Inspection on 23/04/07 for Melrose House

This inspection was carried out on 23rd April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Melrose House 10/06/10

Melrose House 28/09/09

Melrose House 15/10/08

Melrose House 05/11/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Melrose House 95 Alexander Road Southend-on-Sea Essex SS1 1HD Lead Inspector Ms Bernadette Little Unannounced Inspection 23rd April 2007 09:50 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 House DS0000066956.V335998.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Melrose House Address 95 Alexander Road Southend-on-Sea Essex SS1 1HD 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) 01702 340682 01702 436551 melrosehouse@btclick.com Mr Masood Rashid Manager post vacant Care Home 31 Category(ies) of Dementia - over 65 years of age (31), Old age, registration, with number not falling within any other category (31) of places Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. To operate as a care home only. To provide care to 31 older people (OP) over the age of 65 years. To provide care to 31 Older People with Dementia (OP(DE(E)) over the age of 65 years. Maximum number of registered places 31 (both sexes). Date of last inspection 29th August 2006 Brief Description of the Service: Melrose House is a detached property, which is currently registered for 31 older people to provide accommodation and personal care. The registration category includes older people with dementia. Bedrooms are situated on the ground, first and second floors and a passenger lift provides access to all floor levels. There are three communal lounges and dining room on the ground floor. Bathroom and toilet facilities are provided throughout the building. There is limited car parking for visitors at the front of the property. There are gardens at the rear of the house and patio area. The premises are situated in a residential area within a short walking distance of Southend shopping centre and seafront. The home is also in close proximity to mainline railway stations and numerous bus routes. The current rate of fees is between £369 and £450 per week. Additional charges are made for hairdressing, chiropody, clothing, toiletries, papers, magazines and taxes. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit was undertaken over an eight hour period. A tour of the ground and first floor of the premises was undertaken and records, policies and procedures were sampled. Care files for three residents were case tracked. Most of the morning was spent with residents either in their own rooms or in communal rooms. Time was also spent in the dining room at lunch and teatime. The acting manager and deputy manager were on duty at times during the site visit and were open and helpful. Other staff also assisted with various aspects of the site visit. The registered provider was also briefly present. Four staff were spoken with. Seven residents were spoken with. The assistance of all those at Melrose house was greatly appreciated. There were 26 people resident at the home at the time of this site visit and some residents at have varying degrees of confusion/dementia. Information on the views possible to obtain as well as observations made during the inspection are also reflected throughout the report. Completed surveys were received from four residents, four relatives and two healthcare professionals following the site visit, and comments and outcomes are included in various sections of the report. Comments were not received within the timescale from the GPs and three social workers/funding authorities to whom surveys were sent. What the service does well: All the residents’ comments about the staff were positive and they felt that staff were helpful. A survey said “the carers are extremely kind, patient and pleasant”. A health care professional said in a survey “ they treat the residents with respect and kindness.” A relatives’ survey said “all the staff seem to go the extra mile…there is always a management member available” All residents spoken with who were able clearly give their views said they were comfortable in their own bedroom. Some residents felt that the food was nice and that their privacy and dignity was respected. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective users of the service had adequate information to base decisions about the home on. Residents’ needs were not always assessed by the home to reassure the home could meet these. EVIDENCE: The managers advised that prospective users of the service are given a brochure, and this occurred with people who came to look around the home on the day of the site visit. Service user guides are not sent out prior to admission but a copy is available in each resident’s room once they are admitted. The managers advised that the statement of purpose is not sent to people who would be wishing to buy/contract the service. A resident spoken with confirmed they had not had any written information about the home before admission. Surveys indicated that relatives felt they had enough information. The statement of purpose and service user guide do not contain all relevant information required by regulation. Advice has been provided on this by the commission since the last inspection. The acting manager said she was aware that she needed to update and amend the documents. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 9 The managers stated that all residents have a pre-admission assessment, completed by the home at the persons current care environment, for example the hospital. The assessment documentation was requested for the most recently admitted resident. The managers advised that no written pre-assessment had been undertaken for this person prior to their admission to the home, but that the person/family had popped round for a visit. The managers were unaware of the regulation that required them to write to each prospective resident, confirming that based on their assessments of the persons need, the home could meet their needs and so offer them a place. The acting manager advised that the home have now begun to offer ‘step down’ where the hospital would place residents for respite and rehabilitation following hospitalisation and to enable them to return home. The acting manager advised that there were currently no step down clients in the home but that they would always have a preadmission assessment at the hospital. No additional policies and procedures were available in relation to this and the information was not contained in the statement of purpose. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care records were not written for the individual person and so could not confirm individualised and consistent care outcomes for residents, especially for those who were unable to express a view. EVIDENCE: Resident surveys stated that they always or usually receive the care and support or medical support they need. All relative surveys stated the feel that the home meets the needs of their relative, although one qualified as being in terms of physical care. Care documentation was considered for three residents. The home use a preprinted format to identify care needs, with a choice of actions to be taken to meet the needs. The daily care notes for each of the pre-printed areas of need regularly recorded “ fine” and so provided no information on how the care was delivered to the residents and whether or not it was effective. Discussion indicated that a resident, who is diagnosed with dementia, had left the premises unsupervised approximately two months ago, and following a search had been returned by the police. There was no detailed risk assessment and care plan in place to support care staff to manage this consistently and Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 11 safely. On the morning of the site visit, the resident was seen to undo the top bolt on the door and try to leave until persuaded not to by the acting manager, who was in the vicinity. The resident was recorded as having demonstrated verbal and physical aggression. There was no specific risk assessment and detailed care plan in place to identify triggers and how it was to be managed to ensure consistent care outcomes for this resident. Another resident had a care plan from 2005, which said they were verbally and physically abusive. The acting manager and deputy manager said they were unaware of this and that it was not accurate for that resident. While it was noted positively that the home undertake assessments relating to nutrition and pressure area care on admission and that these were regularly reviewed, a care plan titled sleeping advises that the resident is at risk of pressure sores, although the pressure sore risk assessment undertaken at the same time identifies that this is not a concern. Two separate pressure sore risk assessments undertaken for another resident on the same date identified two different outcomes for the same resident. Moving and handling risk assessment documents were on file for each resident. They did not identify the residents’ needs in relation to transfers, for example for bathing, or the number of carers required or any special equipment required. A survey from a healthcare professional advised at the staff communicate and work well with other health care services to improve residents’ health-care needs, which the home usually meet, that staff always have the right skills to support residents, usually respect individuals privacy and dignity and usually support them to live the life they choose. A resident’s cigarettes were looked after in the office. The managers advised that this was because they had been smoking in their room at night. No specific risk assessment or care plan was in place relating to this. Another general assessment identified that this was a low risk. No signed agreement was available from the resident and no record was maintained of the restriction of their rights. Pressure pads were seen to be in place beside some residents’ beds. The managers confirmed that there were no risk assessments, care plans or records of the restriction residents’ rights relating to these. Some residents spoken with said they felt that their dignity and privacy was respected and that staff for example always knocked. A resident said that she had been asked about, and able to refuse, having a male carer give them a bath. Other residents had a different experience and one said “ staff dont always knock before their came in, there are always into much of a hurry”. A resident said they would “love to have a key to their room”, as sometimes other (confused) people do go in. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 12 There was clear evidence that residents were addressed by their preferred name, which is positive. Files sampled indicated that the home support residents to access appropriate health care services such as the GP, district nurses, and chiropodist. Hospital appointments, the reason for them, and outcomes were also recorded, which is good practice. The deputy manager advised that residents usually have at least six monthly medication reviews, which is positive. Residents were weighed regularly in line with the review of their nutrition assessment, which is good practice. Responses from healthcare professionals spoke positively of the good communication with the home, and one comment was “I have always thought that Melrose have responded to residents’ need and that the staff are very caring to their clients”. No resident had a care plan relating to their medication. Medication Administration Records (MAR) had just commenced for a new month. Receipt of the medication was signed for. It was noted positively that two signatures supported handwritten entries on the MAR, which is good practice. A sample list of signatures of those deemed competent to administer medication was available but needed updating. The acting manager advised that some staff have current medication training that included a competence assessment, but for other staff including herself, training was mainly about the system, did not include a competent assessment, is some years old, and up-to-date training is required. Protocols were not in place for ‘as required’ medication and these were explained to the deputy manager. Photographs of residents were said to be kept in a file in the office. Advice was provided on attaching a photograph of the resident to their care plan and to their medication records to assist with accurate identification. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ experiences of the home varied in aspects of daily living, with visitors welcomed but with meaningful and appropriate activities lacking for many residents. EVIDENCE: When asked how residents are supported to pass the time and what activities are provided, the acting manager said that one resident does colouring in, they try to provide outside entertainment every six to eight weeks, there will be a clothes party next month and “ nothing else really” except their hairdresser comes weekly. Two residents said they preferred to spend time in their room following their own interests. One said there was no one downstairs to have a conversation with. While praising staff generally, four residents said staff never had time to sit and talk to them. One resident said, “its difficult to overcome the boredom”. It was observed that staff interaction with residents, while kind, was task based, although a member of staff sat and had a conversation with two residents in the afternoon. Care files sampled showed a lack of personal history for residents to support staff to provide recreational activities. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 14 Pre-printed care plans sampled were confirmed by the managers as not particularly accurate or relevant to the person, for example it recorded that the resident liked to attend church weekly, which they did not, and did not include any of their interests, or the leisure pursuits that the resident did attend, supported by relatives. One resident who was trying to leave the premises asked to go out for a while but was advised that they could not as there was no one available to take them. Care records sampled did not evidence that residents were taken out by the homes’ staff. The acting manager said she was waiting to hear if places were available for two staff on a course on seated exercises, which would be a positive development. A relatives survey said, “ she would possibly enjoy a little more one-to-one attention in terms of conversation, but the constraints of staffing make this difficult”. A resident survey said “ would like to be taken to a nearby park now and then to get some fresh air by a member of the staff”. Surveys indicated varied responses in relation to the availability of activities that were suitable for the person to join in from one person who felt there always were, two people who thought sometimes were to one person who felt there were never any activities that they could join in with. Residents said their relatives/visitors were always welcome. The acting manager confirmed this and said they simply ask visitors to avoid mealtimes. A record of visitors was maintained. One survey contained the comment “my family and friends are always made welcome .. always happy to visit and totally support the current staff”. The acting manager advised that residents are offered choices, for example with food. She added that residents are asked for their preferences on admission, for example no one had shown any interest on church attendance or services when asked. Postal voting cards were advised as given to residents and support given as needed to those who choose to use them. Residents’ views on the food served varied including “ I have no complaints” to “I don’t like the food”. A menu for the week was displayed in the dining room and a recommendation made that the size of the print could be increased to make it easier for residents to see. No clear choice was available at lunch, and the only options exercised during a five week period sampled were occasional and noted to be tinned ham, corned beef and on one occasion fish fingers. There was however a choice of the day of this site inspection and residents had a roast chicken dinner or chicken curry. One resident said, “ the food is nice enough, there’s no choice, you take what comes”. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 15 It was noted positively that menus show there is a good choice at breakfast, including a cooked option, and one resident said this “was great”. One resident advised that this is not always available in practice as there is no cook employed currently and not all care staff cook this. One resident said the teatime choice is very limited, but they were satisfied with the food otherwise and always had a choice of tea or coffee. The record of food served was inadequate as it did not contain a record of breakfast, spasmodically recorded the teatime meal and did not indicate specific dietary needs or other snacks and drinks. Residents confirmed that they are offered a drink and biscuits during the evening. It was recommended when serving liquidised/pureed meals, it is done in separate portions for residents to retain colour, flavour and appeal as mixing everything together looked unappetising. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents had varied levels of confidence in raising issues but were protected by staff’s approach to whistleblowing. EVIDENCE: The complaints procedure was displayed and is also part of the Statement of Purpose. Advice was provided to the manager on including the information that residents may also raise their complaints with their funding authority. One resident spoken with said they would feel able to raise any concerns with staff, another said they would find it hard to talk to staff and another said that they would talk to their friend/relative and ask them to address the issue for them. The acting manager advised that no complaints had been received since the last inspection. The commission received an anonymous phone call, which alleged rough handling of a resident by a member of staff and of falling care standards, and of which the acting manager was informed. The acting manager stated that this had been investigated, and had identified a lack of staff training/knowledge on handling a resident who had fragile skin and that the staff member had been instructed. This had not been recorded as a complaint. No records were provided on request in relation to the recordings in the staff members’ file/subsequent training. There was evidence that four staff had attended training in the protection of vulnerable adults. Three other staff spoken with during the inspection demonstrated an understanding of protecting vulnerable adults and were confident in the use of the whistleblowing procedure. Staff spoken with had not had training on management of aggression/behaviour that challenges. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ living areas were pleasant in some aspects, but the premises did not provide a clean, well maintained/equipped or a safe environment for some of the people who lived there. EVIDENCE: All residents spoke with said they were happy with their own rooms. Many of the rooms were very personalised and one resident said, “ It matters so much to have some of my own bits and pieces”. Residents had a choice of lounges in which to sit. One of these has been redecorated and two have been re-carpeted recently. The dining room was well presented and tables were set with cloths and condiments. Three of the bedrooms had also been fitted with new carpet. Many areas of the premises were in need of redecoration and updating. One resident’s bedroom had a large plastered area on the ceiling that the resident advised has been like that and unpainted since their admission to the home Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 18 some months previously. Walls were scraped and damaged and flooring in several areas needed updating. Several areas also needed a thorough cleaning, for example skirting boards or an area in a resident’s bedroom where the wall was smeared with what appeared to be faeces. Toilets were heavily stained with scale. Some surveys indicated that the home was always clean and fresh while one said it usually was but the home needed another cleaner. Each resident’s bedroom door had a number, and their name hand written on card. Toilet/bathroom doors also had a hand written notice that identified the room’s purpose and the number of that bathroom/toilet. Symbols were not used and bedroom doors did not contain a photograph to assist with recognition where this may be appropriate. There was limited evidence of awareness of current good practice in dementia care in relation to the use of sensory stimuli including colour coding, flooring, lighting. A call box phone was available to residents in the main hallway. This did not offer residents any privacy. The issue of door locks has previously been discussed. New storage units and tiles had been fitted to the kitchen and a new washing machine installed in the laundry. The front door is kept secure by a bolt which, as stated, was seen to be opened by a resident with dementia who had recently left the home unnoticed. The acting manager said they had put the notice on the door asking people to ensure a member of staff locked the door after them when they left, but people dont always do this. The home has an accessible and pleasant garden area. One resident said “staff dont have time to talk, I dont get offered for example to go in the garden although it was a lovely day yesterday, may be you have to ask”. It was noted that some fence panels were missing/damaged. The manager stated that these belonged to a neighbour whom she had spoken to and who was supposed to be replacing them to make the garden secure. Advice was provided regarding the homes responsibility to ensure the safety and security of all residents at all times. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents found staff helpful and kind, but inadequate in numbers to meet their needs and provide quality care outcomes. Residents were not safeguarded by the homes recruitment and training practices. EVIDENCE: The last inspection reported that the number of staff on duty together with supporting supervision was not always sufficient to meet the needs of residents. This was again evidenced at this inspection where the number of staff and their deployment was not adequate, or managed effectively to meet the needs of the residents, several of whom have dementia. Residents able to express a view spoke positively of the staff themselves but with concern as to how the staffing levels adversely affected their care outcomes, as identified also in other areas of this report. Comments included “they are very good, very kind”, “staff are good but very pushed, they need more especially in the morning”, “staff do answer the buzzer, you have to wait a while, they don’t have enough staff”, “carers are kind and helpful .. but have no time”. A resident advised of having to empty their own commode because they found it uncomfortable to be in the room with it until staff could find time to empty it for them. Another resident said they had repeatedly asked to have their nails cut, but staff were busy when asked and they were told to ask the next shift to do it. Apart from the acting manager who was dealing with the telephone, meetings with relatives and a staff interview, staffing levels are one senior and three Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 20 carers in the morning, one of who (advised as usually the senior) undertakes the cooking for breakfast and lunch. A kitchen assistant is employed each day until 2pm, a cleaner on weekdays until 2pm and a handyman/gardener Weekdays to 3pm. In the afternoon there is a senior and two carers, one of who is again in the kitchen undertaking the preparation, cooking, washing-up etc. There are three awake staff at night. Care staff also undertake the laundry duties during the day. The acting manager is trying to recruit a cook and hopes to soon have staff for cleaning hours at the weekend. It was noted that there was limited one to one interaction by staff with residents during the site visit. Residents spoken with by the inspector were clearly keen for the opportunity for conversation. There were periods where lounges were unattended by staff. Two of the three care staff were noted to be folding laundry in the laundry room at one point during the morning. It was unclear why the senior carer was cooking rather than being on the floor, supervising staff and the care of the residents. The rotas showed that there were that there were 20 care staff employed, including bank staff, the acting manager and deputy manager. Certificates for NVQ training shows that four staff had achieved NVQ level 2 and the acting manager and deputy manager had achieved NVQ level 3. The acting manager advised that there are two additional staff interested in undertaking this training and she is endeavouring to access this currently. The recruitment file for the one member of staff, advised as having been employed since the last inspection, was sampled. The persons application was dated as completed on the date they started employment at the home and contained no employment history. Two translated letters of reference from previous employments were available. Evidence of identity was available but no photograph. There was no declaration of physical and mental health. A translated certificate confirming no criminal offences in the previous country of residence was not provided for this staff member. A one day the induction checklist was completed on first day of employment some five months previously. There was no induction programme or record of training on file for this member of staff. The acting manager advised that the training matrix, while available, was out of date and not accurate. A file containing a number of certificates for various staff was available and sampled for some aspects of training. Eight staff had training in dementia, either a one or two day course. As noted previously a limited number staff had had training on pova and medication updates/for training were required for some staff. The manager confirmed that moving and handling training was an area that needed attention and, for example, her own most recent training was in 2003. There was no evidence of training on other Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 21 specialist issues/conditions associated with older people such as diabetes or Parkinsons disease although there are residents in the home with these conditions. This was identified at the last inspection. Recruitment and training information was requested in relation to the agency staff used regularly, including one staff on duty at the time of the site visit. The acting manager advised that they had no information on any of the agency staff used, relating to confirming the persons identity, whether their relevant references and checks had been undertaken and confirmed and evidence that they had appropriate training for the work that they did. Advice was provided on the need to address this without delay. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ best interests were not always evidenced in the management of the home in relation to care outcomes, staffing levels and safety. EVIDENCE: The acting manager has worked at the home for a number of years, including as deputy manager. She will not be applying to be registered as the homes manager. The registered provider advised the commission that he is actively endeavouring to recruit a suitably skilled person for this role. The acting manager demonstrated a desire to do a good job while she is covering the post, but was also aware that she has no previous management experience and has very limited knowledge of many of the responsibilities of the role of registered manager. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 23 The registered person needs to instruct and support the acting manager to manage staffing levels, deployment and tasks more effectively, and ensure that staffing levels are reflective of the needs of all residents including those with dementia. The acting manager stated that she had no awareness of what the homes policy was in relation to monitoring quality and her honesty is respected. It was established that residents completed questionnaires in 2005, under the previous ownership. There was no follow-up or outcome report available relating to these. The acting manager had questionnaires with recent dates provided by a small number of staff. Regulation 26 reports were not available. The registered person does not undertake these as he is on the premises regularly. It is recommended that the registered person undertake these and use them as part of the quality monitoring of the home, and also to reassure himself that he is complying with his legal requirements, especially while there is no registered manager in post. Residents meetings have not occurred since April 2003. The acting manager said they dont have them now as the client group have changed. The acting manager was recommended to introduce them and provide appropriate explanation and support to those residents who may be interested to enable them to participate. The registered provider had not notified the commission that a resident had been missing from the home. The registered provider was made aware of the requirements of Regulation 37 at the last inspection. Effective steps to ensure the safety of residents following this incident were not evidenced. Rosters did not contain the full name of all staff and did not identify the names of agency staff. The acting manager advised that she does not look after any money for residents generally, but pays personal allowances to two residents from petty cash, which is provided by the registered provider. Records of this were maintained and residents’ signatures confirmed receipt of the money. This standard will be inspected more fully at the next inspection. A completed appraisal form for one staff member was dated September 2006 and a completed supervision sheet in November 2006. A supervision contract and recording format were available. The acting manager and deputy manager stated that they had both the attended training on supervision but that it was rubbish. They advised that they do not do supervision now but to do a handover. Current inspection certificates for fire equipment and the lift were provided. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 24 Certificates relating to the gas and electrical system were not available. Monthly checks of the fire alarm and fire doors were evidenced. The acting manager advised that fire drills were undertaken at staff meetings. Records showed that there had been a staff meeting in the June 2006 and December 2006 were fire drills were recorded. The manager confirmed that not all staff had participated. The minutes of the other staff meeting in March 2007 did not include a fire drill. A record of water temperatures was maintained that showed that water temperatures in bathrooms, toilets and bedrooms regularly exceeded safe limits. The handyman explained that no action was taken in response to these high temperatures unless there was an issue for an individual resident but that the home plans to put thermostatically controlled valves on all outlets over time. Separate correspondence has been sent to the registered provider regarding this matter. The safety and security of the premises has been raised previously in this report. Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 25 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 2 X 2 X 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 x X X X 2 1 1 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 2 1 Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 OP1 OP6 Regulation 6 12(1) Requirement The Statement of Purpose and the Service User’s Guide must contain all the information required to ensure that prospective residents have full information about the home. They must be given to prospective users of the service Copies must be sent to the Commission for Social Care Inspection. Previous timescale of 30/11/06 not met. 2. OP3 14 All prospective residents must have a full assessment of their needs by a suitably qualified or a trained person. The registered Person must obtain a copy of the assessment and then must confirm in writing to the resident that based on the assessment, the care home is able to meet their persons needs. Residents care plans and risk assessments must be written about them and their specific DS0000066956.V335998.R01.S.doc Timescale for action 01/06/07 23/04/07 3. OP7 OP8 OP9 15 13(4) 13(5) 01/07/07 Melrose House Version 5.2 Page 27 13(2) individual needs, be updated, accurate, and regularly reviewed with the inclusion of the residents/their representative, to show how staff are to meet the residents needs in daily practice and protect the health and well-being of both residents and staff. Previous timescale of 31/10/06 not met. 4. OP10 OP14 OP15 OP24 12(2),(3), (4a) 13(4)Sch3 q 16(2a)i Residents must be treated in such a way that allows them to feel they are respected, that their right to privacy is upheld and that can have reasonable choices in everyday life. Risk assessments must show clear reasons why limitations are placed on the resident’s freedom of choice and movement, for example the pressure mats, and the resident’s agreement of these must be recorded where this is possible to obtain. All residents, particularly those who have dementia, cognitive impairments or sensory needs, must be offered appropriate and alternative ways to engage and interact in relevant, meaningful and stimulating occupational activities, and staff must be provided with the time, training and facilities to support residents to achieve this care outcome. Residents’ living environment must be kept safe, clean, and reasonably well maintained and decorated. Residents needs must be met and the registered person must DS0000066956.V335998.R01.S.doc 23/04/07 5. OP12 16(2) m & n 18(1)a 01/07/07 6. OP19 OP26 23(1)a 23(2) b, d, o, 18(1) 01/07/07 7. OP27 01/06/07 Melrose House Version 5.2 Page 28 take the number and needs of the residents into account and ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of the residents. This includes both care and ancillary staff. Previous timescale of 30/10/06 not met 8. OP29 17(2) 19 Schs 2 &4 Residents must be protected by the homes recruitment procedures/records. The Registered Person must ensure that the homes recruitment records contain all the required evidence of references and checks, identity, previous history and qualifications/experience for all staff that work at the care home. This also applies to agency staff. Previous timescale of 30/10/06 not met 9. OP30 OP8 OP9 18 13(2) 13(4) 13(5) 13(6) Residents must be supported by 01/07/07 suitably competent and trained staff, and the person registered must ensure that staff are offered training appropriate to the work they are to do and be able to show evidence of this. This includes structured induction training, training and regular updates on all aspects of basic training including moving and handling, first aid, medication, POVA, dementia, management of behaviour that challenges, health and safety/risk assessment etc, issues and conditions associated with older people DS0000066956.V335998.R01.S.doc Version 5.2 Page 29 23/04/07 Melrose House such as Parkinsons disease, pressure area care, sensory needs, or diabetes. 6. OP31 OP33 OP36OP37 9b(i) 24 37 To ensure best quality care outcomes for residents, the registered person must employ a manager to the home who has the necessary knowledge and skills to achieve this. This includes having systems in place to regularly seek the views of residents, monitor and assess the quality of the care provided, take effective actions where shortfalls are identified, keep residents safe, arrange to provide staff with appropriate and timely support through training and supervision, to maintain records required by regulation to protect residents (including accurate rotas and nutrition records), and inform the commission of those notifications required by regulation. 7. OP38 13(4) To promote resident safety, the Registered Person must make sure that he takes all reasonable steps to keep all parts of the home to which residents have access free from hazards to their safety. Any unnecessary risks to the health or safety of service users must be identified and so far as possible, eliminated. Previous timescale of 15/10/06 not met. In addition to the other safety issues identified in these Requirements, this requirement includes the safety of the hot water, Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 30 01/07/07 23/04/07 the security of the premises including the front door and the back garden, the safety inspection certificates regarding the gas and the electrical fixed wiring. Written confirmation is required from the registered provider to confirm/evidence that these issues have been addressed and resident safety protected. 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 OP3 Good Practice Recommendations The Registered Provider should include more background & social history information when carrying out pre-admission assessments to support good quality plans of care. The registered person should ensure that written protocols or guidance are in place for medicines prescribed on a “when required” basis. The Registered Person should manage the physical design and layout of the premises to meet the needs of service users by continuing to develop appropriate signage/ orientation aids, particularly to better meet the needs of people with dementia. The menu should be written in larger print that would be easier for residents to see. The registered Person should be able to show that they have fully investigated any concerns and complaints raised with them, by recording the investigation, the outcomes found and any action taken, and including relevant information in staff files where this is appropriate. DS0000066956.V335998.R01.S.doc Version 5.2 Page 31 2. OP9 3. OP12 4. 5. OP15 OP16 Melrose House 6. 7. OP28 OP30 At least 50 of care staff should achieve training in NVQ level 2. The Registered Provider should arrange training for staff to have a greater awareness of Parkinson’s disease & possible side affects. It is recommended that the registered person undertake detailed reports in relation to Regulation 26 and use them as part of the quality monitoring of the home, and also to reassure himself that he is complying with his legal requirements, especially while there is no registered manager in post. The Registered Provider should arrange for risk assessments covering ‘safe working environment’, to be reviewed at least annually, or sooner if necessary. Outstanding from the last inspection. Not considered on this occasion, carried to a future inspection. 8. OP33 9. OP38 Melrose House DS0000066956.V335998.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 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 © 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 DS0000066956.V335998.R01.S.doc Version 5.2 Page 33 - 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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