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Inspection on 17/03/09 for Melville House Nursing Home

Also see our care home review for Melville House Nursing Home for more information

This inspection was carried out on 17th March 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

The home provides people with comprehensive and informative details of the home. These provide sufficient information for people about the care and services provided by the home. The assessment format used by the home is comprehensive. The assessment is used alongside information received from social services or health care services to assess a person`s needs, before admission to the home. This will make sure the home and residents know that their needs can be met when admitted to the home. Improved care plans provide staff with clear guidance on all aspects of the care needs of people admitted to the home. Relatives and residents said: `They (Staff) look after my X (resident) well I am really happy with the home.` `We are always made welcome and the care is good` `I am happy with the home.` `The staff come and help me when I need it.`

What has improved since the last inspection?

All residents have an up to date care plan outlining the specific support required by staff in order to meet their care needs in the ways that they prefer and require. Records are maintained to monitor a residents food and fluid intake where required so that care can be monitored effectively and the appropriate care provided. At the time of this inspection visit all medicines were available to administer to all residents. Resident wishing to self administer their own medication are risk assessed as able and compliance checks carried out to ensure they safely take their own medicines. An additional and suitable mechanical sluice facility has been fitted in the home, which will help to reduce the risk of cross infection in the home. Thermostatic valves have been fitted to water outlets in resident areas, which include bedrooms and bathrooms/toilets and water temperatures are monitored. This will help to make sure that residents are protected from the risk of being scalded by hot water.

What the care home could do better:

At this inspection one requirement was made related to the management of resident`s personal monies: Appropriate records must be maintained to show how the banking procedures forresident`s monies are operated by the home. This needs to be made clear so there is an effective audit trail available to show how individual interests are apportioned to people`s balances and confirm services and purchases residents have received or had made on their behalf. Reccommendations were also made these include: Appropriate records must be maintained in regard to resident`s money. Records must show what the money was used for and individual receipts kept for items or services purchased on behalf of the resident. Individual costs for all items must be clearly stated. This ensures that the residents` money is spent on items for them and that they are aware of what they are spending. The employment of an activities co-ordinator should be pursued to support activities in the home. This will make sure that staffing levels to provide care are not depleted and ensure that all residents benefit from appropriate social, mental and physical stimulation while continuing to have their health and personal care needs met. Records of meals provided to residents need to be maintained to demonstrate a choice of wholesome and nutritious food is being provided consistently. These also need to show any specialist diets being provided to show residents nutritional needs are being met. The home should make sure that the home is repaired and refurbished to a high standard. This will help to make sure that people are able to live in a comfortable and safe environment that they can call their home. The opinion of people living in the home should be sought and included as far as possible when changes are being made to the home. This will show that their views are considered in plans for the development of their home. The home should make sure that shared bedrooms are appropriately arranged to maintain the privacy of individuals sharing the bedroom. Plans to improve laundry facilities in the home should continue to ensure that staff have a safe and suitable environment in which to work. To support high standards of hygiene in the home and the control of cross infection the cat should not have access to the kitchen in the home.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Melville House Nursing Home 68 - 70 Portland Road Edgbaston Birmingham West Midlands B16 9QU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Yvette Delaney     Date: 1 7 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Melville House Nursing Home 68 - 70 Portland Road Edgbaston Birmingham West Midlands B16 9QU 01214557003 01214549746 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Edgbaston Healthcare Limited Name of registered manager (if applicable) Mr Andrew Beard Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 29 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 29 Dementia (DE) 29 Date of last inspection Brief description of the care home Melville House is a care home providing accommodation for up to 26 residents requiring nursing care. This includes a number of residents who have dementia care needs. The Home is situated in a quiet residential area approximately 4 miles from Care Homes for Older People Page 4 of 30 care home 29 Over 65 0 29 29 0 Brief description of the care home Birmingham City Centre. There is easy access to local amenities. A number of good public transport options are available and there is a bus stop directly outside. The property comprises of two Victorian residences joined by a bridge type construction providing access beneath to the large garden and car parking at the rear of the Home. Limited off road parking is also available to the front of the building, however the access is via a very steep incline and may not be suitable for people with mobility difficulties. There is a range of single and double rooms each with wash hand basin and call bell. There is a range of equipment for moving and handling residents plus a passenger lift in house 70 that gives access to the first floor. There is no lift facility from the ground to the first floor in house 68. The Home provides accommodation for residents from a variety of cultural and ethnic backgrounds and this is reflected in the staff group working in the Home. There are notice boards located throughout the Home displaying information of interest to residents and their visitors and a copy of our last report was on display. Written information about the services and facilities provided was available however details of accommodation fees were not included. This information can be obtained from the home manager. Extra charges are made for newspapers, chiropody, hairdressing and toiletries. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection visit was unannounced. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who use the service and their views of the service provided. The inspection considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The manager for the care home was asked to complete and return an Annual Quality Assurance Assessment (AQAA). The assessment requests further information related to the quality of the service provided by the agency. Some of the information contained within this document has been used in assessing actions taken by the home to meet the care standards. Care Homes for Older People Page 6 of 30 The inspection focused on checking that systems and procedures are in place. Information was gathered from reviewing two staff files and a range of policies and procedures. Discussions with the Manager, Nurses and care staff helped to inform this report. Three residents were case tracked. This involves establishing an individuals experience of living in the care home by meeting, talking or observing them, discussing their care with staff, looking at their care files, and focusing on outcomes. Records relating to the care of the people using the service, training and health and safety were examined. Conversations were held with a number of residents who were able to make active contributions during the inspection visit. Information in this report is also gained from observing interaction between residents, residents and staff and visitors to the home. The manager was asked to give questionnaires to residents and their relatives, which would provide us with additional information on their thoughts of the services provided by the home. What the care home does well: What has improved since the last inspection? What they could do better: At this inspection one requirement was made related to the management of residents personal monies: Appropriate records must be maintained to show how the banking procedures for Care Homes for Older People Page 8 of 30 residents monies are operated by the home. This needs to be made clear so there is an effective audit trail available to show how individual interests are apportioned to peoples balances and confirm services and purchases residents have received or had made on their behalf. Reccommendations were also made these include: Appropriate records must be maintained in regard to residents money. Records must show what the money was used for and individual receipts kept for items or services purchased on behalf of the resident. Individual costs for all items must be clearly stated. This ensures that the residents money is spent on items for them and that they are aware of what they are spending. The employment of an activities co-ordinator should be pursued to support activities in the home. This will make sure that staffing levels to provide care are not depleted and ensure that all residents benefit from appropriate social, mental and physical stimulation while continuing to have their health and personal care needs met. Records of meals provided to residents need to be maintained to demonstrate a choice of wholesome and nutritious food is being provided consistently. These also need to show any specialist diets being provided to show residents nutritional needs are being met. The home should make sure that the home is repaired and refurbished to a high standard. This will help to make sure that people are able to live in a comfortable and safe environment that they can call their home. The opinion of people living in the home should be sought and included as far as possible when changes are being made to the home. This will show that their views are considered in plans for the development of their home. The home should make sure that shared bedrooms are appropriately arranged to maintain the privacy of individuals sharing the bedroom. Plans to improve laundry facilities in the home should continue to ensure that staff have a safe and suitable environment in which to work. To support high standards of hygiene in the home and the control of cross infection the cat should not have access to the kitchen in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Care Homes for Older People Page 10 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has comprehensive information about their services to help people make an informed decision about using the home. People receive a comprehensive assessment of their care needs to ensure that they can be met before offered a place in the home. Evidence: The home has a Statement of Purpose and Service User Guide in place. The documents make sure prospective residents have all the information they need to make an informed choice on whether to stay at the home. Residents who were able to told us that they received information about the home to help them decide whether to move into the home. Three residents were case tracked which involves looking at their records and meeting with the person and their relatives if available to discuss their experience of being admitted and the care they receive. Care Homes for Older People Page 12 of 30 Evidence: All three files contained information from the home and social services, which was comprehensive and showed clearly the care that, would be required on admission. The assessment format used by the home is comprehensive. The assessment is used alongside information received from social services or health care services to assess a persons needs, before admission to the home. Overall residents admitted in the last six months had a pre-admission assessment of their care needs completed before being admitted to the home. The quality of the information is varied and sufficient to be confident that all needs would be met. Information in the assessment form includes who was involved in the assessment, the reason for the assessment, personal details and a persons needs related to their nutrition, mobility, medication and any history of falls. Care Homes for Older People Page 13 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans provide staff with clear guidance on all aspects of residents needs. Medicines in the home are managed safely this will help to make sure current practice maintains the safety of residents. People are treated with respect and their dignity maintained which helps to increase their quality of life. Evidence: The assessments, risk assessments and care plans for three residents were read. It was found that assessments are carried out on admission and for up to about six weeks following admission when a persons care needs are updated. During this time care plans are developed and changed to make sure that all the individual care needs of each resident are fully identified. All care planned is reviewed monthly and any changes are updated on to the written plan of care. Review of care is also carried out six weekly or sooner if there is a change in a persons health. The written care plans told us that staff consider the daily needs of each person. Care plans contained planned action to minimise risk such as breaks in the skin (pressure Care Homes for Older People Page 14 of 30 Evidence: sores) and nutrition. There were no residents with poor nutrition or sore skin at the time of this visit. Care files are organised making them very easy to assess and read. Daily reports are informative but not always dated, timed and signed to provide an appropriate audit and follow a persons care. The nurses were able to discuss the care of the residents and care staff were aware of their social care needs. Residents have access to a GP and other professionals as they need it. Care files contained a record of visits and their outcome. Clear records are made of any outpatient appointments and the support given to ensure that they can attend. For more complex needs such as people with deteriorated mental health problems, care plans were detailed and actions stated were carried out. Staff were seen using moving and handling equipment properly and explained their action to each resident in a quiet and sensitive manner. Three residents medication and charts were looked at together with their care plans and daily records. The medication fridge was clean and had the appropriate medications stored in it. Eye drops and creams and lotions were dated when these had been opened, this is good practice. The temperature of the fridge is recorded daily records are within normal limits, which will help to maintain the stability of medicines stored in it. Storage of medicines was good. All medicines were held in locked cabinets within a locked room. All the relevant details had been recorded on Medication Administration Records (MAR) charts. Audits of the medicines and charts indicated that all the medicines had been administered as prescribed at all times. Audits of the management of medication had been carried out and any concerns or reasons for nonadministration recorded. Residents who are assessed as able are fully encouraged to self administer their own medication. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle people experience in the home needs to improve to show that proactive methods are used to provide meaningful stimulation for people living in the home and considers their preferences. Residents benefit from a nutritious and varied diet. Evidence: Information in the AQAA tells us that weekly activities are organised for people living in the home through Timeless Partnership. Residents are consulted on the activities they want to get involved in and records are maintained to show their involvement. However individual activity records examined did not reflect residents personal interest or reflect the activities planned for that day. Written information states watched TV, resting or sitting in lounge. The activity schedule on the wall in the home for the week of 16 March 2009 showed the following activities were planned for the week reminiscence, floor games, arts and crafts, flower arranging, card games, film nights based on residents personal choice and that residents birthdays are celebrated. Care plans contain a section on social activities for each resident and list interests, hobbies and things they like to do now so that staff can support them in these. It was not clear from social activity information on display that these preferences had been Care Homes for Older People Page 16 of 30 Evidence: fully considered to form part of the social activities provided. It was also not clear that outside visits are regularly planned and take place. No activities were seen to take place in the home on the day of the visit. Staff were observed to sit with residents and have a conversation with them in between their work. Religious services can be provided at the home, staff said that arrangements are however made according to the requests of residents. It was evident that residents are able to make some choice about their care and services and this choice was reflected in care files. The menus showed the meals served during each day but only one choice was listed. The cook explained that residents are offered a choice each day and this is done in the morning. The choices could not be evidenced from menus in place. The home is required to keep records of meals provided to residents to demonstrate a wholesome and nutritious diet is being provided consistently. Residents told us that they enjoyed their meals. On the day of inspection the meal for the evening was planned to celebrate St Patricks Day. The meal was boiled bacon and cabbage and Guinness for those that wanted it. Residents were assisted by staff to eat as required in a sensitive and caring manner. Residents in the lounge on the first floor were observed to enjoy the evening. The home provides residents with three lounge/dining rooms. Residents were currently using two of the lounge/dining rooms while redecoration and refurbishment of the home is carried out. The lounge/dining rooms on the ground floor has been decorated to provide a comfortable atmosphere in which to have lunch or sit and be sociable. However the lounge area on the first floor of the home did not present a homely area for residents. Tables were not nicely laid and the room looked crowded. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident that their concerns will be listened to and acted upon. There are systems in place for staff to respond to suspicion allegations of abuse to make sure people living in the home are protected from the risk of harm. Evidence: The complaints procedure was clearly displayed on a notice board in the reception area of the home and copies are available in the Statement of Purpose. The home has received seven complaints since the last inspection. Complaints records show that these have been appropriately dealt with and resolved; one complaint was upheld by the home. We have not received any complaints regarding this home. Residents spoken to had no complaints about the care and services they receive. A resident spoken with told us that if they had any concerns they would talk to the staff. Speaking to staff it was evident that they are fully familiar with the procedures for managing allegations of abuse. The policy relating to abuse was available and easily accessible for staff to read and become familiar with. Staff confirmed to us that they had received training related to the protection of vulnerable adults. Information in the Annual Quality Assurance Assessment (AQAA) forwarded to us from the provider states that staff receive regular in-house training in adult protection. The adult protection procedure reflected Birmingham Multi Agency Guidelines and included information that made staff aware of the the types of abuse that could occur. Care Homes for Older People Page 18 of 30 Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of improvements being made in the home does not always help to make sure that a homely and safe place is provided for elderly people to live. Evidence: Since our last visit to Melville House ongoing improvements continue to be made to the internal and external living environment for residents. A rolling programme of redecoration and refurbishment is in place. The quality of the work carried out in some areas of the home for example, toilet and bathroom facilities were questioned. Some jobs had not been completed to high standard. This left the areas looking poorly maintained and in some instances unsafe for example the flooring in one of the newly decorated bathrooms on the first floor of the home was not level. This could present a trip hazard and the condition of the flooring could get worse. Improvements made to the home include new lighting, painting, replacement of carpets and furniture, fitting of an appropriate sluice and fitting thermostatic valves which help to control the temperature of water delivered in residents bedrooms, bathrooms/toilet facilities. The quality of some of the furnishings used was not always suitable for their purpose, the condition of bed linen and curtaining had deteriorated although we were told that they had recently been purchased. It was not evident that people who lived in the home were given the opportunity to participate by being Care Homes for Older People Page 20 of 30 Evidence: consulted and involved in the decoration of the home. The home does not offer a good first impression as you approach it. The front doors are in a poor state and there was a shabby looking notice on the main front door giving instructions to use the other door as the entrance to the home. We were told that this is while work is being carried out to the main reception area. The notice looked old and weathered indicating it had been there for sometime. Ramps are provided for access to the rear garden and a resident using a wheelchair was seen to use these. The rear garden provides a secure area for residents. At our last visit in January 2008 we were told that work is being carried out to clear the garden so that it is a pleasant and safer area for residents to use. This work had not been completed at this inspection visit. We looked around the home during our visit and the home was found to be clean and tidy with no unpleasant smells. Residents have a choice of two lounges currently where they are able to watch television easily on large screen televisions. Residents are encouraged to personalise their bedrooms so that they feel comfortable and relaxed in their surroundings. Looking around the home showed that the standard of decoration in bedrooms varied. Bedrooms arranged with the support of relatives looked comfortable and homely others provided minimum possessions and the quality of bed linen had deteriorated. This could possibly be due to the standard of laundering or the quality of linen purchased by the home. Shared rooms viewed were small, beds were close together, and there is a small sink with a small area around it. Curtains used to screen residents and provide privacy provides a very small area for staff to work effectively when delivering care to residents. The home has a separate small laundry room, which provides very little space for staff to work comfortably. The room contains two washing machines but only one drier to service all laundry for the home. There is very little storage space and the room would benefit from being organised and cleaned. Suitable procedures were in place for the collection, washing, ironing and returning of laundry but it was not evident the drying facilities were sufficient for a home of this size. The refurbishment plans show that plans are to relocate the laundry facilities. The kitchen was organised and tidy. Records are kept of cleaning schedules and temperatures of the fridges and freezers. However the back door of the kitchen was kept open and a cat was seen to come into and out of the kitchen at will. This practice does not support good hygiene and prevention of infection procedures in the home. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A review of staffing levels has helped to make sure that the needs of people living in the home can be met. Residents benefit from being cared for by competent staff and are protected by robust recruitment procedures. Evidence: The staffing rota identified that there is one registered nurse and five care workers on duty during day time hours and one registered nurse and two care workers overnight. Duty rotas do not indicate times of shifts worked by staff. This does not help to confirm that duty rotas cover the 24 hour shift. There is dedicated staff to provide cooking, laundry and cleaning services to the home. This helps to make sure that care staff are not involved in non-care duties, which take them away from looking after people in their care. However, care staff on the duty rota covers planned activities. Additional staff are not allocated on the duty rota, which means that care staff numbers are depleted for up to three hours per day. The manager has told us that plans are to employ someone to cover activities in the home. This will be good practice to ensure dedicated time can be given to provide stimulation and promote a varied lifestyle for people living in the home. During the visit staff were present in lounges and residents were not left unsupervised. The cultural backgrounds of residents reflected that of the staff team, this should help Care Homes for Older People Page 22 of 30 Evidence: residents to receive care appropriate to their cultural needs. The personnel files of four of the most recent employed staff were examined. Files are organised, accessible and easy to follow. The files showed that they contained evidence that satisfactory preemployment checks such as Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (PoVA) had been carried out. In the event that staff are employed following the outcome of a PoVA check a risk assessment is carried out to show the procedures to be followed for new staff working in the home until the outcome of their CRB check is known. These procedures ensure that recruitment procedures followed before staff start working in the home help to safeguard people living in the home from the risk of abuse. Information in the AQAA tells us that 95 of the staff have a NVQ (National Vocational Qualification) level two or above. This should mean that people will becontinuously cared for by trained and qualified staff. Kitchen staff are completing a NVQ courses in food safety catering and hospitality food preparation and cooking. New staff receive a two week induction programme and is allocated a mentor for this period. The induction covers aims and objectives for the home and is linked to the skills for care common induction standards. After six weeks staff are booked onto a NVQ level 2 qualification in care course. Training records were available for examination. These showed that staff had completed varied training, which include dementia care, continence management and medication. The manager has told us that training opportunities are to be further developed for nurses by linking to training provided by the Primary Care Trust to develop their skills and practice in areas such as phlebotomy and palliative care. All staff receive mandatory training in moving and handling, infection control, abuse awareness, fire safety and food hygiene. This should mean that staff are updated in safe working practice. Residents told us that the staff are helpful. They are there when I need them. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a competent person to ensure the service is run in the best interests of people living in the home. Financial procedures seen in the home do not completely confirm that residents financial interests are safeguarded. Evidence: The manager and staff show that they are keen to make positive changes in the home. The manager and his senior nurse were present at the time of the inspection. They were able to show us through conversation that they have a good knowledge of the residents in the home. Both are working towards completing a National Vocational Qualification (NVQ) level 4 in Leadership and Management in Care Services. We were told in the AQAA that this should be completed by the summer of this year. The manager for the home is also a member of the local PCT dementia workgroup. He uses things learned at this group to support and benefit the residents living in Melville House. The inspection was also supported by help from the administrator for the home who provided us with some of the records needed to evidence how the home is run for Care Homes for Older People Page 24 of 30 Evidence: the benefit of residents. Overall residents and relatives spoken to were happy with the service and care being provided. Quality audits related to care practices in the home are undertaken monthly by the home manager and staff. Action plans are identified based on the outcome of the audits. The quality assurance manager undertakes monthly visits to the home. Records of these are maintained in the home. We were able to examine copies of these records; areas covered include complaints, accidents, finances and care issues. Staff meetings are held so that issues relating to the management of the home can be discussed. The manager told us that relative and residents meetings are not well attended and it has been better to hold small group meeting or talk to relatives and residents on a one to one basis. However every effort is made to have meetings and the times and dates of quality meetings for relatives and residents are displayed in the front entrance of the home. Records of money deposited by residents and money available was checked and found to be correct. Chiropody and hairdressing receipts had been obtained for services provided. An external company provides holistic therapy services to people living in the home for example, hand massage. The company does not produce individual receipts to show what services they have provided for residents. This needs to be made clear so there is an effective audit trail in confirming services residents have received. However the financial arrangements the home has in place for the management of residents monies was not clear. Procedures for the management of personal monies were not available to confirm the procedures followed by the home. We were told that records are maintained by the Director for the home. We requested that he produce this information for us. At the time of writing this report we have not received this information. We were advised that the home puts residents monies into one bank account. A petty cash system is operated. The home pays for items for individual residents from the petty cash and then residents are invoiced individually. There was no indication of what amounts is held for individual residents in the accounts or what happens to the interest earned on the money. There was no evidence that statements are issued to show if and how interest earned is apportioned to individual residents and whether statements show expenses and balances. This needs to be made clear so there is an effective audit trail available in the home to confirm services and purchases residents have received or had made on their behalf. Since our last visit formal staff supervision has been introduced. Records in place showed that staff had received supervision and appraisals. This will help to ensure staff training and development needs can be identified and competencies can be assessed to ensure residents receive safe and appropriate care. Care Homes for Older People Page 25 of 30 Evidence: Dates were not included in the AQAA to show that policies and procedures had been updated for the home. Information in the AQAA and a review of records and practices in the home showed that health and safety checks had been undertaken. Records examined showed that since the last inspection the maintenance man for the home checks hot water in residents areas monthly. This makes sure that hot water temperatures are operating at safe levels so as not to scald residents. The manager and maintenance man told us that thermostatic mixing valves have been fitted to help regulate the temperatures. It was evident that emergency lighting had been checked and there were records of fire drills and checks on fire extinguishers. Maintenance checks of equipment were undertaken regularly so that they should be safe to use. During the visit we noticed that the flooring in the newly refurbished bathroom on the first floor was warped and this poses as a trip hazard for people in this area. The bathroom has not yet been commissioned to be used by residents. We were told that this would be addressed before the bathroom was used. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 35 17 The Director for the home must produce evidence to show that records maintained about the banking of residents monies is appropriate. This needs to be made clear so that there is an effective audit trail available to show how individual interests are apportioned to peoples balances and confirm services and purchases residents have received or had made on their behalf. 04/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 The employment of an activities co-ordinator should be pursued to support activities in the home. This will make sure that staffing levels to provide care are not depleted and ensure that all residents benefit from appropriate social, mental and physical stimulation while continuing to Page 28 of 30 Care Homes for Older People have their health and personal care needs met. 2 15 Records of meals provided to residents need to be maintained to demonstrate a choice of wholesome and nutritious food is being provided consistently. These also need to show any specialist diets being provided to show residents nutritional needs are being met. The opinion of people living in the home should be sought and included as far as possible when changes are being made to the home. This will show that their views are considered in plans for the development of their home. Records of meals provided to residents need to be maintained to demonstrate a choice of wholesome and nutritious food is being provided consistently. These also need to show any specialist diets being provided to show residents nutritional needs are being met. The home should make sure that the home is repaired and refurbished to a high standard. This will help to make sure that people are able to live in a comfortable and safe environment that they can call their home. The home should make sure that shared bedrooms are appropriately arranged to maintain the privacy of individuals sharing the bedroom. Plans to improve laundry facilities in the home should continue to ensure that staff have a safe and suitable environment in which to work. To support high standards of hygiene in the home and the control of cross infection the cat should not have access to the kitchen in the home. Appropriate records must be maintained in regard to residents money. Records must show what the money was used for and individual receipts kept for items or services purchased on behalf of the resident. Individual costs for all items must be clearly stated. This ensures that the residents money is spent on items for them and that they are aware of what they are spending. The flooring in the newly re-fitted bathroom on the first floor of the home should be relaid to make sure it is flat and safe to use before residents and staff are permitted to start using it. This will make sure that people are not at risk of tripping or falling. 3 19 4 19 5 19 6 20 7 26 8 26 9 35 10 38 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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