Inspection on 13/09/05 for Melrose Care Home

This inspection was carried out on 13th September 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 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

Melrose Care Home 03/07/08

Melrose Care Home 18/07/06

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Melrose Care Home 9/11 Wykeham Road Worthing West Sussex BN11 4JG Lead Inspector Miss H Tomlinson Announced Tuesday, 13 September 2005 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 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. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Melrose Care Home Address 9/11 Wykeham Road, Worthing, West Sussex, BN11 4JG 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) 01903 230406 Melrose Care Limited Mrs Elizabeth Anne Seymour Care Home with nursing. 20 Category(ies) of Old age, not falling within any other category registration, with number (OP) - 20 Both of places Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection N/A Brief Description of the Service: Melrose is registered to provide personal and nursing care for up to twenty residents aged 65 years and over. The home was registered with a new owner in June 2005. Melrose is situated on a main road in a residential area of the town of Worthing. A park is opposite the home. Public transport links are within walking distance. The building is a large detached house which has been converted. Accommodation is provided on two floors with a passenger lift providing access to the first floor. Bedrooms are mix of double and single. There is one lounge and a dining room providing communal facilities. A garden with seating area is accessible to residents, at the rear of the building. A driveway with parking is at the front. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection. The inspector arrived at the home at 10am and left at 5.45pm. The registered manager and the registered provider were present in the home throughout the inspection. Over the course of the inspection nine residents and six members of staff were spoken with. Staff were observed giving support and assistance. Three residents files were examined in detail and other records were seen as was necessary. A tour of the premises took place. Staff files were examined. 14 comment cards from relatives/visitors were received prior to the inspection. These contained positive comments about the staff describing them as “wonderful” and treating residents with “great courtesy and efficiency”. 18 comment cards were received from the residents. These reflected a positive response to life in the home. What the service does well: Residents benefit from a well maintained, clean and tidy home. The furniture, fixtures and fittings were of good quality and domestic in nature, giving a homely feel to the environment. Resident’s rooms were personalised to their taste. The gardens were well kept with seating areas for the residents. Staff were seen to be calm and patient in their approach to the residents. Residents said that staff treated them with respect and protected their dignity and privacy. Staff understood the small details of individual resident’s preferences and made sure these were respected. The residents benefited from a stable staff team and praised them highly for the way they assisted and supported them. Residents liked the meals which were served and could choose to eat alone in their bedrooms or in the dining room. Residents described an open atmosphere in the home where they could discuss issues with the staff or management if they wished. Staff had received the training needed for the work they were doing. There was ongoing training and development within the home and a desire to maintain the good services and make some improvements from the new owner. The fire safety training and precautions within the home were of a high standard. The lady who looked after the laundry was praised by the residents for doing an “exceptional” job and returning clothes “as good as new.” Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 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. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 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 standard(s) 3 Residents were not accommodated in the home without an assessment of their needs having been completed. EVIDENCE: The three residents files examined in detail contained needs assessments carried out by the manager of the home. Other assessments were present, as was appropriate, such as social services, hospital transfers and nursing assessments. The assessment tool was based on dependency levels and recorded as scores. It was discussed with the manager that other notes made at the time of the assessment should be incorporated as these formed part of the overall delivery of care. There was no evidence that written confirmation of the home being able to meet the resident’s needs was given prior to becoming accommodated. This should be done following assessment. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 and 10 All residents had a plan of how their care needs were to be met. Resident’s health care needs were met. The procedures and practices for the recording and administration of medication safeguarded residents. The storage of medication awaiting collection for disposal could be unsafe for residents. Resident’s privacy and dignity was protected by the staff. EVIDENCE: The three resident’s files examined had plans of care documented. These contained very detailed information about the care needs of the resident and how they should be met. Individual needs were identified well, such as social relationships and a clear picture of the resident could be gained from these plans. Health care assessments were on file such as the risk of developing a pressure sore, a nutritional risk assessment and a moving and handling assessment. In two instances these assessments showed residents to be at risk of developing a pressure sore. No care plan had been documented to reduce this risk, though specialist equipment was being used for prevention. All identified risks should have a management plan. One resident’s past history showed them to be at risk of falls. No risk assessment or plan of management was documented. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 Page 10 The care plans were reviewed monthly. There was no evidence that health assessments were regularly reviewed, rather on an ad hoc basis. The health assessments should be reviewed regularly. The method in the home for recording any changes to condition was in the communication book. This resulted in some issues being written which may require a follow up e.g. a resident having a reddened leg and complaining of pain, and no follow up being documented. The use of this book with a view to data protection and the type of information stored should also be reviewed. The qualified nurses were responsible for the administration of medication in the home. The storage of medication which was currently prescribed was safe. At the time of this inspection the disposal of medication laws had changed and the manager was waiting for their supplying pharmacist to obtain a disposal licence. The medication awaiting disposal was stored in a locked cupboard in a resident’s bedroom, which was felt to be the safest place in the home. It was advised that a risk assessment must be carried out for the safety of this practice and alternative storage found if possible. All tablets and liquid medication administered was accurately recorded. Prescribed creams were not recorded on the Medication administration charts. This should be done. A homely remedies policy was present. Residents said the staff protected their privacy when they were assisting and supporting them. They said the bedroom and bathroom doors were always shut, that staff knocked on the bedroom doors prior to entering and treated them with dignity and respect during conversations. Staff were seen to be calm and patient with the residents when offering assistance. Residents had been offered a lock to be fitted to their bedroom doors and it was documented if this had been declined. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 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 standard(s) 12,13,14 and 15 Resident’s views on the social life of the home varied. Staff did recognise the need to meet this part of the resident’s care. Residents were assisted to maintain social contacts if they wished. Residents had choices of how to live within the home environment. The food was nutritious and appealingly served with a variety and choice which suited the residents. It was served in a pleasant environment. EVIDENCE: Resident’s views on the activities within the home varied. Some said they were satisfied with the amount and type of activity provided, others felt there was little to do and would enjoy more. Entertainers sometimes visited the home, but this was not on a regular basis and some would like this more often. There is a minibus and residents go out for trips which they enjoy. The manager said these trips take place twice weekly and they try to encourage different residents to participate. On some days, during the hours of 2pm and 4pm, one care assistant is free of care duties to do group or one to one activities with the residents. Residents said they could socialise with others if they wished. Some said they preferred to stay in their rooms due to a lack of choice of communal area and the more dependant residents being in the lounge, unable to converse. It was discussed with the manager that a review of the use of communal space may result in another seating area being provided. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 Page 12 Visitors to the home were welcomed anytime. Staff were seen to interact with visitors in a friendly and informal way. Residents said they could see their visitors in private or in the lounge as they wished. Relatives and friends were invited to social events in the home and had attended a bar-b-que in the summer with an afternoon tea being organised for the near future. Church groups visited the home on a regular basis to meet the resident’s needs. Residents spoken with said that, within the constraints of living in a home, they could choose how to run their day, what personal activities to do and whether to be alone or in the company of others. Rising and retiring times were flexible and some residents, when able, left the home unaccompanied to enjoy the outdoors. Residents had a choice of main meal at lunch time and a choice of hot and cold snacks at tea time. They said the food was good, with the servings being adequate saying “you’d never go hungry.” The chef understood the likes and dislikes of individual residents and these were catered for. Residents could eat in the dining room, their own bedrooms or in the lounge at individual tables. A written menu was on display which showed the choices at all meals. Breakfasts varied dependant on the resident’s choice, with a cooked breakfast or something less substantial being available. Hot and cold drinks were served throughout the day. Staff discreetly assisted residents when necessary. Residents talked about how they could have their supper at a time to suit them and that should they be hungry at any time staff would make a snack for them individually. The chef said fresh produce was used where possible and there were no budgetary constraints on the food she bought. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 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 standard(s) 16 and 18 Residents and relatives felt able to raise any concerns or issues with the manager or other staff. Residents were protected from abuse. EVIDENCE: Three complaints had been made to the home manager. These were recorded and had been resolved to the satisfaction of all concerned. Comments from relatives were that they felt able to approach the manager with any concerns and if they had done this they had been listened to and the matter resolved quickly. A complaints procedure was on display in the home. The manager knew the procedures for reporting any allegations of abuse which were made. No allegations had been made at the time of this inspection. Staff were aware of the whistleblowing procedure and ten staff members had received training regarding the protection of vulnerable adults. The manager stated all staff would have received training by the end of the year. The West Sussex guidelines and procedures for the protection of vulnerable adults were in the home. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 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 standard(s) 19,22,24 and 26 Residents live in a safe, comfortable, well maintained home. Specialist equipment required to meet the needs of the residents was present. Residents bedrooms were personalised and comfortable. The home was clean, hygienic and free from offensive odours. EVIDENCE: The home was well maintained with furniture and fittings of a domestic nature and of good quality. Cushions, ornaments, plants and footstools in the communal areas gave a homely feel. The fire doors were held open with doorguards which met with the approval of the fire service. The gardens were tidy and pleasant with a seating area for the residents to enjoy. The carpet in to the right of the doorway in the dining room had a tear in it. This should be repaired or replaced. Equipment to meet the needs of the residents was available in the home. Hoists and assisted baths were present. Grab rails were appropriately sited. Pressure relieving mattresses and cushions were in use. A discussion took place regarding the restrictions some of the areas of the home presented to those residents with mobility difficulties. There was limited space in the Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 Page 15 bathrooms particularly. A discussion took place about the plans which were in place to provide safe access to the bath for more dependant residents. An inflatable bath was available in the meantime should a resident not be able to access the bathroom. There was a call system in the home and all residents in their own bedrooms had the call bells made available for them. Suitable and inventive storage had been made for the wheelchairs outside. This provided safe and dry storage for them. The bedrooms seen were personalised and residents had brought in their photographs, pictures, furniture and other personal items. They said they were happy with their bedrooms and the fact they could make them personal. The home was clean and free from offensive odours. The laundry was adequately equipped and residents praised the lady who worked in the laundry saying their clothes came back “as good as new.” Staff knew the procedures to reduce the risk of spread of infection in the care home and appropriate protective clothing was worn by staff. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 At some times during the 24 hour period the numbers of staff on duty are potentially too low to meet the residents needs. Residents are protected by the recruitment procedures in the home. Residents benefit from a trained staff team. EVIDENCE: The staff numbers were reduced in the afternoon/evening and again at night. Some residents commented on the evenings being very busy for the staff and requests taking longer to be met. The staffing levels were not calculated using the dependency scale in the home. The manager was advised to review the current staff numbers based on the Residential Staffing Forum calculation. At all times the residents needs must be met by the numbers and skills of staff. The necessary checks to ensure people working in the care home were fit to do so had been carried out. Confirmation of receipt of satisfactory checks was not kept in the home. This was forwarded to the inspector following the inspection and this process has been changed. The recruitment procedures in the home were not in line with the amended Care Home Regulations and not all information which was required had been obtained. Staff praised the amount of training which was provided at Melrose. They had attended various courses relevant to their work and had completed the mandatory training of moving and handling, health and safety, food hygiene and fire safety. All the registered nurses had completed the appointed first aid course which meant a first aid trained person was on duty at all times. The registered manager said she had an identified trainer who would provide Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 Page 17 specific training such as the protection of vulnerable adults and infection control. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35 and 38 The home is run in the best interests of the residents. The financial interests of the residents are safeguarded. The health and safety of the residents is promoted and protected. EVIDENCE: There is no formal quality assurance system in the home. The residents said they had informal daily communication with the manager and owner of the home. They said they were free to discuss any issues with them and did comment on the day to day life in the home. Residents said they felt involved in the life of the home. Visitors to the home had recently completed questionnaires regarding their views of the home. The results of this would be used to make any necessary changes. The manager said she did not manage the finances of any residents in the home. They were either responsible for their own or their families managed them. They did not hold spending monies for the residents, however money from the petty cash would be used should any resident require a small amount of money to spend. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 Page 19 Residents benefited from a well maintained and tidy home which not present health and safety issues for them. The manager said all equipment was regularly checked and records kept. Thermostatic valves were present on all baths and sinks. All windows on the first floor had window restrictors fitted. The accident book was seen and the manger audited the accidents on a monthly basis to uncover any patterns emerging. Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x 3 x 3 x 3 STAFFING Standard No Score 27 2 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 x x 3 Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 Page 21 N/A 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 9 Regulation 13(2) Requirement A risk assessment for the storage of waste medication awaiting return must be done. Timescale for action 30/9/05 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 7 Good Practice Recommendations Where residents are identified as at risk of pressure sore development a plan of care should be implemented and recorded. Where residents are at risk of falls a plan of prevention should be recorded and implemented. The method of recording on a daily basis in the communication book should be reviewed. The administration of prescribed creams should be recorded. The activities should be reviewed to make sure they meet the needs and wishes of the residents. The tear in the carpet in the dining room should be repaired. The numbers and skill mix of staff on duty should be reviewed in line with the dependancy of the residents. 2. 3. 4. 5. 6. 8 9 12 19 27 Melrose Care Home H60-H11 S63715 Melrose V241444 130905 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Ridgeworth House Liverpool Gardens Worthing, West Sussex BN11 1RY 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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