Inspection on 24/01/07 for Melville House Nursing Home

This inspection was carried out on 24th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Melville House Nursing Home 17/03/09

Melville House Nursing Home 28/02/08

Melville House Nursing Home 24/07/07

Melville House Nursing Home 06/09/06

Melville House Nursing Home 09/01/06

Melville House Nursing Home 19/07/05

Melville House Nursing Home 24/03/05

Melville House Nursing Home 18/11/04

Melville House Nursing Home 17/03/04

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Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Melville House Nursing Home 68 - 70 Portland Road Edgbaston Birmingham West Midlands B16 9QU Lead Inspector Ann Farrell Unannounced Inspection 24th January 2007 09:30 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 Melville House Nursing Home DS0000024869.V327698.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. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Melville House Nursing Home Address 68 - 70 Portland Road Edgbaston Birmingham West Midlands B16 9QU 0121 455 7003 0121 454 9746 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) Edgbaston Healthcare Limited Mr Andrew Beard Care Home 29 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (29) of places Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Maximum of 29 service users, categories OP and DE(E) Service users aged 60 years upwards Up to three places for personal care only (not nursing care) That the home can accommodate one named service user under the age of 60 years requiring nursing care. 6th September 2006 Date of last inspection Brief Description of the Service: Melville House is a care home with nursing providing accommodation for up to 26 residents requiring nursing care and 3 residents requiring personal care. A number of the residents suffer with dementia plus nursing and personal care needs. 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 to the front of the building, however the access is via a very steep incline. 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 The home accepts residents from a variety of cultural and ethnic backgrounds and this is reflected in the staff group working in the home. Written information about the services and facilities in the home is currently being reviewed and updated in order to provide up to date information. Fees range from £395 to £515 depending on residents needs. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork inspection was conducted over two days commencing at 9.30 on 24th January 2007. The manager arrived on the second day and feedback was given to him. During the fieldwork a senior nurse, five members of staff and six residents were spoken to. The feedback varied; resident stated the food was of a good standard and they enjoyed it. They stated some staff were good, but there were some staff who shouted at them and this issue was raised at the last inspection. Some residents were unable to communicate verbally. During the inspection process the inspector toured the home, sampled residents files and other documentation. Case tracking was used to determine care for residents from the time of admission to the home plus direct and indirect observation. Information was also utilised from the pre inspection questionnaire, which is provided by the home prior to fieldwork. A random inspection was conducted in November 2006 in relation to a complaint about security in the home, cleanliness of equipment and response to call bells. In all areas the regulations were not met. A further visit was undertaken in December 2006 to find problems with the heating system. The plumber had visited and a new pump had been ordered, but it was found that sufficient heaters had not been placed around the home to provide adequate heating for residents. This area was addressed, but on returning this visit it was found that the heating system was not working again and it was stated a new boiler was required, which they were in the process of obtaining. On discussion with some residents they stated, “It can be cold at times”. The pharmacist inspector undertook a further visit in December 2006 as the medication was poorly managed at the last key inspection. The medication was found to be of a poor standard and a statutory enforcement notice was served requiring improvement. Although there were some improvements with the medication at this inspection there were issues outstanding and the enforcement notice has been breached. From inspection very few requirements had been met since the last inspection. The proprietors will need to take a more pro-active approach to addressing the shortfalls otherwise the Commission may be minded to take enforcement action. What the service does well: The Home is run and managed by a Registered Nurse with many years experience working in elderly care and there is a fairy stable staff group so Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 6 they are familiar with the resident group. Residents stated some of the staff were good. Visiting is flexible enabling residents to maintain contact with family/friends and/or advocates and exercise choice and control over their lives where possible. The food is of a good standard with a choice of meals and special diets are catered for. Residents stated they enjoyed the meals. What has improved since the last inspection? What they could do better: Many of the requirements from the last inspection remain outstanding. There needs to be a more pro-active approach to addressing requirements or the Commission may be minded to take enforcement action. With the lack of investment in the property over a number of years by the provider there are still many areas of the environment requiring attention. Some areas in the Home remain cluttered and in need of redecoration and refurbishment. Concerted action is required in order to provide all residents with a pleasant and safe environment to live. The medication system needs to be improved and training provided to staff where necessary to ensure that residents receive the medication that is prescribed by the doctor. The communication systems need to be reviewed and improved to ensure all staff are aware of any current issues in the home and any concerns are followed up and addressed in a timely manner. The assessment and care planning process needs to be enhanced to ensure resident’s needs are identified, appropriate plans of action put into place and they are implemented in a consistent manner. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 7 Action must be taken to ensure there are adequate staff numbers of staff on duty with the appropriate skills at all times to meet residents needs. Also arrangements must be put in place to ensure the working time directive in respect of hours worked by staff and rest breaks are adhered to ensuring staff are fit to work. Updated staff training in all basic areas is required for all staff to ensure they have the appropriate skills and knowledge to care for residents. Arrangements must be put in place to ensure adaptation nurses meet the requirements of the educational institution and develop their knowledge before registration is approved. The systems for dealing with concerns, complaints and allegations needs to be more pro-active to ensure residents are listened to and appropriate action taken to safeguard them. Issues in respect of staff attitude and approach need to be addressed and action taken. Improvements in infection control procedures are required with staff training, practices and equipment. Also the standard of cleaning and odour control needs to be improved to minimise the risk of cross infection. It is strongly recommended that the manager liaise with the health protection unit for an infection control audit and advice. The arrangements for activities and stimulation of residents needs to be reviewed and enhanced to ensure resident’s needs are met and they are offered further opportunities and stimulation. The management need to develop the recruitment procedures before staff commence employment to ensure residents are adequately protected by a robust system. The quality assurance system needs to be developed further to include feedback from stakeholders and drawing up a development planned indicating outcomes for residents. The arrangements for resident’s finances need to be reviewed and robust systems put in place that are auditable and demonstrate clear accounting methods to safeguard individual’s finances. A number of areas in respect of the maintenance and servicing of equipment needs to be addressed with some urgency to ensure a safe environment for residents. Also systems need to be put in place to ensure servicing is undertaken in a timely manner in the future so equipment is safely maintained. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 8 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. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 9 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 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4,6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The information about the services and facilities provided in the home has not been sufficiently developed to enable prospective residents and their representatives to make an informed decision about moving into the home. The admission assessment documents are not completed to a satisfactory standard and therefore it cannot be guaranteed that resident’s needs will be identified and met when entering the home. EVIDENCE: The home generally admits residents for long-term and does not take admissions for intermediate care. The manager stated they were in the process of reviewing and updating the statement of purpose and service user guide. On discussion with a resident who had recently moved into the home it was stated they did not receive any written information. Therefore, prospective residents and there relatives would have to rely on verbal information given about the services and facilities about the home. It was Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 11 stated that when these documents are developed a copy would be provided in each bedroom. Consideration should also be given to alternative formats e.g. large print etc. to ensure it is suitable for the resident group. There was no evidence of a contract of residence. This area will need to be addressed to inform the resident and their representatives of the terms and conditions of stay in the home. Also a copy of the contract should be retained on the residents file in the home A small sample of resident’s files were inspected to determine the admission process. It was found that in some cases a pre-admission assessment had been completed, but this was not consistent as they were not available on all files. In some cases the document was not comprehensive, were not dated or signed by the member of staff who had undertaken the assessment. Without this it cannot be guaranteed that the home can meet prospective residents needs. Also there was no evidence that the manager writes to prospective residents confirming that the home can meet their needs, which is required under the regulations. The home has a number of residents who suffer with confusion or dementia. Some staff have undertaken some training in respect of dementia awareness in the past, but this is not adequate to ensure all staff have the appropriate skills and knowledge to meet resident’s needs. Some of the rooms and toilets have limited space and it would be difficult to manoeuvre equipment such as hoists for manual handling etc. The manager of the home must ensure that when assessing residents for admission to the home these factors are taken into consideration and residents needs will be met by the facilities available. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 12 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 poor. This judgement has been made using available evidence including a visit to this service. Improvements to care planning, communication and a more pro-active approach to care and follow up are required to ensure resident’s needs are met in a timely manner. The medication system needs to be developed in order to ensure there are robust systems in place and all residents receive the medication prescribed by the G.P. EVIDENCE: Following admission to the home an assessment and risk assessments are completed in respect of manual handling, skin integrity, bed rails, nutrition etc. However, there was no assessment of continence and mental health where appropriate. Also risk assessments gave conflicting information, some were not accurate e.g. a skin integrity risk assessment score in hospital was 21, but the staff in the home recorded 12 and in another case staff had recorded 12 and the inspector found it was at least 16 on the information available. Where these are not completed correctly risk of pressure sores are not identified accurately and appropriate action taken placing residents at significant risk of developing pressure sores. Bed rail assessments had been completed, but it Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 13 was found there was only one bed rail on some beds and in some cases they were not sufficiently high enough to reduce risks of falls as pressure-relieving equipment was also in use. Care plans are drawn up for all residents following admission to the home outlining how the resident’s needs are to be met by staff. On inspection of a sample of records it was noted that there had been some improvements, but in areas the instructions were vague. Also some of the instructions were not followed e.g. a member of staff was not aware that a resident was to perform breathing exercises. In another case a physiotherapist had visited a resident and advised for a range of exercises to be undertaken and these had not been included in the care plan, and it could not be evidenced that they were occurring. Separate records are retained in resident’s rooms providing carers with details about the resident’s basic care requirements, which was positive. Staff make daily records about residents condition, progress or any concerns. They were found to be rather superficial with comments such as fine or quiet day. It was noted that some concerns had been raised for one resident, but there was no evidence of follow up or resolution of the concern. One resident had been admitted with a low body weight and the care plan did not give any details about monitoring food intake etc. The action required was to weigh weekly, but this had not been undertaken as there was only evidence of one weight record that had been completed on admission to the home. Where residents are of low weight or have lost weight action must be taken with referral to health professionals where necessary. All residents are registered with a G.P. and a separate record of health professionals visits are maintained. Although the date of the visit is recorded there is no record of the outcome of visits to determine appropriate follow up to concerns raised. It could not be evidenced that other health professionals such as chiropodist, dentist and optician saw residents on a regular basis. At the time of the last inspection it was noted that a resident had problems with ill-fitting dentures and this was brought to the attention of the manager. At this inspection it was stated that the home had experienced problems obtaining visits by a domiciliary dentist. The inspector suggested that the resident should go out to a dental surgery. At the last inspection it could not be evidenced that residents with chronic diseases such as diabetes; asthma and high blood pressure etc. were receiving regular health checks. At this inspection it was noted that a surgery had sent a letter advising of such health checks, but there was no evidence that it had occurred. During the inspection other areas in respect of care were noted that require attention: • Staff were not fully aware of catheter care and this puts residents at risk of infection. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 14 • • • • • Call bells were not always accessible to residents in their bedrooms to summon assistance if they required. Also staff were accepting calls in corridors, which is not good practice as they may be delayed attending to a resident. Lemon and glycerine sticks were used for oral care, but are no longer advocated as they tend to dry the mouth. Residents were moved in wheelchairs without footplates and this puts residents at risk of injury. Draw sheets were in use, which are no longer advocated as they may cause damage to skin. Residents who remained in bed did not get their hair washed as often as necessary. The tissue viability nurse was visiting at the time of inspection and stated the number of pressure sores had reduced and currently they were superficial. The home has been in the process of purchasing new mattresses, but a supply of static mattresses and pressure relieving cushions are still required to ensure adequate pressure relief and reduce the risk of pressure sores. Since the last inspection a request has been made for all residents requiring wheelchairs to be assessed to ensure they have appropriate equipment. During inspection it was noted that a number of beds were positioned next to he wall, which would make it difficult providing care to more highly dependent residents. Ideally beds should be situated in the middle of the room to enable staff to access both sides. If situated next to the wall they should be easily manoeuvrable, but it was noted that some beds were of the divan type and did not have castors on to enable easy movement. This are will need to be reviewed and appropriate action taken. Whilst reviewing the accident record it was noted that notifications to the Commission under regulation 37 had not occurred for an accident requiring hospital treatment and a recent death. Whilst touring the home it was noted that creams had been opened and not dated and therefore there is a risk of bacterial contaminating if not used within specific time frames. Also the alarm was sounding on a feeding machine for approximately 30 minutes without any attention. On discussion with some trainee nurses they gave varying accounts in respect of diabetes and administration of medication via feeding tubes, did not know how to calibrate the blood glucose monitoring machine and did not use the appropriate equipment for obtaining blood samples for blood glucose monitoring. A pharmacist undertook the medication inspection in order to assess for compliance against the Statutory Requirement Notice, which was issued due to serious breaches in the regulations for the safe handling of medicines following the inspection on the 19th December 2006 by the pharmacist inspector. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 15 Medicine charts were audited; one nurse and one service user were interviewed. Despite improvements seen the service breached the notice issued. The medicine management for the residents on the ground floor of one side of the home was poor. For one resident the dates recording the administration of medicines were incorrect and nursing staff signed they had administered medicines for four days after the inspection actually took place. Nursing staff had also signed twice for some days, not signed at all for others but the medicines counted on the premise indicated that the total number of signatures counted equalled the number of tablets administered in some instances. Nursing staff had failed to start the Medicine chart at the same time as the dispensed medicines, which had lead to recording problems. This problem was duplicated for another resident indicating that staff are not fully converse with the system installed in the home to receive, administer and record the medicines they handle. Medicines had been signed as administered when they had not been, recorded twice, administered but not recorded as such and the reasons for nonadministration not recorded accurately if at all. Some medicines were not available for administration. One out of date inhaler was found in the medication trolley. It was unlabelled and expired in September 2006. The medicine round still took a long time to complete. One resident wanted to go out but couldn’t until he had had his medication. He asked the nurse three times for his medication, but the nurse did not give them to him until 10:45. This is considered too late for the prescribed medication. Nursing staff are signing the medicine chart that they have administered two medicines, but the resident self-administered these. The resident said that she hadn’t used them for a week but the medicine chart recorded that these had been administered each day. No risk assessments were found to see if she could safely do so and staff are recording a transaction they have not undertaken. The medicine management for the majority of the home had improved overall. Audits indicated that the majority of medicines had been administered as prescribed. A system is being used to check the prescription before it is dispensed and checking the dispensed medication and medicine chart on receipt to the home. Despite this one medicine had not been available to administer for 10 days. Another medicine had been recorded as not available but a new bottle was found in the trolley and one medicine was due to reach Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 16 its expiry date on the day of the inspection. No further supply was seen to replace this. This is of serious concern as despite improvements seen the home still has failed to reach the standards required to ensure the safety and well being of the residents within the home. One resident had been risk assessed to self-administer his medicines. This clearly indicated that he did not have a thorough understanding of each medicine he was prescribed. Despite this the document indicated that he was to self-administer his medicines. The service user and the nurse signed this. However, the medicine chart indicated that staff were actually administering his medicines. The home is still having problems obtaining the medication in time for each new cycle resulting in residents not having prescribed medication to be administered in time. This was to be addressed with the PCT to try and improve this issue. One trainee nurse was interviewed during the inspection. She had a good understanding of the medicines she handled as part of her training. She undertook supervised medication rounds. She was unable to identify errors in the medicine charts, where nurses had not accurately recorded what they had done, for example had signed the medicine chart each morning when the prescribed dose was twice a day. On discussion with resident’s they stated some staff were good. It appears there has been an improvement in the response to call bells, but one resident stated, “There is no one around when I want the toilet”. During inspection some residents were presented satisfactorily, but some had no footwear on, men were not shaved, one resident stated she had not had a bath or shower since moving into the home and another stated she had not had a wash that morning despite being dressed. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made using available evidence including a visit to this service. The meals offered are of a satisfactory standard to meet resident’s nutritional needs and would benefit from a review of timing and menu planning so that all residents preferences are met. Arrangements for social activities were generally poor so leading to lack of stimulation of residents. EVIDENCE: Residents are free to come and go as they wish depending on the capabilities. Visiting is flexible enabling relatives to visit at a time that suits them and contact to be maintained easily. Residents are able to bring personal items into the home enabling them to personalise their bedrooms making them more homely. Since the last inspection the manager has consulted residents about their wishes in respect of times for getting up and going to bed and this is recorded in care plans. The home has a small library and talking books. One resident had a number of library books and stated she really enjoyed reading. Activities included progressive mobility weekly and a singer visits once a month. On discussion with some residents they stated they did get bored. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 18 The manager will need to undertake a comprehensive review of this area and ensure assessments of residents past interests/hobbies is undertaken, they are consulted about a range of activities both inside and outside the home and a plan drawn up to meet residents needs in order to provide adequate stimulation. Then resources must be available to ensure that plans are put into action and records are maintained. Consideration will also need to be given to celebration of cultural events to meet the needs of residents in the home such as Diwali and independence days. It was stated that birthdays are celebrated with a homemade cake, a birthday card and a buffet is provided. Currently there is no visiting hairdresser, a priest visits regularly and one resident goes out to church on a regular basis. The home employs separate catering staff who provide three full meals per day with the main meal in the evening and a light lunch. There is a four-week rotating menu, which provides a choice of meals, but there was no evidence of a cultural option for residents from minority groups. At the time of inspection various diets included diabetic, gluten free and puree meals. It was noted the food for puree meals was mixed together. The cook was advised that the various elements should be served separately so that it looks more appetising and different tastes can be appreciated, which she agreed to address. On discussion with the main cook she stated she does include cultural options when time allows. There was noted to be a large amount of skimmed milk and the cook stated she receives 8 litres of fresh full fat milk three times a week. It is recommended that this be reviewed as elderly residents especially those who are underweight need the extra calories provided by full fat milk and also residents may prefer the taste of full fat milk. On the day of inspection breakfast was being served up to 11am lunch is served at 12.30 and tea at 4.30pm. This means that all meals are served over a six-hour period. This is not adequate; meals must be spaced out across the day in keeping with ordinary life principles. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. The arrangements in place for complaints do not demonstrate staff in the home deal with them appropriately and residents would not be confident that their views are listened to or acted upon. There is a lack of staff knowledge in respect of prevention of abuse procedures to adequately protect residents EVIDENCE: The homes complaint procedure was not on display and there is no service user guide available so it could not be evidenced that residents or their representatives are made aware of the complaints procedure. At the time of the last inspection it required amending to inform residents or their representatives of their right to contact the Commission at any stage of the process and this remains outstanding The home maintains a complaints record and it indicated they had not received any since the last inspection. Complaints/concerns have been raised with the Commission about the security in the home, the cleanliness of equipment, the response to call bells and the heating. In all cases it was found that the regulations had not been met and requirements were made of the home to address the issues, but some are still ongoing. At the last inspection the adult protection procedure and whistle blowing procedure required updating and this remains outstanding. The adult protection procedures were discussed with some staff and the responses were Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 20 not adequate, suggesting that they are not aware of the action to take in the event of any allegation of abuse. Also there was no evidence that staff have received training in this area. The manager must ensure that all staff receive training in respect of adult abuse and whistle blowing procedures to ensure residents are adequately protected. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 21 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although re-decoration is on going there are still many areas that need redecoration and refurbishment to provide a safe and homely environment for residents to live. The standard of cleaning and infection control are not adequate to safe guard residents. EVIDENCE: On arrival it was noted that the exterior of the building requires decorating plus a number of windows and doorframes need replacing, as they are draughty. In order to gain access through the front door there are a number of steps and access for wheelchairs is to the side of house 68 where there is a portable wooden structure and the patio door in house 70 at the rear. The proprietor will need to provide suitable access to the front of the home in order to meet resident’s needs and also the requirements of the Disability Discrimination Act. On arrival the side entrance to house 68 was open and security was not adequate. Some large gates have been fitted to the area Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 22 between the houses, but they are not locked. The manager will need to review the arrangements for security to ensure residents are adequately protected whilst enabling residents to move around freely. This is an ongoing issue since the last inspection. The garden to the rear of the property consists of an area that is tarmac where there is some seating and an incline up to the area of grass. There are a number of discarded items such as wheelchairs, commodes, beds etc along the route, the clinical waste bins are situated to the rear and they were not locked or fenced off, which presents are risk to residents who may access this area. The manager stated he has contacted the clinical waste company and they are to provide some lockable clinical waste bins. The laundry is situated to the rear of house 68 and access if gained through the garden or a kitchenette area, which is no longer used for the preparation of teas and snacks. This area has a kitchen cupboard, sink and the cupboard was damaged, the seal around the sink was coming away and the cupboard smelt mouldy. The laundry has a washing machine and tumble dryer and on discussion with the laundry assistant it was stated she sorted linen and washes soiled linen separately, but there does not appear to be any bags to separate soiled linen such as alginate bags or similar. A cupboard used for the storage of cleaning chemicals was in close proximity, but it was not kept locked. Feedback from residents indicated that items of laundry did go missing. The manager will need to review the laundry system and ensure resident’s laundry is returned to them in a timely manner. There is a small sluice on the ground floor in house 68, which was cluttered and it was difficult to gain access. Boxes of syringes were stored in the cupboards and the manager stated there was no water supply available, which means the area, cannot be used. The proprietor must ensure there are suitable sluicing facilities in all areas/floors with a sluicing disinfector to ensure adequate infection control procedures. During a tour of the home it was noted that a number of doors were propped open with various items. This poses a risk in respect of fire. All fire doors must be kept closed; where there is a need to keep them open they must be fitted with suitable closure devices that are linked into the fire alarm system. An inspection had been undertaken recently by the fire officers and areas were identified that need to be addressed in order to meet the fire regulations. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 23 There are three lounges in total plus a separate dining room in house 70. The first floor lounge/dining room in house 70 has been re-decorated and furnished providing a pleasant area. There is a fridge and tea making facilities in one corner of the room. There was no evidence that the fridge temperature was checked and the inspector was concerned about the use of kettle etc in the room as some of the residents were confused. The manager will need to ensure a risk assessment is undertaken and where any concerns are raised appropriate action taken. The lounge and separate dining room on the ground floor in house 70 have been re-decorated and furnished providing pleasant areas to sit and take meals. The remaining lounge/dining room in house 68 was satisfactory with comfortable seating and dining table and chairs. Many of the bedrooms were inspected and it was found that some had been re-decorated with new carpets and furniture, which were of a good standard. However, a number of rooms still require work to be undertaken and furniture replaced and this is currently ongoing. Some of the bedrooms did not have over bed lighting, two double sockets, locks on bedroom doors or lockable facilities if residents required privacy or to store valuables. Some of the carpets were stained and in some areas they posed a trip hazard due to edges or areas fraying. Some of the linen was fraying, plus areas behind beds; raised toilet seats etc. were not cleaned effectively. It is recommended that when re-decoration is undertaken consideration be given to the needs of residents with cognitive impairment. Different rooms and areas should look different so the residents with cognitive impairment have their independence promoted and avoid unnecessary difficulties. The arrangements in respect of infection control were poor placing residents at risk of infection for example some washbowls were found on the floor, in shared rooms some were not labelled, there was no liquid soap or paper towels in area for staff to wash their hands after supporting residents, the disposal/cleaning of commode pots and urinals was poor. Urinals and commode pots were found on the floor or windowsills in various areas, toiletries were found in bathrooms suggesting they were for communal use, staff were observed walking around the home with gloves on and entering the kitchen with inappropriate protective clothing. Gloves and aprons should be removed and hands washed after supporting a resident. Other areas that require attention include: • Some pillows were lumpy and required replacing. • Some chairs were damaged with foam exposed and will need replacing. • Some commodes were rusting and will need replacing. • A fire exit was obstructed and when it was pointed out to staff the items were removed. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 24 • • • • The lift was not working properly and staff were waiting for the engineer. At the last inspection it was identified that issues were outstanding from the previous service and they have not been addressed to date. There was odour in isolated areas. Equipment needed cleaning. Staff were entering the lounge of house 70 by the patio doors and on one occasion the door was left open and the resident was shivering with the cold. Alternative arrangements should be made for entering the home. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 25 Since the last inspection the call bell system has been replaced providing one system for the whole home and it can be switched off at the point of origin and there has been an improvement in staff response to calls. All areas are individually and naturally ventilated and restrainers are fitted to windows, but some windows do not have handles in place enabling them to be closed effectively. Some radiators have been fitted with covers to reduce the risk of scalding to residents and radiator controls have been fitted enabling residents to alter the temperature in their rooms. However, there are currently problems with the heating system, which has been on going since December. It was stated a new boiler is to be purchased and they were waiting for the technical data. Hot water taps in baths and showers had been fitted with thermostatic valves to reduce the risk of scalding, but they have not been fitted to other hot water taps that are accessed by residents. Also on inspection it was noted that one resident did not have a flow of water from the hot tap in her room and staff had to go to the bathroom to collect hot water in order to wash her in her room. This is not adequate and also puts staff at risk when carrying bowls of hot water form one place to another. There are a number of toilets and bathrooms in the home. One toilet and shower room had been upgraded providing adequate assisted facilities. The remaining need to be upgraded to a similar standard. One toilet/shower room on the first floor was very narrow, there was no lock on the door, no light and would pose difficulties for residents with mobility problems to access. Baths were domestic in character and not suitable for residents. One had a bath seat, but it was noted the arm of the bath seat was broken so could not be used. On inspection of the kitchen the cook had worked hard cleaning and organising all areas. The dishwasher and fridge freezer had been replaced and some new mesh provided to a door and window. Other areas that need addressing to ensure adequate food hygiene: • The mesh to one window needs to be put in place. • Chopping boards were not stored properly. • The quality assurance manager was observed using the kitchen as a thoroughfare from one house to another. • The fridge, freezer, and hot food temperatures need to be recorded and the boarding around the boiler was damaged. • The arrangement for the storage of knives was inadequate and there is a risk of accident. • The extractor fan needs cleaning or replacing. • Chest freezers make it difficult for access food items and stock rotation and it is recommended that some baskets be purchased for use in the freezer. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 26 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 area is poor. This judgement has been made using available evidence including a visit to this service. The recruitment procedures do not demonstrate residents are adequately protected. Staffing levels are not consistently maintained to meet resident’s needs and staff have not received updating training over the past year to ensure they have the skills and knowledge to care for residents. EVIDENCE: A sample of staff rotas were viewed and it was noted that the manager works five days per week and it was stated that he is on call at other times. He is working on the floor as a nurse two to three days each week and supernumerary for the remainder of the time. Rotas indicated there is one nurse and four carers on duty during the day with one nurse and two carers overnight. A number of the care staff work long days, which necessitates a lunch break and therefore a reduction the number of staff available to meet resident’s needs at certain times of the day. It was also noted that some staff are working a late duty followed by a night duty, which is a total of 18 hours. Also staff are working a night duty followed by a late duty, which means they do not have a 12-hour break between shifts. The working time directive does not allow for such working patterns. Also staff will be tired and this will impact on level of care provided. The manager will need to review this area. On the day of visiting there was only three care staff on duty. One had phoned up to say she was expecting furniture to be delivered and would not be arriving Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 27 for the shift. Also there was no domestic member of staff despite her being rotared to work. The nurse on duty stated she had tried phoning some other members of staff to come in to cover, but could not get hold of anyone. The manager must ensure there are adequate staff on duty at all times to meet residents needs and there must be robust systems in place to cover periods of absence It was noted that the home has some overseas nurses who are undertaking there adaptation training. The rota indicated that they worked on a full time basis as carers. However, the documentation shown to the inspector indicated that they should spend at least 50 of their time with their mentor in order to develop the knowledge and skills to practice as a qualified nurse in this country. On discussion with two of the staff they did not display adequate knowledge about various areas. They stated they do their work and try to spend time with their mentor when finished and one stated she had only undertaken one medication round since working in the home. The findings suggest they are not spending enough time with their mentor or the level of teaching is not adequate. This area will need to be reviewed fully to ensure these staff are adequately trained before being registered as fit to practice as nurses. A sample of records in respect of recruitment were inspected. At the last inspection the home had a list of checks in respect of Criminal Record Bureau and Registration Numbers for nurses, but there was no evidence available. In some cases there was no indication of start date, no proof of identity, no work permit or visa for staff from over seas. Although references were available in one case they were from a friend and work college and there was no record of the interview. It appears that no developments have been made since the last inspection and the process puts residents at risk. Staff files indicated that induction training was undertaken over one of two days. The manger provided a copy of a more in depth induction training and stated it had been commenced with two newly employed staff. Records of staff training indicated that some basic core training had been undertaken at the beginning of January 2006, but it was only valid for one year. Therefore staff training in all basic areas e.g. fire prevention, basic food hygiene, first aid, moving and handling, infection control needs to be undertaken. The information provided indicated that at over 50 of care staff had undertaken NVQ level 2 training to provide them with the knowledge to care for residents and meet the National, Minimum Standards. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 28 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Management systems need further development to ensure resident’s benefit from living in a well managed home. The prompt servicing of equipment needs to be addressed to ensure resident’s health safety and well being is protected. EVIDENCE: The Registered Manager is a trained nurse who has many years experience working in elderly care and he has been undertaking the Registered Managers Award. Currently he works 2-3 days per week on the floor and the remainder of the time is supernumerary. There is no deputy manager in post and a senior nurse takes responsibility from time to time. However, there is generally only one nurse on duty at any one time. Many of the requirements Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 29 not met and poor outcomes against many of the standards highlight that the time allocated is not adequate to effectively manage the service Records indicated that staff supervision occurred approximately three times in the past year. The National Minimum Standards state it should be conducted six times per year. There was no evidence of staff meetings occurring. A return visit was made to the home, as records of resident’s finances were not available. It was stated that the personal allowances for the proprietor receives four residents and the money is held in the bank in a separate business account. It was stated that other residents or relatives handle monies. On inspection of records they were found to be satisfactory, except some cheques had not been banked since December. Arrangements must be in place to ensure cheques are banked in a more timely fashion, it is an interest bearing account and records are kept in the home. The home has a quality assurance manager who visits to undertake statutory monthly visits and she visited on the day of inspection. She was observed to use the kitchen as a thoroughfare an issue that was highlighted at the last inspection. There were no copies of reports from the visits and they re not forwarded to the Commission as required under the regulations. Questionnaires were left with the staff in the home for the quality assurance process. However, these were only for residents and staff. Feedback should be obtained from all stakeholders and a development plan drawn up to demonstrate improved outcomes for residents. The home had undertaken some maintenance and servicing of equipment to meet health and safety requirements. However, a number of areas remain outstanding from previous inspections: • Not all wheelchairs had been serviced. • Not all hoists had been serviced and the electric hoist needed a new charger. • The bath seat had not been serviced and the arm was broken. • The servicing of the passenger lift identified some faults and there was no evidence that they had been addressed. In addition, at the time of inspection the passenger lift had not been working properly for approximately 10 days. • There was no current gas safety certificate. • There was no evidence of testing electrical appliances or the electrical wiring system. • The fire officer had recently undertaken an inspection and issues were identified that require attention to ensure adequate fire precautions but these had not been addressed. • There was no evidence that the scales had been calibrated and serviced. • There was no record of hot water temperatures. • There was no record of running water from little used taps and showers to reduce the risk of legionella. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 30 • Risk assessments were not in place for aspects of the building, fire and chemicals. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 31 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 1 1 1 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 1 x 1 1 x 1 1 1 STAFFING Standard No Score 27 1 28 3 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 2 2 X 1 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 32 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 OP1 Regulation 4 Requirement The Registered Person must review the Statement of Purpose and ensure it accurately reflects the services and facilities in the home with copies of any procedures referred to. Timescale of 30/11/06 not met The registered person must undertake a review of the service user guide and update it providing accurate information plus a copy of the complaints procedure and the terms and conditions of residence. Timescale of 30/11/06 not met The registered person must ensure a contract of residence is made available to all residents indicating the terms and conditions and a copy is retained on their files. Timescale for action 30/03/07 2 OP1 5 30/03/07 3 OP2 5 28/02/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 33 4 OP3 14 5 OP4 12(1) 18(1) 6 OP4 12(1) 13(4) The registered person must ensure: • A comprehensive pre admission assessment is completed for all residents. • The pre admission assessment is signed and dated when completed. • Write to the prospective residents to confirm if the home can meet their needs. • The admission assessment is reviewed and fully completed on admission to the home. • Risk assessments are completed in respect of continence and mental health where appropriate. Timescale of 30/10/06 not met The registered person must ensure all staff undertake training in respect of caring for people with dementia commensurate with their position in the home. Timescale of 30/12/06 not met The registered person must ensure that when residents are admitted to the home they are provided with a suitable room to meet their needs and any equipment that is required. 20/02/07 30/06/07 30/01/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 34 7. OP7 15 8 OP7 17(2) 12(1) 9 OP7 17(2) The registered person must 20/02/07 ensure: • The care plan for each resident outlines in detail the action required to meet all the residents holistic. • The process includes consultation with the resident or their relatives. • Care plans are reviewed monthly and updated where there are any changes. • Systems are in place to ensure that care plans are implemented in a consistent manner. • Training is given in the care planning system where required. Timescale of 30/10/06 not met 30/01/07 The Registered Person must: • Effective monitoring of residents conditions. • Ensure all areas of concerns are communicated, followed up and records maintained. • Undertake a review of the communication systems and take appropriate action to ensure shortfalls do not occur in the future. Timescale of 30/9/06 not met The registered person must 30/01/07 ensure daily records clearly indicate the care provided and the condition of residents. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 35 10 OP8 13(1) 11 OP8 12(1) The registered person must ensure: • All residents have opportunity to see the chiropodist, optician and dentist on a regular basis and records are retained in the home. • The outcome of doctor’s visits is recorded effectively and consistently. • All residents with chronic diseases such as diabetes, hypertension asthma, etc are reviewed on a regular basis by a health professional and records are retained in the home. Timescale of 30/10/06 not met The registered person must: Bed rails are used on both sides of the bed and bumpers are in place. • Pressure relieving equipment is always used where a resident is assessed as needing it. • A call bell is accessible to all residents in their bedrooms. Timescale of 30/9/06 not met • 28/02/07 20/02/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 36 12 OP8 13(4) 17(1) 13 OP8 12(1) 18(1) 14 OP8 12(1) The registered person must 20/02/07 ensure: • All wheelchairs and hoists etc. are cleaned on a regular basis. • Wheelchairs are used with footplates unless a risk assessment demonstrates differently. • Bed rails are sufficiently high enough to maintain residents safety, there is one on both sides of the bed and they are maintained on a regular basis and records are retained in the home. Timescale of 6/11/06 not met The registered person must 28/02/07 ensure that nurses are fully conversant with the Waterlow risk assessment and tissue viability needs of residents. Training should be provided where necessary. Timescale of 20/10/06 not met The registered person must 20/02/07 ensure: 1. Multiple use syringes are dated, cleaned, dried and stored properly between uses. 2. Review the practice for oral care. 3. Review the practices for catheter care and ensure all staff are aware of procedures. Timescale of 30/9/06 not met • Do not use draw sheets on beds. • Implement appropriate systems for residents in bed to have their hair washed on a regular basis. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 37 15. OP8 12(1) 16 OP8 13(4) 12(1) 17 OP8 37 18 OP9 13(2) schedule 3(3)(i) The registered person must ensure that an objective tool such as body mass index is used when assessing resident’s nutritional status. Where a resident is deemed to be at risk i.e. below 20 a referral is made to an appropriate health professional. Timescale of 30/9/06 not met The registered person must review the suitability of the beds for moving where they are placed against walls and take appropriate action to reduce the risk of any injuries. The registered person must ensure the Commission is informed about all accidents affecting the well being of the residents and any deaths. The registered person must ensure all the medicines are administered as prescribed at all times and the transaction accurately recorded. The right medicine must be administered to the right service user at the right time and at the right dose and the transaction recorded accurately immediately after it has occurred. The home must keep a record of all medicines kept in the care home for the service user and the date on which they were administered to the service user This requirement was not met. Timescale 30/09/06, 12/01/07 28/02/07 30/03/07 30/01/07 22/02/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 38 19 OP9 13(2) The registered person must ensure that a system is in place so service users have an adequate supply of medicines at all times and do not run out of medicines awaiting a new supply to be obtained. All medicines must be discarded if they have reached their expiry date and a new supply sought. This requirement was not met. Timescale 30/09/06, 12/01/07 The registered person must ensure all new services users to the home medication is checked with their doctor on entry to the home and the Medicine Administration Record (MAR) chart accurately reflects what has been prescribed and administered and is available for use. This requirement was not met. Timescale 30/09/06, 12/01/07 The registered person must ensure nursing staff start the medication round earlier and leave sufficient time between medication rounds. Dedicated time must be allocated for nursing staff to undertake the medication round uninterrupted. Timescale not met 12/01/07 The registered person must ensure nursing staff record the amount of medication administered when variable doses are prescribed. This requirement was partially met. Timescale 30/09/06, 12/01/07 22/02/07 20 OP9 13(2) 22/02/07 21 OP9 13(2) 22/02/07 22 OP9 13(2) 22/02/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 39 23 OP9 13(2) The registered person must ensure that two staff must countersign handwritten medication details. This requirement was not met. Timescale 30/09/06, 12/01/07 The registered person must ensure that any service user wishing to self-administer their own medication is risk assessed as able and regular compliance checks are undertaken and documented to ensure they safely do so. Locked facilities to store their medication must be provided. 22/02/07 24 OP9 13(2) 22/02/07 25 OP9 13(2) Timescale not met, 12/01/07 20/02/07 The registered person must ensure: • All creams are dated when opened and discarded after specified time period. • Staff undertaking blood glucose monitoring have the correct equipment and are aware of the procedure for calibrating the machine. • Drugs are administered according to good practice via feeding tubes and it is consistent amongst all staff. Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 40 26 OP10 12(4) 27 OP12 16(2)(m) (n) 14 28 OP15 16(2)(i) 12(4) The registered person must review systems and take action to ensure residents dignity is respected to include; • Hair is combed. • Bibs are removed after meals. • Staff approach residents with an appropriate manner displaying empathy and interact with them. • Training should be provided in this area if required. Timescale of 30/9/06 not met The registered person must undertake a review of the arrangements for stimulation of residents and activities to include: • An assessment of residents past interests and hobbies. • Draw up a plan for group and individual activities to meet all their needs. • Implement the arrangements. • Maintain a record. Timescale of 30/10/06 not met The registered person must: • Review the current arrangements for meals and meal times following consultation with residents. • Ensure there are cultural options available to meet resident’s wishes. On a regular basis and this is recorded. Timescale of 20/10/06 not met 20/02/07 30/03/07 28/02/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 41 29. OP16 22 30 OP18 13(6) 31. OP19 23(2)(b) 32 OP19 13(3) 13(4) The registered person must ensure the complaints procedure is reviewed and updated to meet the standards. Timescale of 30/10/06 not met. • The registered person must all residents and their representatives are made aware of the procedure. The registered person must ensure: • The adult protection and whistle blowing procedures are reviewed and updated. • All staff are provided with training in respect of adult abuse, the procedures for responding to any allegations including the whistle blowing procedure. Timescale of 30/11/06 not met The registered person must undertake and audit of the exterior of the home replace damaged windows and doors and re-decorate. Forward plan. Timescale of 30/10/06 not met The registered person must ensue the clinical waste bins are kept locked. Timescale of 30/9/06 not met 20/02/07 28/02/07 28/02/07 20/02/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 42 33 OP19 13(4) 34 OP19 23(2)(b) 35 OP19 16(2)(j) 36 OP19 16(2)(j) 37 OP19 16(2)(j) The registered person must: • Undertake of review of the security arrangements and ensure action is taken to make sure residents are safeguarded. • Undertake a risk assessment in respect of the fridge and dining equipment in the first floor lounge and take any action identified as necessary to ensure the safety of residents. Timescale of 5/11/06 not met. The registered person must ensure the garden area is made suitable and safe for residents to use when weather permits and all rubbish is removed. Timescale of 30/9/06 not met The registered person must ensure • Staff do not use the kitchen as a thoroughfare. • Obtain a suitable stand for the chopping boards. • Provide suitable storage for knives. • Record the temperatures of all fridges’, freezers and hot food. Timescale of 30/9/06 not met The registered person must ensure the mesh to the window is replaced. Timescale of 30/9/06 not met The registered person must ensure: • The extractor fan is cleaned or replaced. • Baskets are provided for use in the freezer. 01/02/07 30/04/07 05/02/07 05/02/07 03/03/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 43 38 OP19 23(4) 39. OP19 23(2)(n) DDA 40. OP21 12(4)(a) 41 OP21 23(2)(j) (n) 42 OP22 12(1) 43 OP22 23(2)(l) 44 OP24 23(2)(d) The registered person must ensure fire doors are not propped open. If there is a need to keep them open they must be linked into the fire alarm system. Timescale of 30/4/06 not met. The registered person must provide suitable ramped access to the front of the building in order to meet resident’s needs and DDA. Timescale not reached The registered person must ensure appropriate safety locks are fitted to all toilet and bathroom doors to indicate when in use, but can be accessed in the event of an emergency. Timescale of 30/10/06 not met The registered person must review the toilet and bathing facilities and take appropriate action to upgrade facilities to meet resident’s needs and ensure health and safety guidelines are met. Timescale not reached The registered person must ensure call bells are cancelled at the point of origin. Timescale of 15/12/06 not met The registered person must review the arrangements for storage and make suitable arrangements for storage of the homes equipment. Timescale not reached The registered person must ensure all areas in the home are decorated to a suitable standard. Timescale not reached 26/01/07 30/01/07 28/02/07 30/03/07 30/01/07 30/01/07 30/03/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 44 45 OP24 16(2)(c) 46 OP24 12(4)(a) 47 OP24 23(2)© 48 OP24 16(2)© 49 OP24 16(2)© The registered person must consult all residents as to the furnishing in their bedroom to determine their requirements. Where all the furnishings listed in the National Minimum Standards are not in bedrooms it must be recorded in residents files. If this is due to restrictions in space this must be made clear in the statement of purpose and service user guide. Timescale of 30/12/06 not met The registered person must provide: • Lockable facilities for all residents. • Locks to bedroom doors. Residents must be consulted about holding their own keys and if they do not hold a key for any reason this must be recorded in their file. • Provide two double sockets in each bedroom. • Bedside lighting or over bed lighting to all beds. • Provide mirrors over wash hand basin. Timescale not reached The registered person must audit all furnishings and replace any damaged items plus rusting commodes. The registered person must: • Undertake an audit of all linen and replace any damaged, frayed or worn items. Timescale of 30/10/06 not met The registered person must: • Audit all pillows and replace any worn, thin or lumpy pillows. Timescale of 30/12/06 not met 30/03/07 30/03/07 28/02/07 28/02/07 28/02/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 45 50 OP25 23(2)(b) 51 OP25 23(2)(p) 52 OP25 23(2)(p) 53 OP25 23(2)(p) 54 OP26 13(3) The registered person must ensure all windows can be closed and opened effectively. Timescale of 15/12/06 not met The registered person must ensure there is hot and cold water available from all outlets. Timescale of 15/12/06 not met The registered person must ensure there is adequate heating in the home at all times. Also there must be appropriate contingency plans in the event of any emergencies. Timescale of 7/12/06 not met The registered person must; • Continue with the programme of covers to radiators. • Ensure hot water from all outlets accessible to residents must be 43 degrees or - 1 degree. Timescale of 30/12/06 not met The registered person must ensure adequate infection control procedures to include: Provide dedicated hand washing facilities in all areas where clinical waste or infected materials are handled. • The correct procedures for the disposal/cleaning of commode pots and urinals. • The correct storage of washbowls. • Bar soap and toilets should not be in communal toilets and bathrooms. • Correct us of protective equipment and hand washing. • Ensure the correct use of alginate or similar bags in the laundry. Timescale of 20/10/06 not met • 28/02/07 20/02/07 03/02/07 28/03/07 28/02/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 46 55 OP26 12(1) 56 OP26 13(3) 57 OP26 13(4) 58 OP26 13(3) 59 OP26 13(3) 60 61 OP26 OP27 16(2)(k) 18(1) The registered person must review the laundry system and address any issues to ensure all residents clothing is returned to them in a timely manner. Timescale of 20/10/06 not met The registered person must ensure all areas of the home are kept clean at all times including carpets. Timescale of 20/10/06 not met The registered person must ensure all cleaning materials; paints etc are stored in a locked cupboard. Timescale of 30/9/06 not met The registered person must ensure sluice areas are not used for the storage of “clean” items such as syringes, are accessible and locked when no in use. Timescale of 30/9/06 not met The registered person must ensure there are suitable sluice facilities in all area/floors with a sluicing disinfector. The registered person must ensure all areas of the home are kept odour free. The registered person must; • Undertake a review of the staffing levels and ensure there is adequate staff on duty at all times to meet the needs of residents. • Ensure adaptation nurses work according to the requirements of the training institution. • Provide adequate ancillary cover for every day of the week. Timescale of 20/10/06 not met 28/02/07 10/02/07 01/02/07 28/02/07 30/03/07 20/02/07 01/02/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 47 62 OP27 12(1) 18(1) Working time directive. 63 OP29 17(2) 19 64 OP29 19 65 OP30 18(1) The registered person must ensure: • Staff have suitable breaks between shifts. • Do not work excessive hours in line with the working time directive. • There is a robust system for covering periods of staff absence. All staff files must clearly indicate the following information; • Full name, address, date of birth, qualifications and experience. • The date employment commenced and ceased. • The position held in the home, the work performed and the number of hours employed. Timescale of 30/10/06 not met The registered person must ensure a robust recruitment procedure to include; • Two written references from previous employers • Check all gaps in previous employment. • Evidence of a CRB and POVA check. • Evidence of eligibility to work in the country for over seas staff. • Evidence of nurses PIN numbers. • Proof of identity. Timescale of 30/10/06 not met The registered person must ensure all staff undertake induction training to Social Skills Council standards within 12 weeks of commencing employment. Timescale of 30/10/06 not met 01/02/07 28/02/07 10/02/07 28/02/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 48 66 OP30 23(4)(d) (e) 17(2) 67 OP30 16(2)(j) 17(2) 68 OP30 13(3) 69 OP30 13(5) 70 OP30 13(4) 71 OP33 24(2)(3) 72 OP33 26 The registered person must ensure all staff undertake training in respect of fire prevention and at least 2 fire drills per year and records must be retained in the home. Timescale of 30/9/06 not met The registered person must ensure all staff undertake basic training in respect of basic food hygiene and records are retained in the home. Timescale not reached. The registered person must ensure all staff undertake basic training in respect of infection control and records are retained in the home. Timescale not reached. The registered person must ensure all staff undertake basic training in respect of manual handling and records are retained in the home. Timescale not reached. The registered person must ensure all staff undertake basic training in respect of first aid and there is at least one first aider on each shift and records are retained in the home. Timescale not reached. The registered person must obtain feedback from residents, relatives and other stakeholders regarding the home and draw up an action plan indicating outcomes for residents for the purpose of quality assurance process. Timescale not reached The registered provider must ensure a visit is undertaken to the home each month, write a report, which is signed, leave a copy with the home and forward a copy to the Commission. Timescale of 30/9/06 not met DS0000024869.V327698.R01.S.doc 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 30/01/07 28/02/07 Melville House Nursing Home Version 5.2 Page 49 73 OP35 20 17(2) 74 OP36 18(2) 75 OP38 13(4) 17(2) The registered person must ensure suitable systems are in place for dealing with residents personal money and valuables: • The bank account should be an interest bearing account. • Records of bank transaction must be kept in the home. • Ensure cheques are banked in a timely manner. The registered person must ensure all staff receive formal supervision at least five times a year in line with the National Minimum Standards. The registered person must ensure the following servicing is undertaken and records are retained in the home: All hoists All wheelchairs Address issues in respect of the passenger lift. • A gas safety certificate. • Testing of portable electrical appliances. Timescale of 30/11/06 not met The registered person must ensure servicing and calibration of the weighing scales. Timescale of 30/10/06 not met The registered person must ensure the: • Bath seat is serviced and a record is retained in the home. • The electrical wiring systems are checked and records are retained in the home. • • • 28/02/07 30/04/07 28/02/07 76 OP38 13(4) 28/02/07 77 OP38 13(4) 17(2) 28/02/07 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 50 78 OP38 13(4) 17(2) 79 OP38 37 80 OP38 23(4) The registered person must ensure: • The temperature of water form hot water outlets is checked regularly and records are retained in the home. • Water is run from little used outlets regularly and a record is retained in the home. The registered person must ensure the Commission is notified of all events in the home affecting the well being of residents e.g. lift failure, failure of the heating system etc. The registered person must take action to address the issues identified by the fire officer. 28/02/07 01/02/07 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP36 OP24 Good Practice Recommendations The supervision programme is to be developed further to ensure all staff receive supervision appropriate to their needs. (Carried forward as not inspected) It is recommended that when re-decoration is undertaken consideration be given to the needs of residents with cognitive impairment. Different rooms and areas should look different so the residents with cognitive impairment have their independence promoted and avoid unnecessary difficulties. It is strongly recommended that the manager liaise with the Health protection unit for an audit and advise regarding infection control A training matrix should be drawn up to demonstrate the training undertaken by staff. 3. 4. OP26 OP38 Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 51 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Melville House Nursing Home DS0000024869.V327698.R01.S.doc Version 5.2 Page 52 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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