Inspection on 08/03/06 for Melrose

This inspection was carried out on 8th March 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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Melrose 01/11/05

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 8 and 15th March 2006 09:15 th Melrose DS0000018912.V286131.R01.S.doc Version 5.1 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.V286131.R01.S.doc Version 5.1 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.V286131.R01.S.doc Version 5.1 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@poldercare.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.V286131.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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. 1st November 2005 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 for 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. Melrose DS0000018912.V286131.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced inspection the inspector spoke to seven residents, staff, the Registered Manager (who is also the owner), the Activities Organiser 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. The inspection was completed on a second day, when medication procedures were checked. 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.V286131.R01.S.doc Version 5.1 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.V286131.R01.S.doc Version 5.1 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): 5 Residents are only admitted to Melrose if their needs have been adequately assessed, thus ensuring that their needs can be met. EVIDENCE: No new residents have been admitted since the last inspection, so it was not possible to assess standards 2, 3 and 4. Melrose has well established procedures for the assessment and admission of residents. Contracts were seen on file. Melrose DS0000018912.V286131.R01.S.doc Version 5.1 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, 8, 9, 10. 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. As some residents are unhappy with the existing smoking arrangements it would be sensible to seek to reach an agreement between all residents and the management on the issue of smoking in order to improve the quality of life in the home for all concerned. EVIDENCE: Care plans are on file for each resident. A member of staff reviews the care plans each month and at the moment they are recorded on the care plan by hand. The care plans are detailed and 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 programme that does not allow the retrospective alteration of records. A new programme has just been installed – ACT! – and the Activities Organiser/Administrator is currently entering the care plans on to the programme. The programme pops up a different National Minimum Standard each day as a reminder to staff. Each resident has a folder on the database, which includes the daily report, accident reports, incidents, a photograph (not all on yet) and personal details. The programme can only be accessed by staff using a password and information is Melrose DS0000018912.V286131.R01.S.doc Version 5.1 Page 9 backed up on a central server. Basic details, including the care plan are kept in hard copy. Care records have been held on computer for some time at Melrose and this has proved to be a highly efficient means of record keeping. Smoking is restricted to one small and very well used smoking room. The room has an extractor fan and has been redecorated and re-furnished since the last inspection. It is now furnished with high bar stools and wall shelves (in the style of a breakfast bar). Four residents who visited the room during the inspection (and one other smoker) said that they did not find the room comfortable and would prefer low chairs. One low chair was in the room but had been taken there by one resident for use by another as she could not easily manage a higher chair. The residents felt that the room was designed to encourage them to only stay there for short periods. The Registered Person said that the issue had been discussed at a residents meeting in December 2004 and produced notes of that meeting. He said that he did indeed want to discourage residents from spending long periods of time in the smoke room though he acknowledged people’s right to smoke if they chose to do so. He also had wider concerns about the effects of smoke in the workplace and felt that not all of the residents shared the views of those who had spoken to the inspector. In view of the feelings expressed by residents during the inspection it would be wise for the Registered Person to continue dialogue with residents with a view to finding a solution with which all parties are happy. Residents meetings are held regularly, though attendance is often poor and the last recorded meeting had been in October 2005. The main topic at the last recorded meeting was the issue of outings. Melrose DS0000018912.V286131.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 14, 15, 17. Daily routines in the home are informal. Some activities are provided but 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: Melrose has an Activities Organiser/Co-ordinator who works for 20 hours a week at the home. Her work is not restricted to the organisation of activities as she also plays a key role in reviews and care planning, especially where the computer programme is concerned. An activities programme is in place but is fairly general (board games, art etc.). The home does have the use of a vehicle and this is used for some trips though there are charges for the longer trips and this discourages many residents. The Activities Co-ordinator said that she is planning to use the vehicle for local trips which can be combined with other purposes, such as shopping. The home is in the middle of Hoylake and most residents freely go out to local shops, cafes, pubs and other local facilities in the village. One resident does voluntary work and on the day of the inspection was receiving an award from the Mayor of Wirral in acknowledgement of his contribution. Melrose has facilities which can be used for rehabilitation training though the current residents do not appear to make Melrose DS0000018912.V286131.R01.S.doc Version 5.1 Page 11 much use of them. Residents also have access to a computer (but not the internet) but again it is little used. At one recent meeting some residents showed an interest in a broadband internet connection but no decision has yet been made on this. Some residents told the inspector that they were often bored and the Activities Co-ordinator said that where residents showed some interest in activities – and therefore wanted to alleviate their boredom - she was planning to build on that and develop individualised programmes. She felt that a more common problem was apathy and lack of interest. As the activities programme develops it is important that the Registered Person keeps a record of activities in which residents have taken part. Some residents attend day or drop in centres. The menu is varied and there is always a vegetarian option available. The main meal on the day of the inspection (lasagne) was home-made, using fresh ingredients. The main meal of the day is usually served at lunchtime, though the evening meal is often also cooked. Meal times are flexible. 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.V286131.R01.S.doc Version 5.1 Page 12 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): 19, 20. Appropriate medical care and 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. EVIDENCE: Few residents at Melrose require physical personal support. One older person is a resident at the home (and a variation is in place to allow this) 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 community health services and most also receive support from Community Psychiatric Nurses and psychiatrists. Residents have single bedrooms and can therefore receive guests and visiting professionals in private. No residents retain their own medication and the administration and recording of medication is well organised. The home uses a monitored dosage system (MDS) with most medication dispensed in dedicated blister packs by the pharmacist. The inspector checked the medication for two residents and everything was accurately recorded. Controlled drugs are stored in a suitable controlled drugs (CD) cabinet and their administration is recorded and countersigned in a bound CD register. Depot injections are given by visiting Community Psychiatric Nurses and are recorded on the Medication Administration Record sheets. Medication requiring refrigeration is stored in a dedicated fridge. Melrose DS0000018912.V286131.R01.S.doc Version 5.1 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. Adult abuse procedures need to ensure that all relevant incidents are properly reported. EVIDENCE: The home has an appropriate complaints procedure and complaints are recorded on individual forms. Adult protection policies are available in the home and staff receive training in the protection of vulnerable adults. One recent complaint amounted to an allegation of abuse and it had not been reported via the Adult Protection procedures. The inspector pointed out that all such allegations needed to be reported via the correct procedures. The Registered Person accepted this point and the issue was referred to Social Services and dealt with at a strategy meeting (held before the second day of the inspection). Dealing with allegations in this way does not indicate a presumption that abuse has occurred, merely that it must be properly investigated. Melrose DS0000018912.V286131.R01.S.doc Version 5.1 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, 30. Melrose provides clean, appropriately furnished accommodation that meets the needs of its residents. EVIDENCE: Melrose was originally built as a care home for older people and 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. The smoking room had been redecorated and issue around this facility are dealt with earlier in the report. Residents all have single bedrooms with locks and those rooms visited during this inspection were clean and properly furnished. There are sufficient toilets and bathrooms to meet the needs of the residents and those inspected were clean and well decorated. Melrose DS0000018912.V286131.R01.S.doc Version 5.1 Page 15 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, 35. 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 administrators, catering staff, domestics and a handyperson as well as care staff. The owners employ several staff from overseas and workers from Poland, the Philippines and Romania currently work for them. Such staff are recruited via a specialist agency that screens applicants, takes up references and arranges for work permits and immigration clearance where necessary. No staff have been recruited since the last inspection so no new records could be examined. 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 care they are deemed to be equivalent to NVQ for the purposes of the national standards. Some overseas staff have also done NVQ training and this 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 examined during this inspection. Melrose DS0000018912.V286131.R01.S.doc Version 5.1 Page 16 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, 39, 40, 41, 42. The home is efficiently 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 procedures through residents’ questionnaires and meetings. Several questionnaires had been returned recently and made a number of suggestions, especially for trips out. The Activities Co-ordinator said that they were being analysed and the results would be provided to the residents for information and the management for appropriate action. No national QA tool is yet in use. Records examined were up to date and securely stored. Many of the home’s recording systems are 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. The kitchen was clean and food was safely stored. The home’s registration certificate was displayed in the hall. The registration Melrose DS0000018912.V286131.R01.S.doc Version 5.1 Page 17 includes a condition concerning people over the age of 65 and one such resident is in the home. Melrose DS0000018912.V286131.R01.S.doc Version 5.1 Page 18 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 Standard No Score 1 X 2 X 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X 3 X 3 3 3 3 X Melrose DS0000018912.V286131.R01.S.doc Version 5.1 Page 19 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 YA23 Regulation 13(6) Requirement The Registered Person must make arrangements to prevent service users from being placed at risk of abuse and must therefore report all allegations of abuse via the agreed local Adult Protection procedures. Timescale for action 15/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA8 Good Practice Recommendations It is suggested that the management continue discussions with the residents to find a mutually satisfactory solution to the issue of the furniture and layout of the smoking room. Melrose DS0000018912.V286131.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Liverpool Local 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.V286131.R01.S.doc Version 5.1 Page 21 - 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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