQ2 or equivalent. Some staff recruited from overseas have had their nursing qualifications assessed by NARIC (the appropriate government agency) as equivalent to NVQs. As their qualifications are in the field of personal care they are deemed to be equivalent to NVQ. Despite this, some overseas staff have also done NVQ training which Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 17 will further equip them for the task of caring for people with mental health problems. New staff receive induction training, much of it based on a series of training videos, and the home continues to provide training for other staff, though full details were not easily accessible at the time of the inspection. Staff are supervised but this is not yet adequately recorded. Melrose DS0000018912.V263055.R01.S.doc Version 5.0 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 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): 37, 38, 39, 40, 41, 42, 43. The home is well managed and records are properly and safely kept, protecting the rights and best interest of the residents. EVIDENCE: The Registered Manager is also one of the owners and is qualified and experienced in the fields of mental health care and management. The home operates quality assurance through residents’ questionnaires and meetings and is now considering using a recognised quality assurance tool. Records examined were up to date and securely stored. Many of the home’s recording systems are now held on the computer system and are inputted directly by staff. Staff said that they find this system easy to use and it gives management the advantage of being able to check records from either home. Fire safety checks and fridge/freezer temperatures – both kept on the computer – were up to date, apart from some recent fire safety checks which had been carried out but not yet recorded on the system. The kitchen was clean and food was safely stored. The home’s registration certificate was displayed in the hall. The registration now includes a condition concerning people over the age of 65 and one such resident is in the home. Melrose DS0000018912.V263055.R01.S.doc Version 5.0 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. 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 3 x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Melrose Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 3 DS0000018912.V263055.R01.S.doc Version 5.0 Page 20 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 YA20 Regulation 13(2) Requirement Timescale for action 08/11/05 2 YA24 23 The Registered Person is required to make adequate arrangements for the recording and safekeeping of medicines administered in the home and must therefore ensure that staff: *accurately record the administration of medication; *countersign the administration of controlled drugs; *record the temperature of the medication fridge. The Registered Person is 01/01/06 required to keep the premises reasonably decorated and must therefore: *redecorate the smoking lounge; *repair or replace the lifting vinyl floor and floor seal in the identified first floor bathroom. Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Melrose DS0000018912.V263055.R01.S.doc Version 5.0 Page 23 - 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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