Inspection on 20/02/06 for Melrose House

This inspection was carried out on 20th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Melrose House 18/09/06

Melrose House 28/10/04

Melrose House 21/06/04

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

CARE HOME ADULTS 18-65 Melrose House 41a Muswell Avenue Muswell Hill London N10 2EH Lead Inspector Karen Malcolm Unannounced Inspection 20th February 2006 11:00 Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 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 House DS0000010707.V271986.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Melrose House Address 41a Muswell Avenue Muswell Hill London N10 2EH 020 8444 8483 020 8444 8483 rford81128@aol.com 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) Mr Richard John Ford Mr Richard John Ford Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Four specific service users. Four specific service users who are over 65 years of age, may continue to be accommodated in the home. The home must inform the registering authority if any of these service users leave the home. 8th September 2005 Date of last inspection Brief Description of the Service: Melrose House is a care home registered to provide personal care for six service users who have mental health problems. It has been operating for eleven years. This is a family run home, with the registered proprietor/manager and his family providing the main support system for service users. Care practice is focused on promoting levels of independence that service users are comfortable with and that enables them to have a quality of life that they enjoy. The home is a large first floor maisonette that has been converted to use as a care home. There are spacious communal areas consisting of a lounge/dining area, a kitchen that is large enough to accommodate a table and chairs for informal meals and a more private sitting area located on the upper floor. There is a large garden to the rear of the home. There are two double bedrooms and three single bedrooms, a bath/shower room with toilet, shower room and two separate toilets. There is also a laundry area, which stores a washing machine and dryer and space for ironing. The home is located in a residential street close to the shops, services and businesses in Muswell Hill and local transport links. Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was completed approximately over two and half hours. The registered provider/manager assisted the inspector throughout the inspection. In the home were one service user and the deputy manager. The other service users were at their allocated day centres. The inspection involved sampling care plans, policies and procedures, records, a tour of the building and observing the interaction between staff and a service user, the latter of which was found to be positive. Overall the inspector’s impression was that the home remains well managed and progress has been made to meet all the areas of improvement from the last inspection. The inspector commends this. The manager\provider and the deputy manager that the inspector met were very open and helpful throughout the inspection. What the service does well: What has improved since the last inspection? At the previous inspection six areas of improvement were made and two recommendations. It was evident at this inspection that all six areas of improvement had been addressed. The inspector commended the registered manager on achieving all requirements from the previous inspection. The areas of improvement addressed at the time of this inspection were: • the home’s abuse policy is now amended, reflecting the local authority’s Adult Protection procedures • the manager has now produced a Quality Assurance monitoring system. A summary of the report is now published in the home’s business plan aims and objectives • that risk assessments for each of the service users’ have been updated a Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 6 • • the specific service user’s cultural dietary needs is now being addressed the specific service user wishes in the event of their death or serious illness is now recorded on their file 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 House DS0000010707.V271986.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No Judgment made EVIDENCE: Standard 2 was assessed at the previous inspection and met. Therefore this Standard was not assessed at this inspection. Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users know that their assessed, and personal needs are regularly reviewed by the home and are recorded appropriately on individual’s care plans. However, reviews with the social workers have not been completed, therefore service users care needs may not be appropriately addressed or monitored by the home. EVIDENCE: Each service user’s plan was found to be comprehensive, taking into account the care support needs of the individual service users living in Melrose House. At the previous inspection it was required that the manager ensures risk assessments for service users addresses all areas of their care that is deemed a potential risk and any changes to an individual care needs is updated accordingly. Two care plans were examined. Records of risk assessments completed were robust and in good order. Copies of reviews were in place, however, the manager completed these reviews. Those service users over 65 years had their review completed monthly. It was evident that the last copies of reviews completed by the service users’ placing authorities were completed between 2002 and 2004. The manager stated that none of the service users have a named social worker, although four of the six service users are over 65 years. It was Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 10 advised that all service users must have a yearly review completed by the placing authority, to ensure that the placement for each service user remains suitable. It was also evident on one service user’s care plan that there was no named next of kin details recorded. The manager stated that in view of the fact that no next of kin detail were given at the point of admission he has on a number of occasion place himself as the specific service user’s next of kin. It was advised that consultation with the service user and their social worker/placing authority must take place to establish who may be the named next of kin for this specific user. Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 & 15 Service users have the opportunities for personal development and being a part of the local community on a daily basis. Service users are able to maintain contact with family and friends contact. The meals in this home are good offering both choice and variety catering for special dietary needs. EVIDENCE: Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 12 The care plans examined were comprehensive clear and precise. The manager is commended with the presentation and the information recorded on each care plan. The care plans read by the inspector gives a clear picture of the individuals’ personality, lifestyle, support and care needs. A number of the service users are independent and access the local community at their own leisure. Service users said that they knew the local shops, supermarkets and cafes well. The owner and service users have a good relationship with neighbours. It was evident that a number of service users were out at their allocated day centres, which they attend daily, except weekends. All service users need at present minimum support with regards to activities with the community. Several service users make extensive use of free bus passes provided by the local authority. However, the manager must monitor this as four of the six service users are over 65 years and their individual support needs are changing. At the previous inspection it was required that the manager ensures that the specific service user, whose cultural needs have not been addressed by the home although stated in their care plan must be actioned. At this inspection the manager informed the inspector that they tried on a number of occassions different Caribbean takeways, with little or no success. However, they have made different cultural dishes within the home and this was more successful. The inspector was unable to discuss this issue with the specific service user because the service user was out at their allocated day centre. However, on the service care plan a detail account of the individual’s risk assessment was updated and this included a section on cultural awareness. Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No Judgements made EVIDENCE: Standards 18, 19 & 20 were assessed at the previous inspection and met. Therefore these Standards were not assessed at this inspection. Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Service users are protected from abuse neglect and self-harm by the process and system in place. Therefore service users feel safe living at Melrose House. EVIDENCE: The home’s abuse policy was in place. At the previous inspection it was required that the home’s abuse policy reflects the local authority adult protection’s procedures. A copy of the new amended version was shown to the inspector. Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Recent investment has significantly improved the appearance of this home creating a comfortable and safe environment for those service users living and visiting Melrose House. EVIDENCE: Melrose is a three-storey town house in the middle of Muswell Hill. The home accommodates six service users with mental health problems four of which are over 65 years of age. Bedrooms consist of two double and three single bedrooms. All bedrooms examined are provided with furniture and fittings sufficient and suitable to meet individual needs and lifestyles in the home. The double rooms are adequately sized to accommodate the service users sharing. The home is comfortable, warm and inviting providing a homely place, one service user spoken to confirm this. Since the previous inspection a number of maintenance works had been carried out on the home. A number of bedrooms had been decorated; new carpet had been fitted on the hallway, landings, stairs and lounge/dining areas. During the tour of the building the manager informed one of the service user’s that their bedroom was up next for re-decoration. The service user was asked what colour would they prefer their bedroom painted. At first the service user stated that they were happy with their bedroom the way it was. However, Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 16 they did want their room painted blue. The manager informed the service user that he would obtain some colour charts in blue for them to decide. The service user seemed happy with that. The home was found to be reasonably clean and tidy on the day. Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 Staff morale is high, resulting in an enthusiastic workforce that works positively with the service users. Service users are supported and protected by the home’s recruitment policy and practices. However, the verification of care staff credential is not always checked, therefore service users can be place at potential harm if checks are not completed. EVIDENCE: At the previous inspection it was required that the registered manager reviews the staffing levels within the home. This was to include a contingency action plan with regards to absenteeism. The manager informed the inspector that since the last inspection, one carer has left and three carers have been employed. One of the three carers is employed for 32 hours per week and the other two carers are employed, as casual staff. The home’s full time staffing team now consist of three members of staff this includes the manager, the deputy manager and the new carer. The manager and the deputy are the only staff rota’d to complete sleeping-in duties. The manager informed the inspector that he is still seeking to employ appropriate carers for the home; however, this is proving to be difficult. It is the view of the inspector that although three new staff have been employed the staffing level in the home remains low and this must be reviewed. One of the new carers personnel file was examined. The carer started their employment on 10/01/06. It was evident that all the information required Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 18 under Regulation 7 & 19 Schedule 2 was in place. Two references were sought, however, both references were from the carer’s friends. It was advised that at least one of the references sought by the manager must be from the carer’s last employer. Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 41, 42 & 43 The manager ensures that service users’ and their relatives’ comments are listened to and this is reflected in the homes’ annual development plan. The manager ensures that the health, safety and welfare of service users are paramount to the working practice of the home and this is evident in the home’s documentation and the manager practice. Therefore service users are protected in the home. EVIDENCE: It was evident that the manager’s knowledge and experience of the service user was excellent. The inspector observed this during the inspection. The home’s record keeping is excellent and well maintained. All information held is easily accessible, with a clear index system as a guide. All service users files gives clear comprehensive guidance to understanding individuals needs within the home. The service users care plans are very well maintained and monitored by the manager. Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 20 At the previous inspection it was required that the manager ensures that the homes Quality Assurance is completed yearly. The findings were that this wascompleted and the conclusion were: • Each service users completed questionnaires, some put their names on the form and others did not. No additional comments were added to the questionnaires. The general feedback was rated between good and excellent. The overall conclusion from the findings is that the standards are general good and the service users are pleased with the service provided, but there is always room for improvement in all areas. Relatives’ comments were also positive and one relative stated to the effect that they felt that their relative’s specific needs are being addressed. The inspector commended the feedback and the results of the questionnaire on the day. All health and safety certificates required were in good order. Part of the inspection process included the inspector completing a fire risk assessment whilst touring the building. It was evident that all areas of risk relating to fire procedures and policy was in place. The manager has completed the home environmental & fire risk assessment. The manager has identified some minor areas that need addressing relating to smoke detectors and the emergency lighting. Both are earmarked in the home’s financial business plan for the next financial years budget 2006/07. This commended by the inspector. Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 2 X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Melrose House Score X X X X Standard No 37 38 39 40 41 42 43 Score X X 3 X 3 3 3 DS0000010707.V271986.R01.S.doc Version 5.0 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(1)(c) Requirement Timescale for action 30/05/06 2. YA33 7, 19 Sch 2.5 3. YA6 17(1)(a) Sch 3.3(b) The registered person must ensure that each service users has a regular review of their care and support needs completed by their individual social worker. Copies of the minutes with any action taken must be kept on file. Any follow-up action must be addressed by the home in each individual’s service users care plan. The registered person must 30/04/06 ensure at least one of the two references sought for any member of staff employed is from the staff member’s last employer. Therefore the manager must obtain a reference for the new member of staff recently employed. Evidence of this must be available for inspection. The registered person must liaise 30/05/06 with the specific service user’s social worker with regards to obtaining verification of the service user’s next of kin. Evidence must be available for inspection. Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 23 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 YA33 Good Practice Recommendations It is recommended that staffing levels is to be kept under review by the manager Melrose House DS0000010707.V271986.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 House DS0000010707.V271986.R01.S.doc Version 5.0 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. 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