Inspection on 15/10/08 for Melrose House

This inspection was carried out on 15th October 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Melrose House 10/06/10

Melrose House 28/09/09

Melrose House 05/11/07

Melrose House 23/04/07

Melrose House 29/08/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Melrose House 95 Alexander Road Southend-on-Sea Essex SS1 1HD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 1 5 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Melrose House 95 Alexander Road Southend-on-Sea Essex SS1 1HD 01702340682 01702436551 melrosehouse@btclick.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Sonia Matilda Leggett Type of registration: Number of places registered: Mr Masood Rashid care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Maximum number of registered places 31 (both sexes). To operate as a care home only. To provide care to 31 Older People with Dementia (OP(DE(E)) over the age of 65 years. To provide care to 31 older people (OP) over the age of 65 years. Date of last inspection Brief description of the care home Melrose House is a detached property, which is registered to provide care and accommodation to up to 31 older people. The home is also registered to provide care for people who have dementia. Bedrooms are situated on the ground, first and second floors. There are four shared rooms at the home, the rest are single. Rooms are all equipped with a sink, but most do not have an en suite facility. Bathroom and toilet facilities are provided throughout the building. A passenger lift provides access to all Care Homes for Older People Page 4 of 33 Over 65 31 31 0 0 Brief description of the care home areas. On the ground floor there are three pleasant communal lounges and a dining room. Melrose House has a pleasant garden and patio area at the rear of the house. The home is situated in a residential area within a conservation area. It is within a short walking distance of Southend shopping centre and seafront. The home is also close to mainline railway stations and numerous bus routes. There is limited parking at the front of the property. On street parking may be available depending on the day/time. The current rate of fees is between four hundered and twenty pounds and four hundered and fifty pounds per week. Additional charges are made for hairdressing, chiropody, clothing, toiletries, papers, magazines and transport. Information about the home is made available to people in the Statement of Purpose and Service Users Guide. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced ‘key’ site visit. At this visit we (CSCI) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. The site visit took place over a period of nine hours. A partial tour of the premises was undertaken, care records, staff records, medication records and other documentation Care Homes for Older People Page 6 of 33 were selected and various elements of these assessed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. An expert by experience joined us for part of the site visit, and spent four hours observing activity and talking to people. An ‘expert by experience’ is a person who, because of their shared experience of using services visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The home’s Annual Quality Assurance Assessment (AQAA) was sent in to us (CSCI.) The AQAA was basically completed, and outlined how the home feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives involved professionals and staff. The views expressed at the site visit and in survey responses have been incorporated into this report. We were assisted at the site visit by the manager, and other members of the staff team. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The manager said that care planning to ensure that people’s individual needs and preferences are met has improved greatly. This may be true but records seen did not provide a good or safe basis to provide people with care that reflects their assessed needs and aspirations. People are not involved as they should be in planning their care so that their individual needs and wishes are identified and catered for. People should to feel confident that if they need to use creams to support their care that this is managed properly, with proper prescribing recording and storage practices maintained. People were positive about staff working at the home and felt that they were kind and caring. However, people are not happy with the levels of staffing provided at Melrose Care Homes for Older People Page 8 of 33 House. This needs to be urgently reviewed so that adequate staffing is provided. Staffing levels need to reflect the dependency levels and needs of the people living there. To comply with Regulations and ensure that the home is properly run and managed, the provider needs to carry out and record monthly visits to the home. This process needs to include seeking peoples views about the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People considering moving into Melrose House can be assured that staff will gather information and complete assessments to make sure the home is suitable to meet their needs. People may lack detailed written information that would fully support them in making an informed choice about moving into the home. Evidence: The home had an up to Date Statement of Purpose and Service Users Guide in place. However the manager said that when they visit people to assess their needs and suitability for moving into the home only a copy of the homes brochure is given to them. This gives brief details about the home. They said that a lot of information is given verbally. If a relative or person considering the home and visits they might be given a copy of the service users guide, otherwise a service users guide is available to people in their rooms once they move into the home. The homes brochure does not contain sufficient information to assist people in making fully informed choices. The Care Homes for Older People Page 11 of 33 Evidence: current service users guide does not include details of fees and additional charges as is now required. In spite of this, on five surveys returned to us, four people felt that they had received sufficient information about the home and one said they had not. The expert by experience spoke to the relative of a person who had recently moved into the home. They felt that the home had done everything possible to help their relative to settle in. To ensure that Peoples needs can be met by staff, an assessment of their needs should be undertaken before they move in. We looked at the files of two people who had recently moved in to see if this was happening. The manager said that since the previous inspection the set form used to assist in assessing peoples needs had been expanded and improved. We saw that basic assessments had been undertaken, and that additional information was available from health services involved. Following the assessment, if all is well, a welcome letter is sent to the person confirming the date of admission. To reassure people and comply fully with regulations this letter should also confirm that the home is able to fully meet their needs identified by the assessment. Intermediate care is not provided at Melrose House, but there is provision for people to use the home on a step down basis. This is where people who have been in hospital move into the home for a short period of time to complete their recovery or rehabilitation in a non-clinical setting. People then stay at the home for a few weeks before returning home, or making the decision to move permanently into residential care. People continue to receive support from staff such as physiotherapists, occupational therapists and nurses to aid their recovery during this period. A brochure is available to people explaining the step down process. The manager from the home visits potential step down people to carry out an assessment and ensure that the home will be suitable for them. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot expect their care to be based on clear planning that they are involved with, and which reflects their needs and aspirations. Evidence: Although responses in talking to people and on surveys were variable, in general people were positive about the care received in the home. One person said, My [relative] has been treated very well. Another said that staff, Care about the people in their care and meet their individual needs. During the inspection the step down coordinator and other step down staff visited the home. They felt that the standard of care in the home was good and that staff were helpful. The expert by experience felt that everyone looked clean, well groomed, and were well dressed with appropriate clothing being worn. From comments received however it seems that staffing levels are having an impact on care. One person said, I need to be taken to the toilet more frequently. Often no one around to help with this. A member of staff said, We give the best care we can with the staff available. Care Homes for Older People Page 13 of 33 Evidence: To see how well care is planned for and arranged so that staff are aware of peoples needs, and can meet them in an individual way, we looked at a number of care files. The manager said that since the previous inspection staff had worked hard and care plans had been improved a great deal. The Annual Quality Assurance Assessment (AQAA) said The care plans are now more personalised. It is appreciated that staff have worked hard to improve care records, and that people may receive good general care from staff that know them well. However from records viewed, care given is not based on a robust and person centred approach. This would ensure that people are cared for in a safe and consistent manner in line with their identified needs and wishes. For example, one family had left a note in their relatives room asking for their oral care to be managed in a particular way. Evidence showed that this had not happened. The manager reported that this was due to the persons choice and was clearly identified in the care plan. This was not the case. For one person their care plans did not reflect their current needs as they had not been updated and still referred to them being mobile. Recent changes in both their physical and mental health were not fully identified in ways that would enable staff to deliver appropriate and safe care. Care plans were not always sufficiently detailed and sometimes made general comments such as likes to have a shave every day or needs all help with bathing. There was nothing to show that people receiving care or their families are involved with planning care, other that in supplying a family history. Although people felt that they were getting good care evidence did not always support this. One person was identified as having sore groins and a fungal infection, another as using cream as they were sore under their breasts. A recent safeguarding of vulnerable adults investigation was undetermined, but related to a person alleged to have been admitted to hospital in a poor state that indicated a lack of good care. The situation is not helped by the fact that care delivered is not well documented. The home chooses to keep a number of different records such as continence records, bowel records, bathing records, summarys of care and so on. For one person their care plan identified that they were incontinent and would need two people to assist them to the toilet. Another sheet had daily entries saying pad changed, although use of a pad had not been identified on the care plan. A continence record had no recordings made on a number of days, one entry on some days and two on others. Records of other care such as bathing was also inconsistent. For example the last record for one person having a bath was 29/08/08. Underneath this someone had written to point out this shortfall, but no further entries had been made. Observations of care staff and resident interactions showed a kind and caring approach. However care records often demonstrated either a lack of understanding and empathy, or that staff have difficulty in expressing things in a more person centred way. For example, Wears large nappies due to mobility and will refuse to go to the toilet when asked, Nappy put on, Hoist to be used if [gender] is not co-operative, Very aggressive toward me this morning shouting and spitting at me for no reason, and very rude and demanding when Care Homes for Older People Page 14 of 33 Evidence: putting [gender] to bed. Records show that people access appropriate health care to meet their needs. Records of health professionals visits are well maintained. However issues arising from visits such as the use of creams are not then carried forward onto care plans. Care plans incorporate assessments for nutrition. Currently the home only have stand on scales available. Therefore frailer residents who are unable to stand will not be able to have their weight monitored to alert staff to any changes. In addition to this adequate nutrition records are not maintained. The manager said that any concerns about people not eating would be recorded in the daily records, but that everyone was eating well at the moment. Risk assessments are in place to identify those at higher risk from falls. A general risk assessment sheet is used to identify any other potential areas of risk. Medication at the home is generally well managed and a medication round observed showed that people are given choices with regard to their medications. There were some areas of concern, in particular the management of creams. A tour of the premises showed unlabelled pots of creams in many rooms. Medication Administration Record (MAR) sheets did not identify that these creams were prescribed for, or being used by people, or alternatively identify that they were in use on a homely remedy basis. On most occasions creams had been left on top of heaters. Some were in use past their expiry date, for example, expired 10/06, 05/07 and 07/08. One person had the cream prescribed for a person no longer at the home in their room. Medication that is stored inaappropriatly may no longer be clinically effective or may be unsafe for use. We saw that a number of people have medication to be taken when needed. At the last inspection it was advised that clear protocols should be put in place for the use of medicines to be used on an as and when required basis (PRN.) Since then a policy had been put in place relating to PRN medications. This said, Residents who are prescribed PRN medication must have a care plan in place detailing the reasons the medication is required, and guidance with regard to dosage and frequency. All members of staff administering medication have recently undertaken a distance learning course in the administration of medication. A member of staff administering medication did not understand what a PRN protocol might be. The manager confirmed that none were in place. Although the homes own policies and procedures relating to the management of medicines were available, staff were unaware of the Royal Pharmaceutical Guidance about the management of medicines in care homes. The manager said that this was available but it could not be found. Other best practise issues were highlighted such as the need to ensure that handwritten entries on MAR sheets are signed by two people to confirm that details recorded are correct, the need to monitor the temperature in the medication storage area to ensure optimum conditions, and to date boxed/bottled medication when commenced to provide a good audit trail. Care Homes for Older People Page 15 of 33 Evidence: During the day staff treated people kindly, and respected their privacy. Staff were always observed to knock before entering peoples rooms. The AQAA said that, The shared rooms are now in use with permanent screening so that service users have privacy and dignity at all times. We had a discussion with the manager regarding some issues relating to equality and dignity. It was noticed that most tables in the dining room were very nicely presented with cloths, condiments and so on. However in one area a number of tables had been put together to form a large square and this was where the frailer people who might make a mess or require more assistance sat. Although the manager could see that this might not be good practise they felt that it would be too distressing for people to change this arrangement. In the morning of the visit a person was noted to be sitting in one of the lounges on their own with a protective bib on. This was left on throughout the day and they remained in the same place all day. Their care plan said, [Name] has now improved so that [gender] is now able to feed themself and enjoys sitting in the dining room with other residents. There seemed to be no reason why they were left wearing protection all day, and did not visit the dining room for lunch. This situation did not show respect for the person or uphold their dignity. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people can be confident that their visitors are welcome in the home at anytime, other opportunities to meet peoples interests or to provide social activities are limited so not everyone’s needs or expectations may be met. Evidence: The AQAA said that more outside entertainment now visited the home to benefit people. This was confirmed by the expert by experience who said, The residents told me about some of the entertainers who visit, stating that a couple who come in and host singalong times were very popular. The AQAA also said, We could do better in activities, but sometimes it can be hard to motivate the service users if they do not want to do them. The expert by experience said that two people, Commented that it would be lovely to be taken out sometimes, as they felt a bit isolated from the outside world. Management are currently planning some changes that will provide an activities room in the home. It is felt that this will improve the situation and encourage people to join in more. Peoples care plans sampled sometimes said what they liked doing for example, watching TV, doing quizzes. For people with dementia there was no clear process for assessing their occupational needs. We saw that equipment such as games, and arts and craft materials were available for staff to undertake activities with Care Homes for Older People Page 17 of 33 Evidence: people. Activities records are maintained. A note on the front of these says Must be filled in daily, but over a two week period only six entries had been made. Activities recorded included reading, painting, quizzes, exercises and chatting. On four surveys completed three people said that there are usually activities arranged and one person said that there sometimes were. A relative said, Better leisure and entertainment is needed. The expert by experience said, I did not notice any particular activities arranged by the staff whilst I was there which was a little disappointing, but all conversations I witnessed between staff and residents were very friendly and respectful. Residents were always addressed by name, and there was clearly a rapport between them. People are supported to make choices in their daily lives, and were free to go where they wished during the day, spending time in their rooms or communal areas as desired. The expert by experience said, The residents told me they have a choice of where they sit but they tend to choose the lounge most appropriate to their needs, where they can build up friendships with one another. Visiting at the home is very open and is always encouraged. People felt that the home communicated well with them. One person said, I am kept informed if my [relative] causes any concerns. Liaison regarding my [relatives] concerns and health is good. Another person said, Visitors are always made welcome. The homes service users guide contains useful information for people about advocacy services and other organisations that may provide independent support and advice. It also explained that people are able to bring in their own possessions when they move into the home. Some rooms viewed were homely and people had clearly brought some of their own belongings and personal memorabilia in with them. The home operates on a basic four week menu system that is changed according to peoples choices and comments. Menus viewed showed that a good range of foods are provided, with plenty of fresh vegetables. Jugs of drink were available in lounges throughout the day so that people could always have a drink. People were generally positive about the food provided. The expert by experience said, When asked about the food people were very complimentary, stating that there was always a choice, particularly commenting on the daily cooked breakfast, which they looked forward to. On surveys one person said that, The food is excellent, but another said Sometimes the food could be improved. Lunch on the day of the site visit looked nice and people were offered choice and encouraged to have seconds. The expert by experience said that people who needed more support were helped in a kindly and dignified manner. The site visit took place on a Wednesday, but the menu on display related to the previous week, so did not provide people with the correct information. As highlighted at the two previous inspections the position and format of the menu on display may not be easily seen and read by all residents. Care Homes for Older People Page 18 of 33 Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be proteced by a clear complaints procedure, and staff awareness of safeguarding. They cannot however be confident that staff will be able to understand and assist them with any behavioural issues. Evidence: Melrose House has a clear complaints procedure in place that is available to people. In discussion and on surveys people told us that they usually knew who to speak to, and how to raise any concerns. We viewed the homes complaints records, and saw that two concerns had been recorded since the previous inspection. Another complaint that we (CSCI) had been made aware of, and was managed by the home with input from social services, had not been recorded. The manager said that they had not realised that it had been a complaint. The AQAA completed by the manager only highlighted complaints procedures, and did not identify how people are safeguarded from abuse. Staff have received training in safeguarding people, both externally and some in house. One of the deputy managers has been trained to offer staff training and support in this area. We saw that the most up to date local authority safeguarding procedures were available. However the homes own policy and procedure in relation to safeguarding people could not be found. The manager undertook to ensure that one was put in place. During the site visit the manager also ensured that contact numbers for local safeguarding teams were made Care Homes for Older People Page 20 of 33 Evidence: readily available to staff. Since the previous inspection one safeguarding alert had been raised and investigated in relation to care at the home. From care records viewed it was clear that if people have behaviours that can be challenging, this may not be understood or well managed by staff. It was clear however that management seek the advice and support of other professionals if difficulties arise. Care plans did not give staff clear guidance as to how to respond to behaviours so that consistent care was given. For example one person’s behavioural care plan said, [Name] can be very sweet at times but sometimes [gender] can be verbally of physically aggressive. [Gender] is now on medication for this which is working. Carers to report any changes that medication might not be working. There was nothing to say what the behaviour was or how staff should respond to this in a consistent way. Staff have not received training in managing challenging behaviour. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a homely and improving environment that meets their needs and expectations. Evidence: Since the previous inspection the provider has been gradually redecorating and improving the premises. People have been consulted regarding the choice of colours to be used. The first and second floor corridor areas have been re-decorated. One person said, The decorative order is good and always improving. From discussions with the manager throughout the day it was clear that many further needed improvements are planned to continue to improve the environment for people. For example, extending the dining area, replacing carpets, and providing people with lockable bedroom doors. One person commented that A bigger car park for visitors is needed. This may be due to the fact that car parking availability is currently reduced by being used for the storage of building materials. the manager said that this was due to be moved. The home has three lounges for people to choose from, and these were warm and homely. Communal corridor areas have been made more interesting through pictures and mirrors. The home has a pleasant garden for people to enjoy. Staff are starting to better consider the needs of people who may have dementia and Care Homes for Older People Page 22 of 33 Evidence: other cognitive or visual difficulties. To aid peoples orientation, bathroom and toilet doors have been painted set colours. Corridors have been painted in different colours so People can know what floor they are on. At the moment there is only one assisted bath in the home. To provide better facilities a large walk in shower room has been created on the ground floor. The first and second floors only have normal bathing facilities. The manager said that currently most people go the ground floor for a bath or shower, but that the other bathrooms will be upgraded to provide better facilities in due course. There appeared to be sufficient equipment such as hoists to meet peoples needs. A member of staff said, New equipment is now in place and it has improved our performance and made life easier for our service users as well. During a tour of the premises some isolated areas of poor odour control were noted. The manager said that carpets are cleaned, and that where carpets need to be replaced this will happen in due course as part of refurbishment. On surveys out of four people three said that the home was always fresh and clean. A relative said, The home is always clean, and another that the home is spotlessly clean. The homes laundry area provides sufficient equipment to meet the needs of the home. The area would however benefit from redecoration or a deep clean. Also, although a keep locked notice is on the entrance door to the laundry area, there is in fact no means of locking the door. As the home is registered to provide care for people with dementia, this needs to be addressed, as the area contained many potential hazards. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will be cared for by staff who are safely recruited and well trained. They cannot however expect that sufficient staff will be on duty to consistently meet their needs. Evidence: People said that staff at the home were Friendly and helpful. One person said, All the staff at Melrose House are very good, and another, The staff are very accommodating and will do anything to make my stay enjoyable and comfortable. The expert by experience also received positive feedback about staff. One person said They are absolute angels - nothing is too much trouble for them. Staffing at the home is fairly stable with a low turnover. This provides stability and consistency for people. Staff are positive about their role. One said, We are all good carers. The care in the home is very good. We cover all residents and we abide by their wishes and those of the family. From discussion with the manager, and rotas viewed it was seen that a basic staffing level of three people are considered adequate to meet the holistic needs of the thirty one people living at the home. On weekdays during the day additional cover is often provided as the manager and/or an assistant manager are also on duty. During evenings and weekends a basic level of three is mostly maintained. On some occasions however only two members of management/care staff are identified as working the late shift. On these occasions a member of the domestic staff team is identified as working a late shift. No domestic or catering cover is Care Homes for Older People Page 24 of 33 Evidence: provided from 14.00, so care staff must also cover these duties during the afternoon and evening. The manager feels confident that the current levels are adequate to meet peoples needs. This however is not based on any measurable or systematic approach to assess peoples level of needs, or plan staffing in a flexible way in line, for example, with the residential forum guidance. On surveys and in discussion people did not feel that staffing in the home was adequate. Many made comments about this such as, The care staff do their best to look after the residents, but there are a lot of them and there is often a lack of staff presence on the floor, More care staff are needed in the day rooms during the day, if only on patrol, The residents are often left in a room in a group without a carer. As several of them are quite confused this can be very frightening for them. If they are chair bound it can be difficult for them to gain the attention of a staff member, and My only frustration is when trying to leave, I cannot find a member of staff. Some staff also felt that staffing levels could be improved, Feel not enough staff on duty, 31 residents and only 2 staff and one manager. 29 residents need help with all aspects of life. Another said, Its better when there are four staff on duty. Some people felt that communication was an issue. This was also noted by us during the inspection in relation to one member of staff. One person said, Communication is a major issue due to lack of language and confusion, but the staff do their best within their limitations. During the site visit lounges were often observed to be unattended by staff, with people left to their own devices. It was positive to note that since the previous inspection more domestic staff have been recruited. Management have done well in ensuring that staff access National Vocational Qualification (NVQ) training. This will enhance staffs skills in working with people. Out of nineteen senior/care staff sixteen have an NVQ in care and a further two staff are working toward this. To see how well people are protected by the homes recruitment procedures we looked at the files of three recently recruited staff. These showed that good procedures are maintained and checks such as references, proof of identification, POVA 1st and Criminal Records Bureau (CRB) checks carried out. The manager was reminded that for best practice CRB checks should be in place before a person starts working in the home. If not in place staff must work under supervision at all times. On surveys staff said that their induction had covered everything they needed. On staff files we saw that good basic induction programmes were in place, which had been well completed and signed off. The manager confirmed however that a continuing induction programme based on a Skills For Care Induction programme had not yet been adopted by the home or undertaken by any staff. This issue was raised at the previous inspection and has not yet been addressed by the manager. An ongoing induction programme is important so that staff gain good knowledege to inform their practice Care Homes for Older People Page 25 of 33 Evidence: with people from the start of their employment. Although a training matrix is not maintained, a staff training file was well organised and showed that staff had undertaken a range of training. since the previous inspection levels of training have improved. This was recognised by a relative who said, There has been an increase in staff training which is welcome. Some training undertaken has been external and some in house. The manager encourages staff to go on training and adverts for training courses such as Therapeutic Activities in Dementia Care and Basic HIV Awareness were on display. Staff said, We are constantly on different courses which covers their (residents) needs. Not all staff could be identified as having undertaken up to date training in dementia care for which the home is registered. For example one person had last undertaken this training in 2002, others had no dementia training identified and other staff had undertaken minimal training in a four hour training course. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People do not live in a home that is always robustly managed to protect their safety and interests. Evidence: The manager at Melrose House has been in post for about fifteen months. They are registered with CSCI, and have appropriate qualifications and experience. Staff, relatives and people living in the home spoke well of the manager. Staff said that the management team was very supportive. During the day it was observed that management and staff had a positive relationship with relatives. The manager has a hands on approach and demonstrated a good knowledge of individual peoples needs. The provider is a frequent visitor to the home and a good relationship exists between them and the manager. At the previous inspection a number of requirements were made. Although it is clear that progress has been made, some have not yet been fully met. Some findings of this inspection show that management monitoring of practises at the home need to be improved. For example use of creams in the home, and Care Homes for Older People Page 27 of 33 Evidence: language being used in, and completion of care records. Since the previous inspection surveys have been distributed to people and used to gauge their satisfaction with the service. Each person who attends the home as a step down client is asked for their views on their stay in the home. Survey responses sampled were all positive. The provider is a frequent visitor to the home and the manager said that they know all the residents and families well. However monthly monitoring visits, that are required to be undertaken and recorded by Regulation, are not being carried out. The manager had completed the AQAA this year. All sections were completed and provided basic information about the home, and how they felt they were performing. Some sections could have been better completed to provide a more complete picture, for example the Complaints and Protection section making no mention of how people are safeguarded and Health and Personal Care making no mention of how health care is maintained. The manager confirmed that no monies or personal properties are held by the home for safekeeping. Shortfalls in the quality of records, particularly care records, have been identified in this report. Care records were also noted to not be held securely to protect peoples privacy. Records were stored in an unsecured cupboard in the dining area of the home. Although a key was in the lock this was not used to secure the documentation. No major health and safety issues were noted on the day of the site visit. As the home is registered to care for people who have dementia, the premises and equipment do need to be kept under review. We have previously mentioned the laundry being accessible. Other keep locked areas were also seen to be open. Although the manager said that it was not used one persons room contained a Zimmer frame walking aid on which the ferrules were worn through to the metal. This is a potential hazard and could cause and accident. A recent inspection of the kitchen had found only minor issues to address. A fire service visit had found procedures to be satisfactory. Records showed that regular fire drills are carried out, and that a fire risk assessment was in place to protect people. Records viewed showed that staff are trained and kept up to date in core areas such as moving and handling. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 30 18(1) People who are employed to 31/01/2008 work at the care home must receive training appropriate to the work they are to perform, including structured induction training in accordance with guidance provided by Skills for Care. This is to ensure that staff have the required skills to provide relevant care and support to meet peoples? needs on a consistent basis. The previous timescale of 01/07/07 has not been achieved in full. Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans and care records 17/11/2008 must be improved so that they provide a sound basis to deliver care to people. People must be involved in care planning. Care plans must reflect peoples current needs. People should feel confident that the care they receive is well planed with their involvement and based on their current needs and aspirations. 2 9 13 Medication must be properly 02/11/2009 managed and accounted for. This refers to the management of creams and topical applications. People must be protected by clear policies and procedures in place. They should feel confident that creams and applications are used properly and in line with their assessed needs. Care Homes for Older People Page 30 of 33 3 18 18 Staff must have the training needed to carry out their role effectively and meet peoples needs. This refers to the need for staff to have a better understanding of peoples behavioural needs People should expect their care needs to be identified in a person centred way, that also provides staff with clear guidance to meet those needs consistently. 01/01/2009 4 27 18 Staffing levels must be reviewed, with details of how the review was carried out and the outcome of the review to be sent to CSCI People must feel confident that sufficient staff are provided to meet all of their assessed needs at all times. 28/11/2008 5 30 18 Staff must receive good quality training in dementia care. People should receive care from staff who are skilled in meeting their assessed needs. 01/03/2009 6 33 26 The registered person must undertake monthly unannounced visits to the home to monitor the quality of the service. People should feel assured that the quality of the service is effectively monitored and their views sought. 01/11/2008 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 To ensure that people have good information to assist them in making choices about their ongoing care a Service Users Guide, in a format that is suitable for them, should be provided to them before they move into the home. The Service Users Guide should include details of fees, any additional charges, and the previous inspection report. So that peoples health and wellbeing is properly monitored, adequate nutrition records should be maintained and consideration given to acquiring sit on scales. In line with the homes own procedures, protocols should be in place for medicines that are prescribed to be taken on an as and when required basis. Other best practise issues mentioned in the report should be addressed. To ensure that people are treated equally and with dignity, the current dining arrangements should be reviewed. Management should continue to develop systems to assess peoples occupational needs, and provide them with meaningful activities or occupation in line with assessments and individual needs. 2 8 3 9 4 5 10 12 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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