CARE HOMES FOR OLDER PEOPLE
Melrose Care Home 9./11 Wykeham Road Worthing West Sussex BN11 4JG Lead Inspector
Miss Helen Tomlinson Unannounced Inspection 18th July 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 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 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) 01903 230406 Melrose Care Limited Mrs. Elizabeth Anne Seymour Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th September 2005 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 DS0000063715.V300162.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The inspector arrived in the home at 8.45am and left at 4.30pm. The manager and owner of the home were present throughout the inspection. At the time of the inspection nineteen residents were accommodated. Prior to the visit to the home information was gathered from previous inspections and information received regarding the service. Following the inspection relatives or representatives of all nineteen residents were written to and invited to comment on the service. On the publication of this report no responses had been received. During the inspection a full tour of the premises took place, inspectors spoke to the residents, staff, manager and owner. Care practices were observed, care plans examined and other documents seen as necessary throughout the inspection. Following the last inspection one requirement was made, this had been met at this inspection. No requirements were made at this inspection. Any good practice recommendations made are within the body of the report. What the service does well:
Melrose is an adapted large house, which gives the feel of a homely, domestic environment. The home was clean, tidy, well maintained and free from offensive odour. There is an attractive garden to the rear, with suitable seating and shade, which many of the residents said they enjoyed very much. Many of the staff have worked there for a long period of time and know the residents well. Residents spoke highly of the staff team saying “the girls are wonderful” and describing them as “kind, polite, considerate and caring.” Both staff and residents praised the manager who they said was very approachable, knowledgeable and supportive. Residents said they could approach any member of staff, should they be concerned about any aspect of life in the home. Residents were assessed, prior to being accommodated in the home, to ensure their needs could be met. The records kept regarding the residents health and personal care needs were comprehensive, up to date and regularly reviewed. Residents health care needs were met with other professionals being involved if necessary. Care and support was delivered in a way which protected the privacy and dignity of the residents, who said staff were respectful when Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 6 helping them. Residents said their choices and preferences about routines and how to be helped were sought and respected. Since the last inspection work had been done regarding the social side of life in the home. An increase in staff numbers in the afternoons had helped to make sure activities were available for the residents. Many residents spoke of how this had helped to make sure they could get out of the home for a visit to the local park, or be assisted to join in the other activities which now took place most afternoons. Residents could have visitors whenever they chose. Residents spoke highly of the food which they said was tasty, varied and plentiful. A variety of meals was served and a choice was actively offered at all mealtimes. Staff received a large amount of training, relevant to the work they were doing. Some of this was delivered by the manager and staff said it was useful and helpful for their daily work. All statutory training was kept up to date. Staff were recruited in a manner which protected the residents. Seventy five percent of staff had completed NVQ level two training. This exceeds the required number. What has improved since the last inspection? What they could do better:
The size and layout of some bedrooms and bathrooms presents moving and handling difficulties for residents who need to use a hoist. Whilst this was considered when the manager assessed any prospective residents, a risk assessment was not recorded. The facility for these residents to have their personal hygiene needs met in a way other than a bed bath, should be available.
Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 7 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 DS0000063715.V300162.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Residents were not accommodated in the home without an assessment of their needs being carried out. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The manager stated that all perspective residents would have their needs assessed prior to becoming accommodated in the home. A written assessment was on the file of the last resident to be admitted. The manager had made other notes when visiting this person, in their own home, which would have given a clearer picture of the circumstances leading to admission. This included an assessment of the suitability of the environment for the resident. She was advised to include these notes in the file. Nursing and social work assessments were seen on file. Residents spoken with said they had made a choice to live at Melrose and had received information regarding the facilities and services available
Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 10 Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 All residents had a comprehensive, up to date, plan of care drawn up from health assessments. Residents health care needs were met. Residents said their privacy and dignity was respected and staff were kind and polite. Medication was safely stored and administered with records kept. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service EVIDENCE: All residents had a plan of care documented. Those seen were comprehensive and up to date with regular reviews. Any changes to condition were noted. There was evidence that the resident or their representative had been involved in the plans of care implemented. Health assessments were carried out including nutritional assessments, risk of development of pressure sores, and moving and handling. Risk assessments for falls and the use of bed rails were present. Plans of how to manage identified risks were in place. The manager was advised to weigh residents more regularly and record these. The care staff
Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 12 recorded the care given to residents, including food and drinks taken, on individual charts. Residents spoken with said staff were “very good” and “capable” when assisting them. They felt their health needs were met and they saw other professionals as required. All residents spoken with said staff were respectful and polite. Their privacy was protected when care was being given and they were assisted in a dignified manner. The medication was safely stored and administered. Records were accurately kept. A risk assessment had been done, since the last inspection, regarding the storage of waste medication. Alternative storage arrangements were being investigated. All medication was administered by the qualified nurses. Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Residents said the social activities and pastimes on offer where what they wanted. They could have visitors at any time and could make choices and preferences which were respected. Residents said the meals were good with a choice offered and plenty of food available. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service EVIDENCE: Residents spoken with said the number of activities had increased and they were happy with the type of things on offer. Some residents said they chose not to join in with much, but knew they could if they wished. The activities advertised in the lounge included one to one time, such as manicures and foot massages, group activities of quizzes and board games and time in the garden, out to the shops and park. Residents particularly enjoyed trips out and spoke of going to garden centres and places of interest. One care assistant had been allocated to develop the activities within the home. Some information regarding the resident’s past social interests had been gathered since the last inspection. Residents were assisted to continue with their personal interests, with a library of books being available, pets present in the home and radios and other personal items encouraged.
Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 14 Residents said their relatives and friends could visit anytime they wished and stay for as long as they liked. No visitors were seen during the inspection, however relatives were written to, following the inspection. The comments received XXXXXXXXXXXXX Residents said they were asked their preferences on the routines of daily life including rising and retiring times, food choices, preferred names and where they would like to spend their time. Staff knew the preferences of the residents and many of these were incorporated into the plans of care. Residents spoke highly of the food saying it was tasty and there was plenty of it served at each meal. They said they could choose what to have and the menus showed a good variety of meals served. Hot and cold drinks were offered frequently throughout the day and on the very hot day of the inspection residents were encouraged to have more fluids. Residents who needed help with eating and drinking were given this on a one to one basis. Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Residents were confident their complaints and concerns would be taken seriously and acted upon. Residents were protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: Two complaints had been received by the manager, since the last inspection. Records of these and the investigation and outcomes were kept. They had been resolved to everyone’s satisfaction. Residents said they would talk to the manager or owner, should they have any issues or concerns. They were confident these would be dealt with quickly and satisfactorily. A complaints procedure was on display in the home. Staff had received training in the protection of vulnerable adults. Those spoken with knew the procedures to follow, should an allegation of abuse be made. They were aware of their responsibilities to protect the vulnerable adults in their care. Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22 and 26 The home was clean, tidy, well maintained and free from offensive odours. The bathing facilities were not able to meet the needs of all residents. Equipment necessary to ensure the safety of the residents accommodated was present. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service EVIDENCE: The home was clean, tidy and free from offensive odour. The home is a converted large house, which gives a homely, domestic feel to the premises. The décor and furnishings were domestic in nature and well maintained. The garden was attractive with suitable seating, tables and shade for the residents, who said they were enjoying it this summer. The layout of the building means some communal areas, bedrooms and bathrooms have restricted space. The manager discussed how this was considered when any prospective new
Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 17 resident wished to move into the home, particularly with high dependency needs and a necessity for equipment. Discussions took place regarding the bathrooms. At present there is no facility for any resident, who requires a hoist, to have an immersion bath. They are offered an alternative to ensure personal hygiene needs are met. The owner was investigating what alternatives were available, which would meet with safe moving and handling. Fire doors were closed or held open by devices which meet the requirements of the fire service. Staff had received fire safety training and were aware of the procedure to follow in the event of a fire. Various moving and handling equipment was available in the home. Staff had received training in the safe use of this equipment. All beds could be adjusted in height. Hand rails, raised toilet seats and frames were present. Staff had received training in the control of infection. They were seen to take correct hand hygiene procedures and wear protective clothing. The laundry is neatly fitted into a very small space. This resulted in the linen waiting to be washed being stored in skips on the corridor. These should be covered to prevent the risk of spread of infection. Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The staff numbers and skill mix was suitable to meet the needs of the resident’s accommodated. Staff received appropriate training and a high proportion of them had completed NVQ training. Staff were recruited in a manner which protected the vulnerable adults in their care. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service EVIDENCE: Since the last inspection the numbers of staff on duty had been increased. There were now 3 care staff and one qualified nurse from 8am to 8pm. Both staff and residents discussed how this had helped to allow more time for activities and one to one care, particularly in the afternoons. Some residents stated they had to wait for too long when they used their call bells. It was seen that residents in the lounge were left unsupervised at times, which led to several trying to walk unaided, when they were unsafe to do so. It was discussed with the manager that the deployment of staff should be kept under review. Four staff files were examined and these contained the necessary information to ensure the protection of vulnerable adults. Staff received training which was relevant to the work they were doing. Seventy five percent of the care staff had completed NVQ training of level two and above. All statutory training
Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 19 had been carried out, with records kept. Specific training was provided, with regard to particular residents accommodated, as was necessary. Staff said they were happy with the amount of training and on the job supervision they received. Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Residents and staff benefit from the home being run by an experienced manager. Some quality review is carried out in the home. Staff and the manager recognised the need for them to protect the health and safety of the residents. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service EVIDENCE: The manager is a first level registered nurse and holds the Registered Managers award. She has been the manger at Melrose for the past nine years. She keeps herself updated with clinical nursing issues and works most of her shifts as the nurse in charge. She has completed all statutory and additional training which has assisted in her management position. She has one day per week supernumerary to complete her managerial duties. It was discussed this
Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 21 was a short time and should be kept under review. Residents and staff spoke highly of her stating she was supportive, Knowledgeable and approachable. The quality reviews system in the home are a mix of formal and informal. The manager carries out several audits and implements change were necessary to improve services. The manager and owner chat, informally to residents and visitors, gaining their views on the facilities and services at the home. Questionnaires were done in January for relative’s comments. The home does not manage any resident’s personal monies. These are all managed by the resident themselves or their representative. Accidents were fully recorded, with the action taken to prevent recurrence. Staff had received training in health and safety recently and the manager discussed how this was being implemented in the home, with additional risk assessments. Two issues of health and safety within the environment were noted. A ladder was propped against the wall next to a toilet door, available for residents use. The ramps in the lounge and corridor, to the outside were wooden and showing signs of wear and tear. The one in the lounge had a gap between it and the door. A week following the inspection the owner confirmed in writing, to the Commission that these ramps had been replaced. Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x 2 3 x x x 3 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 3 x 3 x x 3 Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 Care Home DS0000063715.V300162.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worthing LO 2nd Floor, 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. Extracts may not be used or reproduced without the express permission of CSCI Melrose Care Home DS0000063715.V300162.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
