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Inspection on 11/05/06 for Melrose Residential Home

Also see our care home review for Melrose Residential Home for more information

This inspection was carried out on 11th May 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Melrose has a good staff team who work well together as a team, residents spoke well of the care they receive saying that both the manager and staff are very approachable. There comments included, "They are very good here and everything I need is taken care of", "I am very happy with the care I receive, the staff and manager are very good and approachable." "Staff are very kind and good to us". Residents said they are happy with the meals they receive and were able to have some input to formulation of menus in a recent residents meeting. The health care needs of residents are effectively met, systems are in place for recording information and there are checklists to identify any shortfalls in practice.

What has improved since the last inspection?

A new service users guide has been produced which is up to date and has been given to all residents. There has been a tightening up of how nutritional assessments are monitored and the system is now more effective. Two staff have been assigned to looking after residents activities and have put together a programme. A residents meeting has discussed activities and more activities have been provided. A better system to monitor residents personal allowances kept by the home have been improved and monthly checks are now being made. The manager has been working closely with the fire department in producing a fire risk assessment, which is now available. The central heating and hot water system is now working more effectively. The laundry system has been improved and a system put in place to ensure residents receive their laundry back. Work has been completed to improve the laundry floor and books removed from the cellar steps.

CARE HOMES FOR OLDER PEOPLE Melrose Residential Home 50 Moss Lane Leyland Preston Lancashire PR25 4SH Lead Inspector Mr Patrick Rooney Unannounced Inspection 11th May 2006 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 Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 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 Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Melrose Residential Home Address 50 Moss Lane Leyland Preston Lancashire PR25 4SH 01772 434638 01772 434638 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) Mrs Amina Makda Miss Shazmeen Makda Mrs Janet Lesley Turner Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2006 Brief Description of the Service: Melrose is a care home providing personal care and accommodation for up to 26 older people. Nursing care is not provided by the home and the district nursing team undertakes any nursing intervention needed. Melrose is privately owned and is situated close to the town centre of Leyland with all the local amenities. The home provides accommodation on three floors in both shared and single rooms. The majority of the shared rooms have a single occupant. One single room has an en-suite facility. The communal areas are situated on the ground floors and the home has a passenger lift and stair lift. The grounds to the house are small but adequate for the service users to enjoy. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over a seven-hour period. This inspection was the key inspection for the current year as well as focusing on the requirements and recommendations made at the previous inspection in January. At the time of the inspection there were fifteen persons living at the home, one resident was in hospital. During the inspection the inspector spoke to the registered manager, looked at care plans for three residents and discussed their care with them. A further six residents were also spoken to about the care they receive. Nine residents completed and returned questionnaires. Three staff on duty were interviewed separately. In addition, policies, procedures and records were examined. A tour of the whole building was carried out. What the service does well: Melrose has a good staff team who work well together as a team, residents spoke well of the care they receive saying that both the manager and staff are very approachable. There comments included, “They are very good here and everything I need is taken care of”, “I am very happy with the care I receive, the staff and manager are very good and approachable.” “Staff are very kind and good to us”. Residents said they are happy with the meals they receive and were able to have some input to formulation of menus in a recent residents meeting. The health care needs of residents are effectively met, systems are in place for recording information and there are checklists to identify any shortfalls in practice. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: There are continuing problems with regard to the lines of accountability between the registered manager and the owners of the home. While management meetings have been introduced, these do not appear to be effective. Notes of these meetings do not show actions needed and timescales for improvements to be carried out. Consequently there are problems in relation to refurbishment of the home and a consultation process regarding this with residents and staff. The home is in need of a refurbishment programme, which would make the home more environmentally inviting. Another area requiring attention is the availability of budgets for training purposes. Both the previous inspection and this one identified the fact that while there is adult protection procedures in place no training has been provided in this since 2002. There are serious concerns that there is no current electrical safety certificate for the home despite previous requirements being made regarding this. Urgent action is required to rectify this. Recruitment procedures need to be more robust and no staff must take up post before having at least a POVA first check. They should only then be able to work supervised until a full CRB clearance is received. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 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 Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Quality in this outcome group is good Information provided by the home has been reviewed and updated the Statement of purpose and service users guide provides good information about facilities and services provided by the home. Pre admission needs assessments are thorough and care needs clearly identified. EVIDENCE: A new revised service users guide has been produced, this was seen and is relevant to services provided by Melrose and is laid out in a clear and understandable format for residents. During a tour of all residents rooms it was observed that the service user guide has been provided to all residents. Residents spoken to also confirmed that they have received the service users guide. Files of three residents were looked at and these persons were spoken to by the inspector. Iit was shown that initial needs assessments have taken place. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 10 There has been much work carried out on the assessment process and it covers all required aspects. Risk assessments and nutritional assessments have been improved and clearly indicate care required for each resident. An area of improvement discussed with the manager was that some attention could be carried out to develop further information and actions in relation to Social Interests,hobbies,religious and cultural needs. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome group is good. There is a good care planning process in place which provides each resident with a care plan derived from a full needs assessment. There are good processes in place to ensure healthcare needs are met. Policies and procedures are in place to ensure the safe recording and handling of medication however not all staff administering medication have training to do so. Residents right to privacy is upheld by the home. EVIDENCE: The care plans of three residents were looked at and the care they receive these was discussed with them. The care they receive matched their assessments and care plans, including risks and nutritional assessments. Of Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 12 the residents case tracked two had problems with mental health issues, these issues were well understood by staff. Staff spoken to were well informed with problems regarding these conditions and worked hard to ensure these residents feel included and valued. Examination of files and discussion with residents confirmed that health care needs are being met. Visits from health care professionals, including doctors, district nurses and chiropody services are all recorded. There are systems in place for the receipt and safe storage of medication and it was possible to audit medication from receipt to dispensing or return. Medication is stored securely in a locked trolley, which is kept in a locked room. During the inspection it was noticed that not all staff dispensing medication have received suitable training to do this. It was observed that medication was being given to residents in a pot and staff did not ensure it was taken. Residents were able to say that staff showed courtesy and respect in delivering personal care. One resident said, “They are very good here and everything I need is taken care of”, another said, “I am very happy with the care I receive, the staff and manager are very good and approachable.” Another said, “Staff are very kind and good to us”. The inspector observed good interaction between residents and staff and staff spoken to individually showed a good awareness of the need to provide care in a sensitive and caring manner. Privacy is an important issue in the homes philosophy and all staff are required to sign a statement to respect residents privacy. Induction and training records also cover this. There have been improvements to the laundry system since the last inspection and problems previously experienced by residents have been rectified. Unsuitable signs previously seen on a toilet door have been removed. Hairdressing is still carried out in a resident’s room, a more suitable alternative to this should be provided so as to respect the private space of residents concerned. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome group is good. Daily routines are flexible and respect individual’s social, cultural and activity needs. EVIDENCE: Since the last inspection two members of staff have been designated to assist in the organisation of activities. There has been participation by residents in this and a residents meeting was held in January to discuss activities, there was a record of activities was seen during the inspection. These have included outings, bingo, and board games, shopping trips, singers, books and walks. Clergy from different denominations visit the home and church services provided. Residents said that daily routines are flexible to allow them to take part in activities and different church interests. The home has a clear policy regarding visitors and residents told the inspector that all their visitors are made welcome and are provided with refreshments and privacy. A signing in book is provided at the entrance and is signed by visitors. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 14 Residents confirmed that mealtimes and other daily routines may be flexible according to their individual needs. There was a relaxed atmosphere within the home and good interaction between resident and staff was observed. Menus seen showed that a balanced nutritious diet is offered to residents. Resident’s preferences are clearly recorded and residents told the inspector the food is very good and they are offered choices. A meal was observed during the inspection, this was of good standard and well presented, the mealtime was relaxed and assistance given as and when necessary. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome group is adequate. The policies, procedures and training provided by the home were not sufficient to protect residents from potential abuse. Recruitment procedures were not sufficiently robust to protect residents. EVIDENCE: The complaints procedure has been reviewed and includes information about the registered providers, the Commission for Social Care Inspection and the Ombudsman. This available on the homes notice board and is contained in the service users guide, which is in all residents rooms. Residents told the inspector and said they are aware of the complaints procedure. Several of the residents said that they find the manager very approachable and are confident any concerns they raise will be dealt with appropriately. The proprietors have purchased a set of policies and procedures, which include adult protection and whistle blowing, however these need to be made more accessible to staff and training provided. Staff records did not show that any training in adult protection had taken place for some years. On examination of staff records it was noted that one member of staff had begun working at the home before suitable clearances had been obtained. All staff must have had at least a POVA clearance before taking up post and then must work supervised until the full CRB clearance is obtained. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,25 and 26 Quality in this outcome group is poor. While all areas of the home were clean the standard of decoration and maintenance was not of an acceptable standard for residents to live in. EVIDENCE: The inspector toured the whole home both inside and outside. All areas are in need of refurbishment. Paintwork was flaked, commodes are in need of replacement and all curtains are very old. Some curtains were not properly fixed onto the rails. Residents should be consulted about any refurbishment to take place. Benches situated at the front of the building were rotten and were not safe to sit on. These must be removed. The garden area looked uncared for with weeds growing. It was of serious concern that an inspection of the homes electrical system in August 2005 shows a number of areas requiring urgent attention. Consequently the home does not have a current electrical safety certificate. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 17 This work must be carried out as a matter of urgency. A letter has been sent to the registered providers regarding this. A refurbishment plan was required following the previous inspection, this has not yet been provided. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome group is adequate. The numbers of staff with training and experience provide a mix of skills to meet resident’s needs. Training to NVQ2 level is in need of improvement. Recruitment procedures need to be more robust to protect residents. Staff receive a foundation and induction process to ensure they are able to carry out their duties. EVIDENCE: Rotas showed that there is always a good mix of experienced staff on duty to see to the needs of residents in the home. Three staff on duty at the time of the inspection were spoken to individually and all said they were happy working at the home and felt they are supported in this by the manager. Two of these staff have worked at Melrose for some years and the other has worked for five months. A suitable induction programme had been carried out for the new member of staff. Out of 17 members of staff 4 currently are qualified to NVQ2, this is below the recommended 50 . However there are currently five staff doing NVQ2 who Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 19 will shortly bed completing this. Four other members of staff are about to start NVQ2 training. Recruitment procedures are in place to ensure suitability of potential staff members and a checklist is in place to monitor applications. However examination of staff records showed that one member of staff began working in the home without having POVA or CRB clearances. It is required that all new staff must have received at least a POVA first before taking up post and must only work supervised until the full CRB clearance is received. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome group is poor. The lines of accountability between the registered manager and the proprietors are unclear; there is no annual development plan for the home. A staff supervision and appraisal system has been introduced but not fully implemented. Procedures for dealing with resident’s finances are good. Systems to ensure the health and safety of residents need to be more effective. EVIDENCE: The registered manager is qualified and experienced to run a care home and has received further training in adult protection, care of people with dementia Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 21 and the management of medicines. Three care staff who were spoken to separately were happy with their relationship with the manager. They felt that lines of accountability between them and the manager are clear. However in discussion with staff in the home it is still apparent that communication between the home and the registered providers is still poor. While a management meeting has been introduced no action is taken regarding discussions, not decisions or actions are recorded following management meetings. The management meeting minutes should clearly state what was discussed, what actions are necessary and who is responsible for carrying them out, with time scales included. As stated previously there needs to be a refurbishment programme for the home. Currently when things that need replacing or repairing are identified only partial actions are taken to rectify them and there is no consultation with staff or residents with regard to replacement carpets, curtains, or décor. Consequently curtains and carpets do not match and bedding provided does not blend with the colour scheme. It was identified that a number of commodes are in need of replacing; one seen by the inspector had a broken seat, which had nails protruding. The lift door keeps on breaking and is only repaired temporarily. There is still a lack of budgets available to ensure necessary repairs and renovations are carried out. No annual development plan was available at the inspection while there had been a residents survey and a residents meeting held, these had not resulted in a full assessment of how the home was meeting its objectives. However residents had been able to have some input to a review of menus. There are systems in place to ensure any valuable an money kept on behalf of residents are kept safely and good records are maintained of this. The manager has begun a system of supervision and appraisal for staff and records were seen regarding this. Further input is required to ensure staff receive regular individual supervision and records maintained of this. From training records it was seen that there is training in safe working practices and there are policies and procedures in place relating to health and safety. Since the last inspection the manager has been working closely with the fire department in order to produce a fire risk assessment, this is now in order. Following the last two inspections a requirement was made that the five yearly test of the electrical wiring must be completed and a certificate issued confirming safety. While an electrical inspection was carried out on 24/8/05 a certificate of safety has still not been obtained. This is of serious concern as the inspection carried out by an approved contractor identified 16 areas Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 22 requiring urgent attention, 18 areas requiring improvement, 3 areas requiring further investigation and 2 areas that do not comply with current standards. The inspector was told that the emergency lighting was regularly checked, however up to date records of this had not been maintained. To ensure the health and safety of residents and staff in the home these issues require priority attention. Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 2 X 2 Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 24 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 OP18 Regulation 13 (6) Requirement The adult protection policy and procedure must be reviewed and appropriate training be offered to staff members. (Previous timescales not met) All parts of the care home should be kept reasonably decorated. (Previous timescales not met) Repair and maintenance tasks must be attended to promptly and action taken recorded. (Previous timescales not met) A refurbishment plan must be produced for the home. (Previous timescales not met) Timescale for action 31/05/06 2. OP19 23 (2) (d) 31/05/06 3. OP19 23 (2) (b) 31/05/06 4. OP19 23 (2) (b) 31/05/06 5. OP29 18(a)(b) 6. OP33 24 (1) (a) The registered manager must 12/05/06 obtain at least a POVA first clearance prior to any staff taking up post. All staff with POVA first clearance must work supervised until a full CRB clearance is obtained. Residents and other stakeholders 31/05/06 must be consulted about the quality of care provided. DS0000039455.V287262.R01.S.doc Version 5.1 Page 25 Melrose Residential Home (Previous timescales not met) 7. OP33 24 (1) (a) (b) 23 (2) (c) An annual development plan must be produced for the home. (Previous timescales not met) The five yearly test of electrical wiring must be completed and a certificate confirming safety is available for inspection. Action being taken to address this matter to be notified to CSCI by the date indicated. (Previous timescales not met) Emergency lighting must be tested monthly and a record maintained. Action being taken to remedy this shortfall to be notified to CSCI by the date indicated. (Previous timescales not met) 31/05/06 8. OP38 25/05/06 9. OP38 23 (2) (p) 25/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5. Refer to Standard OP9 OP9 OP20 OP28 OP31 Good Practice Recommendations Staff dispensing medication should make sure residents take medication at the same time. Staff dispensing medication should receive accredited training. Garden areas should be made more accessible to residents and gardens tidied up. Benches at the front of the home are rotten and in need of replacement. At least 50 of staff should be qualified to NVQ 2 Notes of the monthly management meeting should be available for inspection. These meetings need to have a more focused structure, which identifies areas needing action recorded with and timescales for improvements to be carried out. DS0000039455.V287262.R01.S.doc Version 5.1 Page 26 Melrose Residential Home 5. OP36 Care staff should receive formal supervision a minimum of six times a year. Alternative hairdressing facilities should be identified. 6. OP10 Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Melrose Residential Home DS0000039455.V287262.R01.S.doc Version 5.1 Page 28 - 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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