CARE HOMES FOR OLDER PEOPLE
Melville House Nursing Home 68 - 70 Portland Road Edgbaston Birmingham B16 9QU Lead Inspector
Jane Walton Announced 19 July 2005
th 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 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. Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Melville House Nursing Home Address 68 - 70 Portland Road Edgbaston Birmingham B16 9QU 0121 455 7003 0121 454 9746 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Edgbaston Healthcare Ltd Mr Andrew Beard Care Home 29 Category(ies) of Care Home registration, with number of places Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Maximum of 29 service users, categories OP and DE(E). 2. Service users aged 60 years upwards. 3. Up to three places for personal care only (not nursing care). 4. The Registered Manager achieves the Registered Managers Award or equivalent to NVQ 4 in Management of Care by April 2005. Date of last inspection 24th March 2005 Brief Description of the Service: Melville House is a care home with nursing for up to 29 residents. The home is situated in a quiet residential area approximately 4 miles from 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 home. 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. Off road parking is also available at the front o f the building, however the access is via a very steep incline. Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was announced and took place between the hours of 09.45 and 20.45 on the 19th July 2005. The inspector was assisted throughout by the homes’ manager. There were 28 residents at the home, and the inspector spoke to seven of them to obtain their views of life at Melville House. Other information was gathered from conversations with staff, examining care and medication records and by undertaking a tour of the home. This report has been delayed due to the inspectors extended sick leave. Subsequently, any requirements made of the home that were not immediate at the time of the inspection, have necessarily been given extended time scales. This report should be read in conjunction with the latest inspection report in order to obtain a complete overview of the service offered by this home. What the service does well: What has improved since the last inspection?
Several areas of the home have been decorated and new carpets laid. New dining furniture has been provided in one of the lounge/diners. The standard of the recruitment procedure has improved, and all staff files examined contained the required information and documentation, apart form a recent photograph, and this issue is to be addressed. The home now employs more than 50 of care staff who have been trained to NVQ2. All staff now have formal, documented supervision sessions, and annual appraisals. A training matrix has now been developed to identify staff training needs, and a programme of
Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 6 training is implemented to covers areas of statutory requirements and other areas relevant to the care of the current resident group. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 Prospective service users are provided with clear and comprehensive information to allow them to make an informed choice of whether they wish to live at Melville House or not. EVIDENCE: There was a very comprehensive Statement of Purpose available for all residents and their families, including a Service Users Guide. The documents were currently being reviewed and updated where needed. Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9,10 The registered manager has worked hard to maintain the good standard of medicine management within the home. Residents are generally well supported by the nursing and care staff to ensure that their health and personal care needs are met appropriately. EVIDENCE: Evidence was seen that residents have a personalised care plan, that identified the individuals needs and the plan of care addressed the management of these needs. One resident informed the inspector that, “ I know that I have a care plan, and my wife helped put it together with the manager”. A record was seen in individual plans of health professionals visits to the resident. Whilst there was evidence that most plans had been reviewed regularly, one indicated that a review had not taken place since October 2004. An audit of the medicine administration in the home was undertaken by the pharmacist inspector who noted that the majority of audits undertaken were correct demonstrating that the nursing staff administer medicine in accordance with the doctor’s prescription and accurately record these transactions. Staff were observed during the inspection interacting well with the residents, and according them due respect. Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14, 15 Overall Dietary needs of residents are well catered for with a balanced and varied selection of food available , that promotes their well-being. Residents are enabled to maintain contact with family and friends, and are helped to exercise choice and control over their lives, thus promoting their emotional and physical well being. EVIDENCE: Several visitors were present in the home, and one commented ”We get a nice welcome from staff. Visiting is very flexible, and we visit mum at different times of the day.” Residents spoken to confirmed that “I usually go to bed at 9pm and I get up when I wake up, usually about 5am and have a cup of tea in bed. Occasionally I like to have a lie in.” Another resident commented that, “ I like to stay up late, and I go to bed when I want to, various times.” Evidence was seen that residents are included in the production of their care plans, and residents spoken to were aware that they had a care plan. The inspector joined residents in the first floor lounge/diner for lunch, and again at supper time. The lunchtime meal served was presented well, hot and tasty. A choice between roast beef or roast chicken was available. One resident commented, “ The food is always good, I particularly like my puddings.” Dessert was a choice of trifle or Angel Delight. Fresh fruit was also available. Staff in attendance were observed to offer encouragement or assistance where needed. Soft drinks were available, either lemonade or blackcurrant.
Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 11 Menus examined demonstrated that a varied and well balanced diet is offered to all residents, and a choice of main dishes is available. The supper supplied was cheese on toast, a selection of sandwiches, tea, coffee and squash. As it was a residents’ birthday, a Birthday cake was provided and shared with other residents. Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home has a satisfactory complaints procedure that is accessible to residents and visitors so that they are aware of how to make a complaint ensuring the promotion of protection matters. The homes’ Abuse policy does not follow the local guidelines thus potentially placing residents at risk. EVIDENCE: There was a complaints policy and procedure in place that was accessible to all staff, residents and their visitors. There were no recorded complaints in the complaints log which was seen. There was an abuse policy and procedure in place, however it did not reflect the local guidelines for Birmingham, and the manager stated that it would be amended as a priority. Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 24, 26 The standard of the environment in the home is variable, and does not always ensure that the residents have safe and comfortable surroundings in which to live. EVIDENCE: The home has a redecoration and refurbishment programme for 2005/6 which was examined. Residents bedrooms and communal rooms were listed individually with items that needed attention. It was evidenced that some areas have had new carpets fitted, and new items of furniture supplied and some decoration has been carried out. The layout and structure of the building is not ideal for the resident group, and has not been purpose built. Not all rooms have the minimum items of furniture required by the standard, however personal possessions in bedrooms, were much in evidence. Not all bedrooms were fitted with privacy locks, and in some areas the corridors had no handrails .Although there was an emergency call bell system, it requires adapting in some areas of the home, so that it can only be cancelled at the source. En suite facilities are not provided in any of the rooms, however
Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 14 there are communal toilet and bathing facilities available. The call bell in one of the toilets could not be reached by a resident if they had fallen onto the floor. The home has a laundry, where the washing machine has a sluicing facility, however, only clothing is laundered in the home. All bedding is sent to an outside laundry. There is also a sluice facility to aid infection control within the home. At the time of the inspection the home did not have any unpleasant odours and areas seen appeared clean. Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Staffing levels are generally adequate to meet the needs of the residents. The home has a robust recruitment procedure thus ensuring the safety of the residents. Staff have received appropriate training in order to carry out their duties to ensure residents are protected, and cared for appropriately. EVIDENCE: Staff rotas were taken away and examined. They demonstrated that on most days there were sufficient staff on duty to meet the needs of the residents in the home. There is a “staff bank” system in place when shortfalls in staffing occurs. There are sufficient ancillary staff rostered, and there is a full time administrator in post to support the manager. There does not appear to be a designated deputy manager in post, who would be able to support the manager, and deputise in his absence. Staff files examined demonstrated that the home has a robust recruitment policy and procedure that is adhered to. All files seen were complete, with the only outstanding item, an up to date photograph. Suitable references, CRB checks, and for trained nurses, PIN checks had been carried out, and evidenced. The manager maintains a matrix of staff training undertaken and required. Each staff member has a signed and dated supervision agreement, and evidence was seen that supervision has indeed been carried out with staff, and a record maintained. A good number of the care staff have NVQ training in care, and others are currently undertaking training. It was evidenced that statutory training had been delivered, in moving and handling, health and safety, cross infection, food hygiene and first aid. Training in other areas of relevance to the care of the current resident group, including
Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 16 Dementia care, Care of the Dying and Bereaved, Falls, Medicine management and Managing Challenging behaviour had also been undertaken. Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 35, 36, 38 The home has good systems for consultation with residents where their views are both sought and acted upon. The management style of the home engenders an open and inclusive atmosphere The homes’ generally high standard of record keeping safeguards the residents’ rights and best interests. EVIDENCE: The Registered Manager is a trained nurse with a number of years experience in caring for elderly people. He is currently undertaking the Care Managers Award qualification. An open door policy is operated in the home, and staff and residents spoken to stated that they felt able to talk to the manager easily, and that they were listened to. Formal, minuted staff meetings are held and informal meetings with residents take place to obtain feedback from both groups. Residents confirmed that the manager spent time talking to them. Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 18 The home currently manages the money of only one resident, and the records for this were found to be complete, accurate and receipts were evidenced for all expenditure made on items for the resident. Each staff member has a signed and dated supervision agreement, and evidence was seen that supervision has indeed been carried out with staff, and a record maintained. The home does not always inform the Commission for Social Care Inspection (CSCI) appropriately when an accident or incident occurs that affects the health or well being of a resident. Maintenance records indicated that safety checks in relation to gas and fire procedures are carried out regularly and documented, and risk assessments were in place for staff, residents, premises and fire. Some bedroom doors were observed to be wedged open, at the residents’ request. These doors must be fitted with automatic closures in the event of fire, as this practice constitutes a serious fire risk. Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 2
COMPLAINTS AND PROTECTION 1 1 2 x x 2 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 3 3 x x 3 3 x 2 Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 15(2)(b,c) Requirement The manager must ensure that all residents care plans are reviewed on a regular basis, and documented. This requirement was left as an immediate requirement on the day of the inspection. The manager must ensure that the homes policy and procedure for the prevention of abuse, reflects the local Birmingham Guidelines. This requirement was left as an immediate requirement on the day of the inspection. Outstanding from March 2005 inspection. 3. 19 23(b) The outside window frame of the downstairs storeroom must be repaired and repainted, or replaced. This requirement was left as an urgent requirement on the day of the inspection.
Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 21 Timescale for action 19/7/05 2. 18 13(6) 19/8/05 19/8/05 4. 24 12(4)(a) The manager must ensure that bedroom doors are fitted with locks that are suited to assessed capabilities and accessible to staff in an emergency. Outstanding from March 2005 inspection. March 2006 5. 6. 29 38 19(1)(b) 23(4)(a) The manager must ensure that 3/8/05 all staff files contain a recent photograph of the staff member. **The manager must ensure 19/7/05 that the practice of wedging open residents bedroom doors ceases. These doors must be fitted with 19/12/05 appropriate automatic closures in the event of fire. **This requirement was left as an immediate requirement on the day of the inspection. 7. 38 12(1)(a) The manager must ensure that the call bell in the identified downstairs toilet is modified to ensure that if a resident were to fall to the floor they are able to reach a pull cord. Left as an urgent requirement on the day of the inspection. The manager must ensure that all accidents and incidents that occur that affect the health or welfare of residents or staff are notified to the Commission for Social Care Inspection (CSCI) without delay. This requirement was left as an immediate requirement on the day of the inspection. 19/8/05 8. 38 37 19/7/05 Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 22 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 Good Practice Recommendations Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 23 Commission for Social Care Inspection Birmingham and Solihull Local Office 1st Floor, Ladywood House 45/46 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Melville House Nursing Home E54 S24869 MelvilleHseNH V231297 190705 Stage 2.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
