Inspection on 23/04/08 for Melrose Residential Home

This inspection was carried out on 23rd April 2008.

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 Residential Home 19/11/08

Melrose Residential Home 26/04/07

Melrose Residential Home 11/05/06

Melrose Residential Home 04/01/06

Melrose Residential Home 26/04/05

Melrose Residential Home 12/10/04

Melrose Residential Home 01/06/04

Melrose Residential Home 24/02/04

Similar services:

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

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

CARE HOMES FOR OLDER PEOPLE Melrose Residential Home 50 Moss Lane Leyland Preston Lancashire PR25 4SH Lead Inspector Mrs Pat White Key Unannounced Inspection 23rd April 2008 10:45 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.V360125.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 Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Melrose Residential Home Address 50 Moss Lane Leyland Preston Lancashire PR25 4SH 01772 434638 F/P 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 Vacant Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability (1) of places Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered in the category Old Age, not falling into any other category (OP) for 25 persons, and one named person in the category of Physical Disability (PD). The total numbers in the home are not to exceed 26 Date of last inspection 26th April 2007 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. There are garden areas at the front and the back of the house grounds and parking facilities at the front. The home has a Statement of Purpose and Service User Guide providing information about the care provided, the qualifications and experience of the owner and staff and the services residents can expect if they choose to live at the home. A copy of the Service User Guide is issued to all residents and their relatives/representatives on admission. The fees from 1st April 2008 will range from £329 to £392 per week for care and accommodation. Additional charges are made for such things as hairdressing, papers and private chiropody. Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 Star. This means that people who use the service experience poor outcomes. This inspection site visit to Melrose was carried out on the 23rd April 2008. The site visit was part of an inspection to determine an overall assessment on the quality of the services provided by the home (see above). This included checking important areas of life in the home that should be checked against the National Minimum Standards for Older People, and checking the progress made on the matters that needed improving from the previous key inspection. The inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents’ care records and other documents and discussion with the acting manager and owner. Six residents spoken with gave their views on the home. In addition survey questionnaires from the Commission were sent to residents, relatives and staff asking them for their opinion of the home. At the time of writing this report only 6 residents had returned completed questionnaires. Some of the views expressed in these questionnaires are included in the report. In addition the home provided the Commission with written information about the residents, staff and services provided, and some of this is also included in the report. What the service does well: Residents said they were happy living in the home and felt that they received the care that they needed. Comments included, “the staff are very good ”, “it’s good in here” and “I am quite happy here at Melrose”. In the questionnaires one said “ Melrose provides comfort care and a very homely environment for its residents and is to be congratulated for the genuinely warm relationships between providers of care and residents”. Relatives spoken with also felt that people were well looked after. One said that he visited the home a lot and would know if things weren’t right. Another relative said that staff were kind and caring and that there was a good staff team at Melrose. Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 6 There is a relaxed friendly atmosphere in the home and residents are happy with the care they receive. Residents said they are happy with the meals they receive and were able to have some say in food provided. Melrose has a good staff team who work well together and is relatively stable. A large proportion of staff have undertaken the right qualifications for working in a care home and this should help them look after the residents properly. The home was clean and there were no unpleasant odours and this helped to make a pleasant environment for the residents. The residents’ money was managed safely and good records were kept of all the money received and spent on residents’ behalf. What has improved since the last inspection? What they could do better: All people should have their needs properly assessed before they are admitted to the home so that a decision can be made about whether or not the home can meet their needs. This assessment should include a mental health assessment so that people’s mental health needs are clearly identified and a decision can be made about whether the home is suitable to meet those specific needs. Emergency and unplanned admissions should be avoided where possible so that there is time to carry out an assessment of needs (see above). All residents should have a written care plan including those having respite care so that staff have written information about how to look after people and the assistance that they need. The care plans could be further improved and updated when the care needs of people change, and also should give clearer guidance to staff about how to look after some people with mental health needs. The medication procedures followed should be improved and made safer so that residents receive all the medication prescribed and that accurate Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 7 information/instructions are written down so that staff know what to give and when. Accurate records should also be kept of medication received into the home so that medication can be properly traced and checked. This will help to identify and eliminate mistakes. The home needs to provide more activities to the residents and also make sure that they provide specific activities to individuals with specific needs such as those with dementia. Some residents and relatives felt that there were not enough suitable activities. The manager and owners should make sure that the correct procedures are followed according to Local and Government guidance if there are any suspicions or allegations of abuse. Some other aspects of the premises and furnishings could be improved. Some beds and bedding needed replacing. The carpet in the lounges should be made safer as the joins were becoming a safety hazard. A lounge window needed a curtain or a blind and the dryer in the laundry had not been working for some time. The owners must ensure that they respond to the request for repairs and renewals within a satisfactory timescale to ensure the facilities remain safe and the home is a pleasant place in which to live. When recruiting new members of staff to work in the home the manager should make sure that the references sought and accepted are in accordance with good practice to ensure that a genuine view of applicants’ work performance and character is given. The staff training programme could be further improved. Staff needed updated training in moving and handling and first aid so that they could provide care in the safest way. Also if the home continues to accommodate older people with mental health problems staff should receive specific training in these matters. The manager should make sure that the Commission is informed of all incidents that affect the health and welfare of the residents such as falls that require treatment, and deaths, so that the Commission can monitor such events. 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 Residential Home DS0000039455.V360125.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 Residential Home DS0000039455.V360125.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, 3, 4 & 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The admission procedures did not help prospective residents, relatives and staff understand people’s needs and whether or not the home would be able to meet these needs. EVIDENCE: The service user guide was seen in the residents’ bedrooms. This included useful information about the home, but should be reviewed and updated as services and facilities change. It should also include a copy of the most recent inspection report. In the questionnaire surveys most of the residents said that they had enough information about the home before moving in to help them make a decision. All the six residents completing questionnaires said that they had a contract and therefore had the home’s terms and conditions of residency. Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 10 The viewing of the records and information from the acting manager showed that some residents had not been admitted to the home in a planned way and it was not clear if the home was meeting their needs. These residents and or relatives had not been able to assess the home’s facilities and services prior to admission. One resident had recently been admitted as an “emergency” for a few weeks respite care. For this resident neither an in house assessment or a social work assessment had been undertaken. There was no written information about this person’s needs, which were associated with mental health problems rather than physical personal care needs. Two other residents had been admitted to the home on the same day as assessments had been undertaken and one of these residents also had mental health needs that had not been satisfactorily assessed. It was therefore not clear whether or not the home was meeting these needs as the home is not registered to accommodate people who have a mental disorder. Melrose Residential Home DS0000039455.V360125.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 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all residents had a written care plan, and not all care plans included sufficient up todate information about all aspects of Health, Personal and Social Care to assist staff in the delivery of consistent care. Residents’ medication was not always given as prescribed and therefore residents could be at risk. The residents right to privacy was in general respected but some aspects could be improved. EVIDENCE: One resident who was recently admitted to the home did not have a care plan (see above section). On the care plans viewed there was a good level of useful information in some aspects of health and personal care needs, including some preferences of residents. However these care plans had not been fully reviewed or updated for a number of years. One resident’s needs had changed considerably but the care plan viewed had not been updated with respect to Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 12 vulnerability to pressure areas and the need for bed wedges. There was no risk assessment to demonstrate that this was the most appropriate protection from falling out of bed. There was little information about people’s social history and leisure interests. The care plan for another resident did not sufficiently address mental health needs and as stated above it was not clear whether or not these needs were understood. Some other risk assessments including nutrition assessments also needed reviewing and updating. Other records however showed that residents received the health care they needed, including contact with the mental health services. There were records of visits by General Practitioners, opticians and chiropodists. Residents’ weights were monitored and the district nurses attended as needed. However wheelchairs were being used without foot rests and some residents may have been at risk from foot and leg injuries being moved in this way. There were no risk assessments to support this practice. In the questionnaires returned to the Commission, four out of 6 residents said that they “always” received the care and support needed and two said “usually”. Only one said that staff were “always” available when needed and 5 said “usually”. However all were satisfied that they received the medical support they needed. There were policies and procedures for the administration of medication but these did not cover ordering medication, leave/visits, use of oxygen, “when required” medication and verbal changes. Medication was stored safely in a trolley and there was an appropriate cupboard to store controlled drugs. Staff administering medication had undertaken satisfactory training and there was evidence that General Practitioners instigated medication reviews. However the competence of staff in the handling of medicines was not being formally assessed nor was a system of internal auditing being implemented. The acting manager said that there was an auditing system in place but that it was not being used. Also prescriptions were not being checked prior to being passed to the pharmacist for dispensing so errors at this stage were not being identified. Records of three residents were looked at and the following errors were seen: Not all medication received in the home had been recorded accurately. None of the medication for one resident had been booked in for the month prior to the site visit and the strength of some medication had not been recorded. The records for one resident and a count of tablets showed that for a few weeks a medicine was being signed as given but had not been given. There was also insufficient information on the Medication Administration Record (MAR) sheet about when 2 medicines for this resident should be given. The information leaflets about these medicines were also not available in the home so timing of administration could not clarified. Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 13 The MAR of one resident indicated that two different pain killers were prescribed but there was insufficient information and guidance about when these should be given in relation to each other and the resident could have been at risk from taking too many pain killers. It was not clear whether or not both pain killers should be given and whether one was to be administered as “when required”. The medicines of one resident had been changed several times in a short time period and the hand written instructions on the MAR were confusing and unclear with respect to medication that had been “discontinued” and medication that could be administered as “variable dose”. In general the records viewed had a lack of written guidance for “when required” and “variable dose” medication. Most residents spoken with said that staff treated them properly and respectfully, and staff were seen interacting with residents in a positive and pleasant way. In conversation relatives also said that they thought the staff were caring and hard working. However the hairdresser who was in the home at the time of the site visit was using a resident’s bedroom on the ground floor for washing hair, and cutting and setting hair was being done in the lounge. There was a bathroom on the first floor that was for the hairdresser’s use. Staff should ensure that this is used and respect the rights of the residents to privacy. Melrose Residential Home DS0000039455.V360125.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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Daily routines are flexible and respect individual needs and wishes, but there were insufficient interesting and stimulating activities. The food served met the residents’ preferences and was wholesome and nutritious. EVIDENCE: There was general agreement between the residents and the staff that there were insufficient interesting and stimulating activities. Staff said that they didn’t have time to organise activities and with this in mind the owners were considering employing an activities coordinator. There was some information about residents’ leisure interests on the care plans, but this could be developed further to include some useful information about their past lives. In the questionnaires returned to the Commission most residents said there were only “sometimes” suitable activities in the home. One resident said she was bored in the home. Residents said that daily routines were flexible and that they were able to make decisions about when they get up or go to bed. Meal times can be Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 15 flexible and residents have the choice of eating in the dining room or in the privacy of their own rooms. There was a relaxed atmosphere within the home and good interaction between residents and staff was observed. The home has a clear policy regarding visitors and a number of visitors were seen throughout the day all of whom said that they were made welcome in the home. Relatives spoken with indicated that there was a good atmosphere in the home. Menus seen showed that a balanced nutritious diet was offered to residents. Resident’s preferences were clearly recorded and residents told us the food was very good and that 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. Most residents spoken with said that they were satisfied with the food served, and of those who completed the questionnaires three out of six said they “always” liked the meals, and three said “usually”. Melrose Residential Home DS0000039455.V360125.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. The residents and relatives felt that their concerns were taken seriously and concerns and complaints were investigated. The policies and procedures and staff training regarding Adult Safeguarding should help to protect people from abuse but the management need to ensure the correct procedures are followed in the event of a suspicion or allegation of abuse in the home. EVIDENCE: The home had a complaints procedure that was accessible to residents and visitors. Of the residents who completed questionnaires, all apart from one said they knew what to do if they weren’t happy with something. Most relatives who were spoken with also said they knew how to make a complaint but one said they did not. Relatives were generally satisfied about the way their concerns were handled. Records showed that one complaint about the home’s heating had been investigated and resolved, though the complainants had not been informed in writing of the outcome of the investigations. The home’s written policies and procedures to protect residents from abuse were satisfactory, and were generally in accordance with Government guidance. However the acting manager was still unclear about the correct procedures to follow. Minor changes to the procedures were advised to give Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 17 sufficient clarity regarding what to do in the event of an allegation or suspicion of abuse. Staff had undertaken training in the “Protection of Vulnerable Adults” and this should help to protect residents. Melrose Residential Home DS0000039455.V360125.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, 20, 23, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides clean, comfortable and safe accommodation for the residents and there has been some improvement in decoration and repairs. However there is still no adequate repair and maintenance system in place and further repairs and refurbishments were necessary. EVIDENCE: A tour of the premises showed that some of the repairs outstanding at the last inspection had been completed. For example the bathroom with water damage and tiles missing had been restored. Some bedrooms had new bedding and curtains and there was new furniture in the conservatory. All the bedrooms were now being used as single rooms and this was to be a permanent Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 19 arrangement. The building work in one half of the house to create another dining room and 3 en suite bedrooms was nearly completed. All areas of the home were comfortable and the bedrooms, used as single rooms, were spacious and personalised with small items of residents’ own possessions. There were garden areas at the front and the back of the house and the areas at the back would benefit from tidying and development to create a pleasant area for the residents to enjoy. Communal space, comprising of a two - part lounge and a through dining room, was adequate for the residents’ needs. However the kitchen was at the other side of the home from the dining room and staff had to carry food through the home and up and down 5 steps. This means that food could be cold when it arrives at the table and also presents a potential hazard to staff when negotiating the steps whilst carrying food. There was a risk assessment about the hazards associated with these steps but this needed reviewing and updating, and particularly in relation to staff carrying food. There was still no maintenance and renewal plan for the premises and in spite of some improvements there were other matters that needed attention. For example a dryer in the laundry had been broken for about 2 months, and a deep fat fryer in the kitchen had been out of order for about a month. The provider was aware of these. One of the windows in the lounge had no curtain, and the joins in the communal carpets were separating and could present a trip hazard. Some bed bases were damaged and needed replacing. All areas of the home were of a satisfactory state of cleanliness and there were no unpleasant odours. The washing machines had suitable programmes for all types of laundry but as stated above one dryer was not working. Also there were no laundry procedures in the laundry for easy viewing by staff. In the questionnaires residents said that the home was always or usually fresh and clean. Melrose Residential Home DS0000039455.V360125.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers of staff with training and experience provide a good mix of skills to meet residents’ needs but some updated training was needed. Recruitment procedures were sufficient to protect residents from unsuitable staff. EVIDENCE: Staffing levels at the time of the site visit were suitable for meeting the needs of the residents and there was a cook and a cleaner in the home to ensure good standards of cleanliness and meals were maintained. However some relatives and staff said that there was not always enough staff on duty, when staff were off sick and not replaced. There was a relatively low turnover of staff and residents and relatives appreciated the staff team for being caring and hard working. Most staff had the right qualifications for working with older people and 15 out of 16 members of staff had qualifications to at least NVQ level 2. Staff had also completed training in dementia, fire safety with external trainers, medication and adult abuse. Staff spoken with confirmed that they hadn’t undertaken any recent training and that there were no facilities for in house training. Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 21 Only one member of staff had been recruited since the previous key inspection and the records viewed for this person showed that the procedures followed for staff recruitment were in accordance with the Care Homes Regulations. All the necessary checks, such Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks and written references had been completed before this person started work in the home. However one of the references was from a friend, and these are not generally accepted as being the most genuine. This person had previously worked in care and a reference could have been sought from this place of employment. Melrose Residential Home DS0000039455.V360125.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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home needs a qualified and experienced manager who has support from owners to manage the home effectively. Communication between the owners and the staff and the residents is poor. The health and safety of the residents and staff was promoted and the premises were safe. EVIDENCE: There was an acting manager in the home since the registered manager left in 2007. She was not qualified but had experience of working as a senior carer in the home. The owners were in the process of recruiting another manager. The care staff who were spoken to felt the acting manager was approachable and supportive. However the registered provider does not make frequent and Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 23 consistent unannounced visits to the home under Regulation 26 of the Care Homes Regulations and discussion with staff in the home indicated that communication between the home and the registered providers was still poor. Staff meetings every few months have been held to improve communication, but the “manager” of the home still does not have the authority to make the necessary improvements, and funds are not made available when needed for repairs etc. There was still no “development plan” for the home (see section on “Environment”). There was still no regular one to one supervision, as the acting manager had not sufficient time to do this. She was also on call every night and at weekends and it was strongly advised that an “on call” rota be set up so that the acting manager can have some genuine free time. The acting manager said that the owner had sent quality assurance questionnaires to residents, relatives and staff at the end of last year. However there was no report in the home and the acting manager did not know how this would impact on the home so there was no evidence that the views of the residents were acted upon. Checks were made on residents’ spending monies managed by the home and they showed that this was managed safely. Good records were kept, and for those monies checked the amount of money remaining balanced with the amount stated in the records. The information provided by the owners to the Commission prior to the site visit, to assist us with the inspection, was not comprehensively completed. There was minimum information in it, and some sections were left blank particularly those relating to what could be improved. This does not give the Commission the assurance that the registered providers will be committed to making the improvements necessary in the home. The home’s health and safety policies and procedures helped to ensure that the home was a safe place to live and work. Fire equipment, electrical appliances, electrical and gas installations and other equipment in the home had been serviced and maintained appropriately. The hot water temperatures were tested regularly and the records and the spot checks at the time of the site visit showed that they were within a safe range. However staff had not undertaken updated moving and handling training, so it was not clear if they were moving people correctly, and there was not a person with a current first aid qualification on every shift. Fire precautions were satisfactory and staff had completed appropriate fire safety training. However the fire alarms were only tested monthly and this may not be frequently enough to ensure they are in good working order. Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 24 The home was not notifying the Commission of incidents affecting the Health and Welfare of the residents, or when residents had died, so the Commission could not monitor these incidents. Melrose Residential Home DS0000039455.V360125.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 1 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 1 2 X X 3 3 X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 2 X 2 Melrose Residential Home DS0000039455.V360125.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 OP3 OP4 Regulation 14 (1) Requirement Timescale for action 30/05/08 2 OP7 15 (1)(2) All residents, including those on respite care, must be admitted only on the basis of a comprehensive assessment that includes relevant mental health matters. This is so that the needs are understood and the management can make a decision about whether or not the needs can be met in the home. This assessment must be written down so that staff know and understand what people’s needs are. All residents, including those on 30/05/08 respite care, must have a written care plan so that staff have instructions about the care needed. All the care plans must be reviewed and updated in all aspects of health, personal and social care. 3 OP7 15 (1) The care plans must include all matters relating to health, personal and social care, including mental health and information about prevention of DS0000039455.V360125.R01.S.doc 30/05/08 Melrose Residential Home Version 5.2 Page 27 4 OP8 13 (4)(c) 5 OP9 13 (2) 6 OP9 13 (2) 7 OP9 13 (2) 8 OP12 16 (2)(n) 9 OP18 13 (6) pressure areas. (Previous timescale of 31/05/07 not met) Residents must not be moved without the use of foot rests unless there is a risk assessment specific to the individual that shows that it is safer without All medication must be given as prescribed unless there are written instructions from the prescriber. Accurate records must be kept of medication received into the home and administered to residents, and there must be accurate written information/instructions when the General Practitioner changes the medication and the dose. There must be accurate written instructions and guidance for the administration of painkillers so that when two painkillers are prescribed residents are given this medication safely and in the right quantity. There must be suitable activities in the home to suit the individual needs and preferences of the residents. All staff, including the management team, must know what action to take in the event of a suspicion or allegation of abuse. 30/05/08 23/05/08 23/05/08 23/05/08 30/06/08 30/05/08 10 OP19 11 12 OP30 OP31 16(2)(c) & All parts of the home must be in 23 (c) a good state of decorating, furnishing and repair, including beds, bedding, curtains and repairs of appliances. (Previous timescale of 31/05/07 not met) 18 (1) (c) The staff must undertake updated moving and handling training. 26 The registered providers must DS0000039455.V360125.R01.S.doc 31/07/08 31/07/08 30/05/08 Page 28 Melrose Residential Home Version 5.2 13 OP38 37 ensure that there is effective communication between themselves and the home and that the responsible individual makes regular unannounced visits to the home to monitor the services and care and assist in this communication. A copy of the report of these visits must be sent to the Commission The Commission must be notified 23/05/08 of all the incidents that affect the health and welfare of the residents and of all deaths. 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 and Service user Guide should be regularly reviewed and updated as services and facilities change and develop and the Service User Guide should include the summary of the most recent inspection report. Prospective residents and or relatives should be given the opportunity to visit the home to see if it is a suitable place for them There should be written guidance on the MARs according to the prescriber’s instructions about when medication is to be given. There should be clear written information on the MARs regarding when “when required” medication should be given and what dose should be given when the dose is variable. Hairdressing should take place in privacy and not in a bedroom that is occupied or in the lounge. The complainants should be informed in writing of the outcome of the investigations into complaints. The registered provider must ensure there is and effective programme of maintenance and renewal in place and DS0000039455.V360125.R01.S.doc Version 5.2 Page 29 2 3 4 OP5 OP9 OP9 5 6 7 OP10 OP16 OP19 Melrose Residential Home 8 OP19 9 10 OP20 OP33 11 OP33 12 13 14 OP36 OP38 OP38 forward to the CSCI by the date stated The position of the kitchen and the dining room should be reviewed and safety aspects of the current situation should also be assessed to ensure that food is carried as safely as possible through the home. The outside areas should be developed to provide a pleasant area for residents to enjoy. The home’s own quality monitoring assessment report (AQAA) to the Commission should be fully and comprehensively completed and should address all the issues identified for improvement. The registered providers should use the results of the last questionnaire survey to plan services, should ensure the views of the residents are taken into account and should give feedback to those involved. The registered providers should ensure that there are sufficient personnel to undertake regular one to one supervision with care staff. The fire authority should be consulted about the frequency of testing the fire alarms. There should be a person on every shift that has a current first aid qualification. Melrose Residential Home DS0000039455.V360125.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Port Way Preston PR2 2YQ 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. 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