CARE HOMES FOR OLDER PEOPLE
Melrose Court 74 Cambridge Road Southport Merseyside PR9 9RH Lead Inspector
Mrs Elaine White Unannounced Inspection 26th October 2005 and 2nd November 2005 09:30 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 Court DS0000065047.V262045.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 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 Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Melrose Court Address 74 Cambridge Road Southport Merseyside PR9 9RH 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) 01704 226177 01704 226177 Melrose Court Rest Home Limited Mr Ian Burns Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 2. Service users to include a maximum of 21 in the category of Old Persons, not falling within any other category. Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 5 Date of last inspection 24th May 2005. Brief Description of the Service: Melrose Court is a residential care home, which is registered to provide personal care and support for up to 21 elderly residents. There were 15 residents accomodated at the time of the inspection. 18 single and 1 double room are provided. En suite facilities are provided in 4 single rooms and the double room. Communal areas consist of a 2 lounges, conservatory/dining room and smoking room. All are located on the lower ground floor. A large enclosed garden is well maintained and used by the residents during the summer. All areas provide wheelchair access. There is parking at the front of the home. A call bell system is available throughout. Nursing care is provided when required by the district nursing service. The home is situated close to the seaside resort of Southport and its amenities can be accessed via the local transport. The registered manager is Mr Ian Burns and the home is owned by Melrose Court Rest Home LTD. Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 2 days. It was an unannounced visit and conducted as part of the regulatory requirement for care homes to be inspected at least twice a year. Requirements highlighted during the last inspection have been met been. A tour of the building and garden was conducted and a selection of care staff and home records were viewed. Case tracking was undertaken for 3 residents to assess the care provided at the home. This involved discussion with the manager, 4 staff members, 5 of the 15 residents and 1 relative to obtain their views obtained of the home. Satisfaction comment cards were also given to residents and relatives to complete at their leisure. Comments received were favourable regarding the home and the very caring nature of the staff. What the service does well:
The new owners have made progress in the last eight weeks since their takeover to improve the standard provided at the home. They are aware of the need for improvements, decoration and replacement of furnishings and have made some progress to addressing these areas. Positive comments were received from the staff, relatives and residents interviewed regarding the immediate changes made. “I am pleased with the changes. The small lounge looks lovely”, (Resident). “Ian is wonderful. You can see the improvements being made”, (Relative). “Ian is great to work for. This is the best home I have worked in” (Staff). Relatives and visitors are made welcome and this was observed throughout the inspection as visitors called to see their relatives. “I call in at all times of the day and everyone is so friendly. The staff are very caring,”(Relative). The home had a pleasant relaxed atmosphere and at the time of the inspection all areas were clean and hygienic. Staff recruitment and selection follows the correct procedures and all staff are employed following a POVA (Protection of Vulnerable Adults) check, 2 written references and an induction programme. An ongoing training programme is in place to ensure the staff are equipped with the skills to carry out their roles.
Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 7 What has improved since the last inspection?
Since the last inspection a number of new staff have been employed. These include both a domestic and a cook. The home was found to be homely and clean a number of improvements have been made to improve the standard of accommodation and appearance. The manager/owner is aware of the need for improvements; decoration and refurbishment required and has made progress in addressing these. Since the takeover of ownership during the last eight weeks 2 bedrooms have been refurbished, repairs to the conservatory roof, blinds cleaned, plumbing repairs undertaken and thermostats fitted on radiators, dining room converted into a small lounge, conservatory converted into the dining area and a new washer and tumble dryer purchased for the laundry. A large tree has been dismantled in the garden to allow more natural light to the home and make way for the new patio. Residents, staff and a relative spoke positively regarding the improvements made and the manager/owners commitment to improving the standard. “We can all sit together now in the conservatory to eat our lunch”, “The small lounge is very cosy” (Residents). A new cook has been appointed and has introduced a new 4-week menu, which consists of wholesome and nutritious food. The menu has been decided following discussions with the residents on their ‘likes and dislikes’. Alternatives are available and the cook is in regular contact with the residents to obtain their views. The residents interviewed said, “The food is lovely”. “Lots of home cooking and cakes”. The residents can choose to eat in the dining area or their own rooms if they wish. Medication policies and procedures are in place and all administrations are recorded when given by senior staff. A new statement of purpose is in place to outline the new ownership and services provided. This is available to residents and prospective residents. The activity programme has been reviewed and a range of activities provided includes quizzes, clothes shows, films and music afternoons. There are now two lounges available for the residents to choose if they wish to join in the activities or sit quietly, read, watch TV or chat. A clothes show was taking part in the conservatory during the inspection and a number of residents were observed to take part and purchase items they need.
Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 8 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 Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 9 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 Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 10 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): 1,3. There is a good standard of assessments enabling the home to be sure of meeting residents’ care needs. The information provided to prospective residents, residents and relatives has been updated to reflect the changes in management and staff. EVIDENCE: The statement of purpose and service user guide has now been updated to reflect the change in management and ownership. This is available to all residents, prospective residents and visitors to the home. 3 care plans viewed identified all relevant aspects of health, social and personal care. The care plans are detailed, easy to read and are reviewed regularly by the manager. Discussion with the manager confirmed that the needs of one resident should be reviewed involving the GP and other services involved in the placement. This was agreed to be arranged and staff are to
Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 11 continue to monitor progress and record any concerns or action taken with the care plan. Staff interviewed demonstrated a clear understanding of the care needs of the residents and the importance of care records being maintained. Residents provided positive comments on the care and support provided. “The staff are lovely, but I have my favourites”, “If there is anything I need they will get it for me”, “nothing is too much trouble”. A relative said, “I can’t fault the care here. The manager is so approachable”. Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 12 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): 7,9. The health, personal and social care needs of residents are understood and set out in an individual plan of care. Residents are protected by the home’s policies and procedures for dealing with medication. EVIDENCE: Individual plans of care viewed demonstrated that care needs have been assessed and are reviewed regularly by the manager. The staff employed when interviewed showed a clear understanding of the needs of the residents and are quick to report any changes. These are recorded within the home’s recording systems and discussed at the handover period to ensure staff are kept up to date. Where there is a need to involve other health care professionals this is conducted by the manager or senior on duty. During the inspection a resident requested a visit form his GP and the staff on duty addressed this immediately. Medication policies and procedures are in place and staff have been trained in the safe handling of medication. During the inspection it was recommended
Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 13 that controlled Drugs should be stored in a Controlled Drug cabinet, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973 i.e. a locked box within a locked cabinet. This is highlighted within the recommendations of this report. Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 14 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): 14,15. The daily life and routine in the home is flexible and residents are encouraged to make choices over their lives and day-to-day running of the home. Meals are wholesome and appealing and provided in comfort. EVIDENCE: Menus are provided on a four weekly cycle and these have recently been reviewed by the new cook who has discussed ‘likes and dislikes’ with the residents. “The cook commented, “The residents decided they wanted to have chips twice a week so I do them on Tuesdays and Fridays”. All residents interviewed stated that they were very pleased with the meals and were observed to enjoy the main meal of the day at lunchtime in the conservatory. The menu offered a good choice of hot and cold meals 3 times a day with light refreshments, home made cakes and trifles. Special diets are catered for and recorded in their plan of care. Meals are served at set times however arrangements are flexible to suit individual needs. Should residents prefer to receive their meals in their rooms this wish is respected. The menu of the day should be displayed for the residents to see and make their choice of the alternatives available. This was discussed with the cook who will make this available to the residents.
Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 15 Thoughout the inspection relatives and friends visited the home and were made welcome by the staff. A relative were spoken to said “The staff are all very nice and I am always made welcome. The music afternoons stimulate the residents”. The home has two lounges and a dining room. These areas are used to provide activities, watch TV, sit and chat to relatives or listen to music. The residents spoken to said they are happy with the new arrangements and the changes and have more choice in what they do. One resident was using the small lounge to sit and talk to her visitor; the conservatory was being used for a clothes show and the second lounge to watch TV. Residents’ choice and control over their lives is encouraged through reviews, meetings and individual discussions. However where this could be detrimental to their health and personal care needs the manager calls a review of those involved in their care and ensures records relating to this are kept up to date. Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 16 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): 18. An abuse policy and procedures are in place. Recruitment and selection procedures are robust. All financial transactions made are recorded and receipts obtained. EVIDENCE: Policies and procedures are in place on abuse and staff spoken to demonstrated their awareness of the procedures. A relative spoken to said, “I wouldn’t hesitate to report any concerns to the manager. If I wasn’t happy with something I would talk to Ian about it”. A resident commented, “I will say what I think. I can’t fault the staff”, (Resident who has lived in the home for 6 years). The manager is not appointee for any of the residents’ monies and is only responsible for 2 residents personal allowance records. Documentation seen confirmed that records and receipts are obtained for all transactions. Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 17 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): 19,26. Surroundings are comfortable and homely. The new owners are addressing improvements, decoration and repairs required. The home is clean and hygienic. EVIDENCE: The communal areas and a number of private rooms were viewed and showed that the home provides a comfortable, homely setting for the residents. Since the last inspection the home has undergone new ownership. Within the eight weeks of their takeover improvements have been made in a number of areas. These are addressed within the section of this report ‘What has improved since the last inspection’. Discussion with the manager and residents confirmed that work is due to start on refurbishing the front of the home, replacing old windows, guttering and repainting. This will enhance the appearance of the
Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 18 home, which at present looks neglected from the outside. The manager/owner aims to improve both the exterior and interior by conducting repairs and maintenance issues in a planned and programmed way. The fire escape is in need of repainting to ensure a safe exit. Both residents and a relative provided positive comments on their satisfaction with the improvements, the cleanliness and homely setting provided. “You can see the improvements being made. Excellent changes” (Relative). “I love the improvements. I can’t wait for my new windows” (Resident). The home was found to be clean and hygienic. Plenty of protective clothing is available and hand-washing facilities are in place. Staff confirmed their awareness of the need for hygiene standards to be maintained to avoid any cross infection. Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 19 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): 28,29,30. The recruitment and selection procedures are robust. Staff are trained to equip them with the skills to do their jobs to help safeguard and protect the people living in the home. EVIDENCE: Staff employed are encouraged to take NVQ (National Vocational Qualifications). The deputy manager has NVQ Level 3 and aims to complete her level 4. A training plan is in place and staff interviewed confirmed that they supported and encouraged to undertake training courses and have recently been updated on Moving and Handling. Comments included, “Ian believes in staff training”. “I am hoping to do my NVQ Level 3”. Staff files viewed confirmed that the recruitment and selection procedures are robust. Two written references and a POVA (Protection of Vulnerable Adults) check are received prior to employment. A full induction programme is in place for all new staff. Residents interviewed provided positive comments on the staff employed. “”10 out of 10 for all the staff”, “The new cook is lovely and the food is good”, “The cleaners are lovely” and “The staff are all so caring”. A relative said, “The staff
Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 20 are all so pleasant. I just wish they had time to sit and chat to the residents more”. Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 21 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): 31,32,35. The manager is qualified and creates an open, inclusive management of the home. Residents finance records are recorded, securely stored and the interests of the service users safeguarded. EVIDENCE: The manager has a qualification in NVQ Level 4 and demonstrates clear lines of communication with staff and residents. Staff, residents and a relative interviewed provided positive comments regarding the support, supervision and ‘open door’ approach of the management. “The manager deserves 100 out of a 100. He is a very good man and always listens to me”. “Ian is very good and always has a smile for me”, (Residents). “Things have improved. The staff are more settled. Ian is very approachable”. “Ian is great. He cares”, (Staff). “Ian is wonderful you can see the improvements”, (Relative). Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 22 Residents’ personal financial records were viewed and all monies received are recorded and receipts obtained. The manager is not appointee for any residents. All monies are securely stored. Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 23 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X X X Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 24 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 OP19 Regulation 23 Requirement The registered manager to continue his programme of planned maintenance to improve the standard of the home. Priority should be given to repainting the fire escape to ensure safe access. Timescale for action 31/03/06 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 OP9 Good Practice Recommendations Controlled Drugs should be stored in a Controlled Drug cabinet, which complies with the Misuse of Drugs (Safe Custody) Regulations 1973 i.e. a locked box within a locked cabinet. Menus should be on display for the residents. 2 OP15 Melrose Court DS0000065047.V262045.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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