Inspection on 05/11/07 for Melrose House

This inspection was carried out on 5th November 2007.

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 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 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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Melrose House 95 Alexander Road Southend-on-Sea Essex SS1 1HD Lead Inspector Mr Trevor Davey Unannounced Inspection 5th November 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Melrose House DS0000066956.V354207.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.V354207.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 Sonia Matilda Leggett 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.V354207.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 23rd April 2007 Brief Description of the Service: Melrose House is a detached property, which is registered to provide care and accommodation to up to 31 older people. This includes older people who have 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 £410 and £450 per week. Additional charges are made for hairdressing, chiropody, clothing, toiletries, papers, magazines and taxes. Information about the home is made available to prospective residents in the Statement of Purpose and Service User’s Guide. Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Key Inspection site visit covered a period of 11.75 hours and covered all key standards. The registered provider, manager, staff, residents, health care professionals and some relatives were available during the site visit and were spoken with. Their comments and contributions received were helpful in assisting the Inspector to prepare the report. As part of the site visit, a tour of the premises took place. Personal care records and other official records within the home were inspected. The information included in the annual quality assurance assessment form (AQAA) which had been submitted to the Commission for Social Care Inspection, was also used in compiling the inspection report. This form gives homes the opportunity of recording what they do well, what they could do better, what has improved as well as future plans for improving the service. Matters relating to the outcome of this inspection were discussed with the registered provider and manager. Full opportunity was given for discussion and/or clarification both during and at the end of the site visit. What the service does well: The registered provider together with the registered manager are committed in promoting high quality care and ongoing improvements have taken place in the home since the last inspection. There is a warm and homely atmosphere and the staff team are motivated in providing improved quality of personalised care to meet the needs, choices and aspirations of residents. The senior management group work and communicate well together with delegation of specific responsibilities taking place. Residents spoken with were complimentary about the staff who were said to be good and responsive in meeting care needs. Positive comments were also made to say that staff consulted residents regarding the most appropriate type of care and support needed. Relatives spoken with stated that from their experience, there had been good examples of personal care that had improved the well-being of residents. A health care professional visiting the home, mentioned that staff were good and co-operative and that a good working relationship existed between them. Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 6 The registered provider takes a keen interest in the home and regularly visits to give ongoing support to the manager and staff team. One resident stated that having mentioned a concern to the Registered Provider, this was promptly looked into and dealt with. There is very little staff turnover and appropriate training is provided to ensure staff have the improved skills necessary to care and support for the residents who have a variety of needs. What has improved since the last inspection? What they could do better: Although the Statement of Purpose has been updated, additional information should be included to show how the home provides facilities and provides social stimulation to all residents including those who require dementia care. Improvements to the information provided in individual care plans should be completed and risk assessments included as part of this process where appropriate. Staff should be given additional training in these areas. Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 7 The topics and areas covered as part of the induction training for new staff, needs to be reviewed and updated. The home is already taking steps to implement this. Bathroom and toilet areas need refurbishing and the registered provider is including this as part of the ongoing programme for structural improvements in the home. A quality assurance system needs to be introduced to establish the effectiveness of the service provided by the home. This should include the views of users of the service such as residents, relatives, staff and other health care professionals. The feedback received should be used to contribute to improving the service provided by the home and any ongoing development plan. 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.V354207.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 (standard 6 is not applicable in this home) People who use the service experience good quality outcomes in this area. Residents can expect to have their care needs assessed by the home to ensure that the proposed placement is suitable. This judgment has been made using available evidence including a visit to the service. EVIDENCE: Information about the home is available in the updated Statement of Purpose and Service User’s Guide. Copies of the Service User’s Guide had been given to residents and were available in their rooms. These documents had clear information and details about the service provided. When next updated, more information should be provided in the Statement of Purpose to show how the specific needs of residents requiring dementia care are met and provided for by the home. Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 10 A sample check was made of pre-admission assessment information for some of the residents recently admitted to the home. The homes own assessment form included current medical conditions, carer and family involvement, other social contacts, religious and cultural needs as well as physical needs and wellbeing. In addition, information regarding personality, hobbies and communication was also included. When considering admissions from hospital, the manager visits the prospective resident as part of the assessment procedure and the home is provided with additional information regarding identified needs and the support required. Where possible, the manager discusses the placement with the prospective resident and relatives as well as senior staff regarding the suitability of the placement and whether the home is able to meet the assessed needs. Potential residents are also given the opportunity of visiting Melrose House as part of the pre-assessment process. A welcome letter has now been introduced which is sent out when agreement has been reached that the home is able to meet the needs of new residents. The home has now begun to offer step down where the hospital place residents for respite and rehabilitation following hospitalisation to enable them to return home. At the time of inspection, one resident was admitted through this arrangement and is likely to return home shortly. Information, which included a photograph as well as the named key worker, was included in the personal client details of the care records. Information relating to local doctors and social workers was documented. Medication profile and activities of daily living had been completed. It was evident that they had been appropriately assessed to ensure the home could meet their needs. This information had been used to create care plans which are updated to take account of any changes. A relative spoken with during the inspection was positive regarding staff who were described as caring and supportive since the admission of their family member four weeks ago. The relative went on to explain that since being admitted, this resident had not had any falls and had received good personal care from staff. The relative also appreciated that this was a period of assessment and that it had been explained to them that a review would need to take place to determine the most suitable type of residential care that could be made available to meet the identified needs. Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experienced adequate quality outcomes in this area. Residents cannot expect to have a plan of care drawn up by the home that details all their assessed needs and the management of risk but can expect to receive the services of health care professions. Residents can expect the home to manage the administration of medication in accordance with accepted good practice guidelines. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Time was spent in the lounge/dining areas and staff were observed to be interacting positively with residents with an understanding of their needs and being able to communicate effectively. A sample of five sets of personal care records were inspected which included care plans, risk assessments, reviews and daily record sheets. Since the last inspection, improvements had been Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 12 made in the setting out and recording of information shown on a number of care plans. Information is now more personalised and written for individual residents rather than having pre-printed headings. The registered provider had previously acknowledged in the AQAA self-assessment form that more work needs to be done on care plans to make them more personalised. From some of the samples inspected, the problem/need, aim and action required had been recorded together with daily reports. These included identified needs such as washing and dressing, toileting, mobility, eating and drinking. In one case, a pressure sore assessment had been assessed at high risk but there was no care plan to show how this area of need should be managed by care staff and the involvement of other health care professionals. In another sample inspected, information had been recorded on the care plan, which related to an incident involving two residents but had not identified clearly the specific need or how this should be managed. There were other examples of where care plans had been clearly completed with specific information recorded. This included details as to how to respond to verbally abusive behaviour. Reviews which had taken place were clearly documented. In some of the personal records inspected, care plans have been completed but these had not always been accompanied by risk assessments. The process of updating care plans and risk assessments needs to be completed to give care staff clear information as to identified needs and how these should be managed and by whom. It was also noted that there were some gaps of three or four days in completing some of the daily log reports. Since the last inspection, the manager has introduced key worker task forms for staff to use. Some of the residents spoken with confirmed that staff are good at providing personal care according to their needs. Staff were observed providing nail care for residents as well as other personal care, which included taking residents for bathing and toileting. Where residents required the assistance of wheelchairs, these were being manoeuvred in accordance with safe practice. Personal care records included details where visits and treatment had been provided by other health care professions. Emergency hospital admission forms have also now been prepared which include relevant and essential information to accompany residents when necessary. The manager stated that there was a good working professional relationship with doctors and community nurses who attended as required. One of the active daily living advisers from the local hospital was also spoken with during the inspection. Their role is to assist staff/residents with mobility issues. This is in conjunction with the Step down arrangement where the Primary Care Trust provide funding for certain beds in the home to enable people to be assessed and cared for on a temporary basis, before returning to their own homes or moving into residential accommodation. Positive comments were made about the staff who were said to be caring and cooperative. Other residents spoken with said that they liked the home and staff look after them well. One relative spoken with was positive about the assistance, support and care provided by staff. The management were said to Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 13 be responsive and helpful where relatives had raised concerns. Other positive comments were made by relatives indicating that the health and well-being of residents in the home, had improved since being admitted. Since the last inspection, security arrangements had been improved to the main entrance door by installing a key pad system. A check was made of the medication administrative arrangements in the home. These records included photographs, which had been attached to individual medication administrative records for clearly identifying residents, details of floor level in the home and room number. Written confirmation available confirmed changes to medication, which had been authorised by local doctors. Tablets were clearly labelled and the medication trolley was secure in lockable storage when not in use. From sample checks made, some PRN, (to be taken as required) medication did not have protocols in place to enable staff to be clear of what symptoms should be identified before administering this medication. Some of the medication did not have clear and precise dosage instructions but only to be taken as directed and doctors must be requested to include clear dosage instructions in prescriptions issued. One of the staff spoken with mentioned that they were currently on a medication course where the tutor from the college comes into the home each week for a twelve-week period. Staff are expected to complete workbooks for this course. Training records stated that eleven staff had completed this course. Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People use the service experienced adequate quality outcomes in this area. Residents can expect to receive a balanced diet and assisted in maintaining family/friend/community contact. Residents cannot always be assured of a meaningful activities/recreational programme that meets their needs and interests. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Records were available of indoor social activities which taken place and the residents who had been involved. These included card games, quizzes and armchair exercises. Since the last inspection, the variety of activities available as increased and a pantomime has been planned to which relatives are to be invited with staff participating in the pantomime. Song and dance entertainers have visited the home. The manager stated that she is encouraging staff to spend more time talking to residents about their family backgrounds and past experiences. Staff rotas have been re-arranged to enable specific care staff to go with residents to the local shops and park, which are situated near to the Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 15 home. On these occasions, extra staff come on duty to ensure there is adequate cover. Some family members also take an interest and like to be involved. Information included in the AQAA self-assessment form, indicates that children from the nursery next to the home visit and the residents enjoy seeing them. Other comments included in the AQAA form state that more work has been completed in gathering details of the social history of residents and family background. This is to give staff a greater awareness and knowledge of the people they are caring for in the home. A number of residents in the home require dementia care and others experience various degrees of confusion. Some of the staff have attended training in dementia care and social activities need to be arranged to meet this area of need. Social stimulation should include some form of reminiscence and occupational activity as this is important to promote improved quality life experiences for residents. These needs should be assessed on an individual basis to ensure that different social backgrounds and interests are taken into consideration. The meals provided reflected the preferences and individual choices of residents. During lunchtime, staff were observed assisting residents as required which included providing an alternative meal as requested by one of the residents. The meals provided were nutritious with sufficient portions. The majority of residents spoken with confirmed that the quality of food is good and well prepared but one comment was made that sometimes meals were not as hot as they could be when served. Residents stated that they had roast beef the previous day and on the day of inspection, shepherds pie was the main meal as well as other alternatives, which were served. They also confirmed that they are consulted about changes to the menu and the alternatives, which are available. An up-to-date menu was displayed in the dining room. However, as noted at the last inspection, menus need to be made available in a format that meets residents’ needs. A new cook has been appointed since the last inspection and overall, improvements have been made in the variety of meals available and presentation. The Inspector was advised that menus are discussed with residents by senior staff. The cook has also recently completed a food hygiene course and records were also available showing meat, fridge and freezer temperatures. Records of meals actually selected and provided were also available. The cook was aware of the diabetic needs of residents and appropriate food was being provided. Melrose House DS0000066956.V354207.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 and 18 People use the service experience good quality outcomes in this area. Residents can expect to have their complaints taken seriously and be assured that they will be protected by the home’s safeguarding adults from harm procedures. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The complaints procedure is set out in the Service User’s Guide and a copy of this document is given to all residents. No complaints had been recorded since the last inspection. Where concerns are brought to the attention of the management team, these are dealt with as they arise rather than having issues develop to the point where the official complaints procedure needs to be instigated. Where compliments had been made of the service, these are also recorded. The AQAA self-assessment form identifies that improvements could be made to include a complaints folder to show that complaints are dealt with in an appropriate way. This would include information as to the main issue of complaint, what the home did to resolve it and the time it took to investigate and bring about change. Residents and relatives spoken with, were confident and assured that the registered provider and management team are approachable regarding any complaints or issues of concern that they may have and that these would be dealt with. Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 17 Policies and procedures on safeguarding adults from harm were in place and the manager had arranged to attend a special course on ’safeguarding’ the next week following this site visit. Although other staff had attended training, the manager stated that arrangements are being made for this to be updated in the near future. Some of the staff spoken with had an awareness of the home’s safeguarding adults from harm reporting procedures but this procedure and the role of the local authority Adult Protection Unit needs to be explained to give greater understanding about issues of this nature and how they are dealt with. Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 18 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): 19,21,24,25 and 26 People who use the service experience good quality outcomes in this area. Residents can expect to live in a clean and comfortable environment. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A number of improvements have taken place in the home since the last inspection including the provision of new carpets in the lounges, dining room and some bedrooms. Other improvements have taken place in the kitchen area and the exterior of the building has been repainted. Plans are being made to refurbish and upgrade the bathrooms and toilets. This includes adapting the existing ground floor bathroom into a walk in shower room, which will be suitable for wheelchair dependent residents. A tour of the building took place and photographs with the names of residents have been affixed to doors to assist residents in identifying their bedrooms. Pictorial Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 19 symbols were also available to identify toilet areas. Bedrooms had been personalised with items and possessions reflecting the individual tastes of residents. Ornaments, books and family photographs were on display. Some of the redecoration included one of the bedrooms, which had remained unpainted at the last inspection. One of the stairways from the second to the first-floor was poorly lit and could pose a risk to residents should they use this area. This was drawn to the attention of the Registered Provider who undertook to remedy this and provide additional lighting. Liquid soap and paper towel dispensers were available throughout the building as well as disposable gloves and aprons with appropriate disposal facilities. Staff have an awareness of infection control procedures and whilst residents were having lunch in the dining room, a member of staff was observed using this opportunity to be cleaning one of the lounges. The Inspector was advised that there is a weekly cleaning programme in place, which includes equipment and furniture. Staff spoken with, had an awareness of the control of substances hazardous to health (COSHH Regulations) and infection control procedures. Cleaning materials were kept in secure lockable storage. In their AQAA self-assessment form, it has been acknowledged that the ongoing maintenance programme for rooms, corridors, dining room and bathrooms could be improved. Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 20 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): 27,28,29 and 30 People who use the service experience good quality outcomes in this area. Residents can expect to be cared for by suitable numbers of staff on each shift, which meets their needs. Residents can be assured that records will be able to demonstrate that the home has followed robust recruitment and employment procedures. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Since the last inspection, a new manager who is registered with the Commission, has been appointed. In addition, the normal provision of rostered staff includes two assistant managers who cover different shifts but they also overlap and work together for certain hours during the week. The rota also allows for one of the assistant managers to cover different evenings. This has improved the overall supervision of care staff during the waking day and helps to provide continuity of practice. There are also three care assistants on each shift up until 10 p.m. each evening. Night cover is provided by three care workers on awake duty. The staff team includes both male and female carers and issues of dignity were discussed with the manager relating to the opportunity for residents to express their preferences regarding male or female staff to provide personal and intimate care. Residents, or their representative, Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 21 should be asked if they have a preference and their responses recorded in their care plan. It is important that the home identifies any potential risks which could occur and that appropriate action is taken to ensure the well-being of both residents and the staff team is protected. Since the last inspection, a permanent cook has been appointed to cover Mondays to Fridays and a part-time cook has been appointed to cover weekends. There is also domestic cover five days a week from 8 a.m. until 2 p.m. and additional domestic cover for a further three days per week is shortly to be introduced. Maintenance duties in the home are covered by a separate member of staff from 9 a.m. until 3 p.m. Staff were observed to be interacting appropriately and sensitively with residents as well as having a clearer understanding of their roles and responsibilities. The provision of identified catering staff and kitchen assistants to help prepare breakfasts and lunches, has helped to release care staff to spend more time with residents. The assistant managers are now both able to focus their time on getting alongside care staff to provide supervision and support. Both relatives and residents spoken with were positive regarding the personal care and support provided by staff. When asked about staffing levels, residents spoken with felt that there were sufficient staff in the home at the present time. A sample check was made of the homes recruitment records. One new member of staff had been recruited since the last inspection. Checks completed showed that Criminal Record Bureau checks, application forms, references and proof of identification including photograph were in place. Where final clearance is awaited for CRB clearance, the manager ensures that staff concerned work under constant supervision and P.O.V.A. First checks are made prior to them starting work. This is a means of ensuring there are no immediate concerns which will prevent staff working with vulnerable adults prior to the full CRB check having been completed. When agency staff are required to work in the home, confirmation of recruitment procedures carried out by the agency concerned is requested by the home. Staff spoken with confirmed that they had completed various training courses including dementia care, medication as well as recent updates in food hygiene. Training records were available which included the names of staff attending first aid, moving and handling, health and safety and one of the assistant managers had recently completed a Training the Trainers course on moving and handling techniques. Plans have also been made for some of the staff to attend updated training for safeguarding adults from harm. The manager is also aware that staff need additional training on care planning and risk assessing which is to take place. As mentioned in previous reports, staff should receive training to give them a greater awareness and understanding of caring for residents with health conditions such as diabetes and Parkinsons disease. The manager has also acknowledged that the induction training Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 22 programme requires updating with proper documentation to evidence how new staff are inducted into their jobs together with topics covered. At the time of this inspection, just under 50 of the care staff had completed National Vocational Qualification Levels 2 or 3 and a further member of staff is currently studying Level 2 of the N.V.Q. Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 23 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 and 38 People who use the service experience good quality outcomes in this area. Residents can expect to live and be supported in a home where the management and administration of the service is good. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The manager has considerable experience and has obtained the National Vocational Qualification Level 4 Registered Manager’s Award. Since being appointed in July 2007, the manager has also attended a seminar on the new Mental Capacity Act. The registered provider visits the home frequently during the week and is in regular contact with the manager where a good working relationship exists. Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 24 The manager has instigated a number of improvements in the home and has been focused on addressing the requirements and working through the improvement plan that was requested by the Commission. The staffing structure together with roles and responsibilities have been clarified with additional staff being appointed where required. One member of staff commented that things are much better organised with issues being identified that require attention as well as the manager giving support to the staff team. Staff confirmed that one-to-one supervision now regularly takes place, training issues are being addressed and care plans are being updated to include more written information. The manager has also set up three monthly reviews to which relatives are invited together with the resident and staff key worker. Staff have responded positively to being more involved in completing care plans and the manager takes responsibility, together with the assistant managers, for overseeing that these contain relevant and updated information. Policies and procedures for the home are also in the process of being reviewed and updated. New local policies have been introduced covering personal issues, smoking in the home as well as wheelchairs and their safe use. Risk assessments for a safe working environment were in place that included fire doors and alarm system failure, hoists, the lift and electrical equipment. Risk assessments had also been drawn up for safety in the kitchen that were completed in August 2007. Food hygiene procedures and cleaning rotas in the kitchen had been dated and signed which included evidence of where kitchen equipment had been maintained. Evidence of maintenance checks and servicing certificates were available which included fire alarms, emergency lighting and a fire risk assessment, which had been completed in October 2007. Safety certificates for electrical wiring, gas services and maintenance of the lift were also available. Records of hot water temperatures were available which had been checked monthly and monitored for safety. Where temperatures were above the recommended safety reading, thermostatic controls had been adjusted. Records of legionella water checks were also in place. The manager is arranging for the portable appliance testing to take place shortly. Since the last inspection, improvements have been made in providing security and safety for residents by installing a keypad system to the main entrance. At the time of the inspection, the home only had responsibility for the personal allowances for two of the residents. Records of transactions were available which had been properly signed for and documented. The relatives or representatives of other residents are invoiced periodically for additional items paid for by the home. The registered provider and manager are actively looking for ways to improve the quality of the service and life experience for residents. A relatives forum Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 25 has been arranged to take place shortly which will include questionnaires for people to give their comments on the service provided by the home. A systematic quality assurance system needs to be introduced to include the opinions of residents, relatives and other health care professionals who are involved with the service. This gives an opportunity to prepare an action/development plan with timescales to bring about improvements suggested. It is acknowledged in the AQAA self-assessment form that there is a need to ensure that the residents and the needs of staff are the number one priority and this can only be achieved by listening to what people have to say about the service. The manager was advised to obtain the most recent version of the Care Homes Regulations 2001 which incorporate the latest amendments to legislation up to and including September 2006. Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 3 Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 13(4) Requirement Care plans must continue to be updated after consultation with the service user or representative as to how the service user’s needs in respect of health and welfare are to be met. This must include risk assessments to prevent unnecessary risks to the health or safety of service users, which must be identified and so far as possible, eliminated. This is to ensure staff are fully aware of identified needs and how these can be safely and consistently met. The previous timescale of 01/07/07 has not been achieved in full. Suitable facilities and services must be provided to all residents, including those who have dementia, cognitive or sensory needs by consulting with service users about their social interests. Arrangements must be made to enable them to engage and interact in relevant, DS0000066956.V354207.R01.S.doc Timescale for action 15/01/08 2. OP12 16(2) (m) & (n) 01/02/08 Melrose House Version 5.2 Page 28 meaningful and stimulating occupational activities. This is to ensure that residents are given every opportunity of experiencing a quality of life, which brings fulfilment. The previous timescale of 01/07/07 has not been achieved in full. People who are employed to 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. A system must be established and maintained for evaluating the quality of the services provided by the care home. This is to ensure that peoples’ views/suggestions are taken into consideration for making improvements to the service. The previous timescale of 01/07/07 has not been achieved. 3. OP30 18(1) © 31/01/08 4. OP33 24 01/03/08 Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 29 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 OP1 Good Practice Recommendations The Statement of Purpose should include more details of how the home provides for the needs of people who require dementia care and any special facilities available for this purpose. It is recommended that the pre-admission assessment form be redesigned so that more space is available to record all necessary information for prospective residents. To improve the practices for safe medication of medicines, arrangements should be made for local doctors to give clear dosage instructions and protocols should be prepared by the home for PRN (to be taken as required) medication. Arrangements should be made to improve the physical design and layout of the premises to meet the needs of all residents living in the home by continuing to develop appropriate signage and orientation symbols. The menu should be written in larger print that would be easier for residents to see. All staff should be made aware of the role of the Adult Protection Unit within Social Services in dealing with allegations of abuse to vulnerable adults. Arrangements should be made for staff to have a greater awareness of caring for residents with health conditions such as diabetes and Parkinson’s disease, including possible side affects. 3. 4. OP3 OP9 5. OP12 6. 7. 8. OP15 OP18 OP30 Melrose House DS0000066956.V354207.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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.V354207.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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