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

This inspection was carried out on 24th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 24/01/07

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 Key Unannounced Inspection 24th July 2007 08:00 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.V338204.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.V338204.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.V338204.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 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) The Registered Manager achieves the Registered Managers Award or equivalent to NVQ 4 in Management of Care by April 2005 That the home can accommodate one named service user under the age of 60 years requiring nursing care. 24th January 2007 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 was available on entering the home. Fees range from £395 to £539 depending on residents needs and it was stated that where a nursing element is paid by the statutory agencies it is refunded to the resident or their representative. Extra charges are made for newspapers, chiropody, hairdressing, toiletries etc. Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social care inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that needs further development The inspection was conducted over two days commencing at 8.00am and the home/provider did not know we were coming. This was the first statutory key inspection for 2007/2008. The manager was present for the duration of the inspection. Information for the report was gathered from a number of sources: a questionnaire was completed before the inspection, a tour of the building, an examination of records and documents in relation to the management of the home, conversation with managerial and care staff plus direct and indirect observation. Three residents who live in the home were’ case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Written comments were also received from residents and visitors to the home. What the service does well: What has improved since the last inspection? Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 6 Staff had been busy addressing many of the requirements from the last inspection. Some had been completed and some were still in progress. They are to be congratulated on the work to date. The medication system had improved and was of a good standard, so ensuring residents receive the medication that is prescribed by the doctor. There had been some improvements in the assessment and care planning process providing staff with the information they require to meet resident’s needs. There were adequate staff on duty and a range of training had been undertaken and more is planned. This provides staff with the skills and knowledge they require to meet resident’s needs. The recruitment procedures had improved, so ensuring any new staff recruited are suitable and residents are safeguarded. There had been some improvements in respect of infection control, odour control and the standard of cleanliness, so providing a more pleasant environment for residents to live and reduce the risk of infection. A member of staff had been employed who is to take the lead role in respect of activities, so that residents are stimulated and receive the opportunity to go out for activities. The outstanding maintenance and servicing of equipment had been addressed, so ensuring the equipment was safe for use. Feedback had been obtained from residents as part of the quality assurance system. Some further bedrooms have been re-decorated, carpets and new furnishings fitted. In addition, the process of providing locks to doors, over bed lighting and extra electrical sockets in bedrooms is in progress, so enhancing the environment for residents. What they could do better: Consideration should be given to providing the service user guide in alternative formats to make them more accessible to residents. There needs to be a more pro-active approach to interventions in respect of the nutritional status of some residents who have been identified to be at risk, to ensure they receive a nutritious dietary intake. Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 7 The assessment and care planning process needs to be further enhanced to ensure appropriate plans of action are put into place and all staff are fully aware of them. Further improvements in infection control procedures are required to ensure residents are protected from infections. Issues and concerns raised by residents and the attitude of some staff needs further attention and action taken to ensure residents are safeguarded. Also systems need to be in place to ensure residents are provided with choices to ensure they have some control over their lives. Plans for activities and stimulation of residents need to be drawn up and implemented to provide residents with a suitable range of stimulation. Ongoing re-decoration and upgrading of facilities is required to provide residents with a safe, homely and comfortable environment to live. The quality assurance systems need to be further developed to ensure a culture of continuous development with feedback from all stakeholders. 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.V338204.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information was available to enable residents or relatives to make a choice about whether the home is suitable for their needs. The collection of information about residents needs before they move into the home would benefit from further detail to ensure staff can meet resident’s needs and provide assurance to prospective residents on entering the home. EVIDENCE: The home generally admits residents for long-term care and does not take admissions for intermediate care. Information was available on entering the home about the services and facilities enabling prospective residents or their representatives to make an informed choice about moving into the home. On reviewing the information it was found to be typed; the statement of purpose had been drawn up in 2002 and some of the statements were a little vague. This should be reviewed and consideration be given to providing it in Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 10 alternative formats e.g. large print etc. to make it more accessible to residents. Of the sample of records inspected, a copy of a contract of residence was available indicating the terms and conditions of residents stay in the home. However, there was no indication of the room allocated or the arrangements for fees and payment of the nursing element. The contract of residents will need to be reviewed and updated in line with the regulations outlining the room occupied, the arrangements for fees and details of all additional costs to inform the resident and their representatives of the terms and conditions of their stay in the home. A small sample of resident’s files were inspected to determine the admission process. It was found that an assessment had been completed before admission, so that staff could determine if the home could meet the prospective residents needs. In some cases these lacked detail and were not consistently signed and dated by the member of staff undertaking the assessment. This area will need to enhanced to ensure staff obtain the appropriate information to make a decision as to whether a persons needs can be met before they enter the home. The staff now write to prospective residents or their representative informing them if the home can meet their needs. This provides confidence that their needs will be met on moving into the home. The home has a number of residents who suffer with confusion or dementia. Since the last inspection staff have commenced training in respect of NVQ level in dementia care and it was stated that all staff would undertake the training. This is positive, as it will provide staff with the appropriate skills and knowledge to care for this group of residents in an effective manner. In addition, they are implementing some good practice recommendations about the environment to aid orientation and independence of residents with dementia. 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.V338204.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There had been some areas of improvement in the arrangements for planning care and assessing resident’s risks; further improvements are needed to ensure all residents’ needs are met in a consistent and appropriate manner. There had been improvements in the arrangements for meetings resident’s health care needs; further developments are required to ensure they are met in a consistent manner. Medication systems were of a good standard, so ensuring residents receive the medication prescribed by health professionals. EVIDENCE: Following admission to the home a further assessment with risk assessments are completed and a care plan drawn up outlining the action required by staff to meet resident’s needs. Risk assessments were completed in respect of manual handling, skin integrity, bed rails, nutrition etc. However, there was no assessment of continence and mental health where appropriate. The manager stated they are to implement new risk assessments in respect of bed Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 12 safety rails and nutrition, which will be more effective in safeguarding residents. On inspection of a sample of care plans they were found to have improved and there was a range of comprehensive information, but in some cases the instructions were vague e.g. supervise as much as possible. The care plans had not been updated where changes had been identified e.g. May need a little help to stand and walks slowly, but the residents was bed bound. On discussion with staff they were not fully aware of the instructions and how to meet residents needs. This area will need to be reviewed and action taken to ensure records are up to date and all staff are aware of the contents to ensure resident’s needs are met in a consistent manner. Daily records were maintained in respect of each resident and there have been improvements in the recording, so providing information about the care provided. This could be further enhanced by including details about residents feelings, mood, activities undertaken etc to provided a more rounded picture of the residents condition and day. All residents were registered with a G.P. and a separate record of health professionals visits were maintained. Since the last inspection this record ha been enhanced, so providing information to staff about the outcome of visits. There was evidence that the optician had visited and on discussion with residents they stated a chiropodist had seen them and the doctor was called when required. However, there was no evidence of visits by a dentist. Also there was no evidence that any monitoring of chronic diseases such as diabetes, high blood pressure, asthma etc had been monitored in order to review medication, identify complications and prevent deterioration. On discussion with the manager he provided a letter indicating that a specialist nurse had visited in respect of a resident with Parkinson’s disease. The manager must ensure a clear suitable record is maintained of all visits by health professionals to demonstrate that resident’s health is being monitored and treated effectively. The staff in the home have been working closely with the tissue viability nurse. It was stated they had purchased all the equipment that had been recommended and it was noted that a number of pressure relieving devices were in place. The staff liaise with the specialist nurse when required, which was demonstrated in the case of one resident, whose sore had recently healed. On inspection of the records it was found that there were no photographs/ graph of the wound and no details of the size and depth. These should be used to enable effective monitoring and response to treatment as good practice. On inspection it was noted that one resident had been admitted and was identified at high risk nutritionally. Although a referral had been made to the dietician and the home were waiting for a visit they had not implemented any Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 13 measures to improve the residents nutritional status with food boosters such as milky drinks, milk shakes, thick yogurts or extra snacks etc. Records of food and fluid intake were recorded and this was confirmed on inspection of records and discussion with staff. Also the resident was prescribed thickeners for drinks due to the risk of choking. However, there were no details of how much to be added or the consistency of fluid to be given. On discussion with staff they gave a different description to that found in some records and on inspection a drink in a beaker in the residents room it did not appear to have any thickener in it. These issues were discussed with the manager to enable action to be taken to address them immediately. Some residents are fed via a tube into the stomach. The care plan did not provide details of the procedure for the administration of medication. On discussion with some of the nurses they were unable to clearly outline the procedure. This area must be reviewed an clear instructions that are in line good practice are detailed in the care plan and all staff are aware of the procedures to ensure there are no drug interactions. The care of the tube was recorded in the care plan, but from inspection of records and discussion with staff it could not be confirmed that the care was undertaken on a regular basis to ensure it was maintained satisfactory. Whilst reviewing records it was noted that residents had not been weighed for a number of months and the reason provided was because the scales were broken. Action must be taken to ensure the scales are repaired or replaced and residents are weighed on a regular basis to enable monitoring of nutritional status. There is a range of equipment in the home that is used for moving residents safely. However, it was observed at one stage that staff were not using the correct procedures, despite many of them recently having had training. In some bedrooms where residents were being nursed in bed there was no evidence of slide sheets. These should be for individual use to reduce the risk of infection. Slings for hoists were available, but some residents were being barrier nursed due to an infection. The care plans stated they were moved with a hoist and they did not have their own equipment. In cases where residents have an infection they must have their own moving and handling equipment to reduce the risk of cross infection in the home. On discussion with a member of staff about the appropriate size of sling to be used with residents they were unable to state how they would know or assess this. A full review of the manual handling equipment should be undertaken and action taken to ensure there is an adequate number of hoists slings etc and staff are aware of their use to ensure safe procedures and reduce the risk of cross infection. During inspection they following was noted; • Some call bells were not accessible to residents or extension leads were not available to summon assistance when required. Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 14 • Residents were moved in wheelchairs without footplates and this could put residents at risk. The manager stated that some residents refuse to use them when in the home and risk assessments had been completed. This must be constantly kept under review due to the potential risk. Some residents were being nursed in bed and pressure relieving equipment was in place. This can pose difficulties with sitting people up in bed and consideration will need to the given to the purchase of some profiling beds that enable easier moving and positioning of residents who are nursed in bed most of the time. Upon inspecting accident records it was noted that an accident for one resident had not been recorded in their personal record and notification had not been made to the Commission as required under the regulations. These records should be completed to ensure an accurate records for each residents is maintained and auditing can take place. This issue remains outstanding since the last inspection. The medication was stored in a medication trolley, which was kept in a locked room. Medication for disposal was kept stored in the medication room, but was not secured in a locked cupboard, which is required for safety purposes. The medication trolley was observed to be clean and organized so that medication could easily be located. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home had copies of the original prescription (FP10’s), so they were able to check the prescribed medication against the MAR chart when it entered the home, so ensuring a robust procedure. Medication management was found to be of a good standard and only one discrepancy was noted. Daily recordings of medication fridge temperature was undertaken to ensure that medication was stored at the temperature required to remain within the product licence of the drug. However, the minimum and maximum temperature should be recorded daily. The staff have worked hard to address the shortfalls previously identified and ensure residents receive their medication safely. On inspection residents were generally well presented. On discussion with residents a number stated they were well cared and staff were good. Some stated it depended on which staff who were on duty and they did things their way. Comments from residents in the home quality system indicated that staff listened to them, but did not always act on what had been said. The manager stated he had been working with staff about these issues and was addressing issues with individuals. Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of meals was good, so ensuring residents receive an adequate and nutritious diet. There were instances were residents were not given choices and so lacked control over their lives. Visitors can visit at time that suits them enabling residents to maintain contact with them. Some progress had been made in respect of activities with the employment of a dedicated person; plans need to be developed and implemented now to ensure residents are adequately stimulated. 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. The home has a small library and talking books. There is a television in each lounge, but there is only a portable television in the first floor lounge and this Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 16 was not suitable for elderly residents with sight problems. There was an activity programme on file that included activities such as skittles, darts, bingo, board games etc. However, there was no evidence of this during the inspection. The record of activities included progressive mobility weekly and a visit by an entertainer once a month. This was confirmed on discussion with residents and some stated they did get bored. On discussion with the manager he stated they had just employed a carer who had previous experience as an activity co-ordinator and there were plans that they would spend part of their working day involved with activities for residents. It was stated that birthdays are celebrated with a homemade cake, a birthday card and a buffet is provided. There is now a visiting hairdresser, who has been popular and it was stated that it has become an event, as she is very sociable and chatty with residents. A priest visits regularly and one resident goes out to church on a regular basis, so residents spiritual needs are being addressed. 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 was 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. The menu is available in the lounges/dining rooms, but it is produced in small type and is not accessible to for residents. This should be reviewed and an alternative format provided to make it more accessible to residents. At the time of inspection various diets included diabetic, gluten free and puree meals. On discussion with the main cook she stated she does include cultural options when time allows. Currently the home is looking to recruit a second cook who will cover the cook’s absence and provide continuity in the service. On discussion with residents they stated they enjoyed the meals and the food was of a good standard. They stated they did get choices some times and this was confirmed on inspection of the record of food. Also feedback from the homes quality assurance questionnaires indicated some residents were not given choices in various aspects of daily living including meals. The manager is to address the issue, so residents have more control over their lives. Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 17 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. Feedback indicates that residents are not always listened to any issues acted upon. Policies, procedures and staff training are required to ensure robust procedures in the home to safeguard residents. EVIDENCE: The home maintains a record of complaints. There had been one complaint and one adult protection referral in the past year. The complaint had been investigated and upheld and the manager has made arrangements to meet with a member of the family on a regular basis to provide feedback and address and issues. The adult protection referral had been investigated by Social Care and Health and was not upheld. Complaints/concerns had been raised with the Commission about the security in the home, the cleanliness of equipment, the response to call bells and the heating in the last year. In all cases it was found that the regulations had not been met and requirements were made of the home to address the issues. Feedback from residents in the quality assurance questionnaires indicated staff may listen but so not always act upon issues or concerns raised and they are not always given a choice in various aspects of daily life. Also it was stated that some staff are not helpful and “It has to be their way”. The manager is aware of these issues and will need to take action to address them. Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 18 The adult protection procedures still require updating and training for staff has been arranged to be undertaken in August 2007. This should provide staff with the knowledge to identify any areas of abuse and the appropriate procedures to follow, so residents are safeguarded. Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 19 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): 19,20,21,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are ongoing improvements in the décor and facilities, so enhancing the environment for residents. Upgrading of bathing facilities is required to ensure suitable assisted bathing facilities for residents with mobility problems. EVIDENCE: Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 20 On arrival it was noted that the exterior of the building required decorating as paintwork was damaged. Also some of the windows are made with wood, which appeared to be rotten and some were draughty. An audit must be undertaken and replacements made where necessary. 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 and the patio door of house 70 at the rear where there are portable wooden structures. 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. The security to the home has been improved since the last inspection and guttering has been repaired to ensure the safety of residents and anyone using the steps. 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 were a number of discarded items that were waiting for disposal. The clinical waste bins were 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 was situated to the rear of house 68 and access is gained through the garden or a kitchenette area. This area has a kitchen cupboard, sink and the cupboard was damaged, the seal around the sink was coming away. Liquid soap was available for hand washing, but there were no hand towels and the area needed re-decorating to ensure adequate infection control procedures. There was a washing machine and tumble dryer in the laundry and a new press had been purchased for ironing linen. The area needed re-decorating Since the last inspection the staff have been addressing the issues raised by the by fire officer to ensure the home meets the fire regulations and residents are protected in the event of a fire. However, during a tour of the home it was noted that some doors were propped open with wedges and 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. 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. Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 21 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. It was stated that the remaining lounge/dining room in house 68 and the reception area were due to be re-decorated in the near future. In addition, there are plans to provide staff facilities so that the kitchen is not used by care staff and hairdressing facilities are to be provided for residents. A number of bedrooms had been inspected and were found to have been redecorated plus new carpets and furnishings provided. Also the provision of extra electrical sockets, over bed lights and locks to bedrooms doors were in the process of being fitted, so enhancing the facilities and privacy for residents. Whist the decoration is being undertaken staff had been researching the needs of residents with dementia and are to include specific colours and aids to assist residents with orientation and independence. The arrangements in respect of infection control need further improvements. Although soap dispensers and hand gels had been provided in areas paper towels were not always available. Staff were also seen walking around the home with gloves and aprons on after providing support to residents. These should be removed and hands washed after providing support. Also staff were seen to be walking around the home with used incontinence pads in their hands prior to disposal. A review in respect of the hand gels should be undertaken with the client group, as they are small portable bottles Other areas that require attention to ensure it is safe and reduce the risk of cross infection for residents included: • Some of the linen was frayed. A full audit should be undertaken and any frayed damaged items should be replaced. • Staff were entering the lounge of house 70 by the patio doors. Alternative arrangements should be made for entering the home to ensure residents comfort during poor weather. • The sealant around sinks was damaged and needs replacing. • Toiletries, steradent and a razor were found in bathrooms and pose a risk to residents. These must be returned to individual residents rooms after use. • Extractor fans in some areas were not working. • Toilet roll holders were not always accessible to residents. • The shower area needed some re-grouting Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 22 All areas are individually and naturally ventilated and restrainers are fitted to windows to ensure safety and security. Some radiators had been fitted with covers to reduce the risk of scalding to residents and radiator controls had been fitted enabling residents to adjust the temperature in their rooms. A new boiler is to be fitted in the near future and will ensure consistent heating arrangements. New domestic staff have been employed and there had been improvements in the standard of cleaning, so enhancing the environment for residents. There are five bathrooms around the home and 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. At the time of inspection there was no water flow from a residents tap and a tap in the staff toilet. One toilet and shower room had been upgraded providing adequate assisted facilities. The remaining needs to be upgraded to a similar standard and it was stated there are plans to upgrade one in the near future. 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 one had a bath seat to enable residents to access it. On inspection of the kitchen the cook had worked hard cleaning and organising all areas. Fridge, freezer and hot food temperatures were recorded, so ensuring food was safe for residents. Chopping boards were now stored separately and there was a safe area for the storage of knives. Other areas that need addressing to ensure adequate food hygiene: • The mesh to one window and door needed attention. • The extractor fan was very noisy. • Sauces had been opened and had not been dated. • Potatoes were stored on the floor. Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a fairly consistent staff group who were aware of residents needs and were able to meet them. There have been improvements in staff recruitment procedures and staff training; so ensuring staff have the knowledge and skills to meet residents needs and they are protected. EVIDENCE: A sample of a staff rota was 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. The rota indicated there was one nurse and four/five 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. On the day of visiting there was one nurse and five carers on duty plus domestic and catering staff. However, it was noted on a number of occasions that residents in all lounges were not supervised and had no way of summoning assistance. There must be adequate staff on duty at all times to meet resident’s needs and supervise residents effectively. Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 24 A sample of records in respect of recruitment were inspected. The records included an application form and health declaration, two references and proof of identity. There was evidence that a Criminal Record Bureau Check had been undertaken, but a copy was not available in the home. Where a home does not hold the full copy of the CRB for inspectors to see at the time of inspection. The minimum expectation with regards to CRB checks is that on receipt of the disclosure, the umbrella organisation or corporate body should issue a letter to providers stating; • The name of the person • The date of disclosure • Level of disclosure. • Including POVA check. • Disclosure reference number. • Date POVA first check was received and the POVA first reference number. Some staff had been provided with a contract, but in some cases there were no details about the date of commencing employment and hours worked. Nurse’s registration numbers had been checked at the end of last year, but some were out of date and this will need to be checked again to ensure nurses are registered to practice. Since the last inspection a new induction programme had commenced, which meets the Social Skills Council standards. On discussion with staff they stated they had been provided with a file that had to be completed. This will provide them with the appropriate knowledge to care for residents when commencing work at the home. The information provided indicated that over 50 of care staff had undertaken NVQ level 2 training to provide them with the knowledge and skills to care for residents and meet the National Minimum Standards. A number of training courses had been undertaken by staff since the last inspection and included core areas such as basic food hygiene, infection control, manual handling and fire prevention, so providing staff with the skills and knowledge to meet resident’s needs. Training for health and safety plus vulnerable adult procedures were booked for August 2007. On discussion with some staff they were not fully aware of the fire procedures and some poor manual handling procedures were observed. These areas will have to be followed up to ensure all staff are fully aware of correct procedures and residents are safeguarded. Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 25 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 adequate. This judgement has been made using available evidence including a visit to this service. There have been improvements in the management systems, so ensuring residents health, welfare and safety needs are being met. EVIDENCE: The Registered Manager is a trained nurse who has many years experience working in elderly care and he has completed 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. Records indicated that staff meetings and residents meetings were occurring regularly now, enabling staff and residents to discuss various areas and enabling them to have some input into the running of the home. Formal staff Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 26 supervision was occurring regularly so providing staff with support, identifying training needs and areas of improvement. Many of the policies and procedures required updating to provide staff with the information as to how various aspects of care and procedures should be carried out safely and it was stated that the process had begun The home holds money for residents, but the records and finances were not available for inspection as the administrator was not at work due to illness. This means that residents would be unable to access their money or records. This is not acceptable and arrangements must be put in place so that these are available at all times when the administrator is absent. Requirements form the previous inspection have also been carried forward as there were issues raised In respect of the bank account used for residents money and the banking of cheques. The home has a quality assurance manager who visits regularly to undertake statutory monthly visits in order to monitor the conduct of the home and write a report. However, copies of the reports were not available and had not been forwarded to the Commission as required. Residents had completed questionnaires recently as part of the quality assurance process, but have to be analysed yet. Feedback should also be sought from other stakeholders and a development plan drawn up indicating outcomes for residents, so that there is a process of continuous improvement. A range of maintenance and servicing of equipment had been undertaken. A sample of records were inspected in respect of the wheelchairs, passenger lift, hoists, fire and emergency lighting and gas equipment and they were found to be of a satisfactory standard. Legionella testing is to be undertaken when work is completed on the boiler. The only areas outstanding were in respect of servicing of the hoists and passenger lift. Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 27 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 2CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 2 1 2 2 2 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 1 3 2 2 Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 28 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 OP2 Regulation 5 Requirement Timescale for action 30/09/07 2. OP3 14 Residents or their representatives should be provided with a contract that clearly indicates the room to be occupied, the full arrangements for fees and services that are not included in the fees, so that they are fully aware of the terms and conditions of residency. Assessments should be 30/08/07 comprehensive in order to provide detailed information about residents needs when being admitted to the home so that staff have the information to draw up a detailed care plan to meet residents need. All care plans should provide clear, detailed information about the action required by staff to meet residents needs and it must be updated when there are any changes in residents needs. All staff should be fully aware of the care plans to ensure residents needs are met in a consistent manner. All accidents must be recorded in DS0000024869.V338204.R01.S.doc 3. OP7 15 30/09/07 4. OP8 37 30/07/07 Page 29 Melville House Nursing Home Version 5.2 resident’s individual notes and the Commission informed about all accidents affecting the well being of the residents. Timescale of 30/1/07 not met 5 OP8 12(1) Staff must ensure food boosters are used where it is identified that resident’s nutritional status is poor when waiting for a visit from a dietician to ensure residents receive an adequate dietary intake. 30/07/07 6 OP8 12(1) 7 OP8 13(3) Where thickeners are prescribed there must be clear instructions as to the use of them and all staff must be aware, so that the risk of a residents choking is reduced. The arrangements for care of 15/08/07 peg feeding tubes and the administration of medication must be clearly recorded in care plans and all nurses must be fully aware of the arrangements to ensure the correct care and reduce the risk of any drug interactions. 30/07/07 Infection control procedures should be reviewed to reduce the risk of infection in the home and ensure residents safety to include: • Staff must wash hands and remove gloves after supporting residents or handling infected materials. • Provide paper towels in all areas. • Appropriate bags should be available for the disposal of continence pads. • Toiletries should be returned to resident’s rooms after use. Timescale of 20/10/06 not met DS0000024869.V338204.R01.S.doc Version 5.2 Page 30 Melville House Nursing Home 8 OP8 12(1) 9 OP8 13(3)(4) 10 OP8 13(4) 23(2)(n) 13(6) 11 OP18 12. OP19 23(2)(b) 13. OP19 13(3) 13(4) 16(2)(j) 14 OP19 15. OP19 23(4) 16. OP19 23(2)(n) DDA The weighing scales must be repaired or replaced and residents weighed on a regular basis to assist in monitoring their nutritional status. A review of manual handling equipment should be undertaken and action taken where necessary to ensure there is an adequate supply of slings, sliding sheets etc. to ensure residents are moved safely and cross infection is prevented. Call bells or extension leads should be accessible to residents to enable them to call for assistance when required. The adult protection and whistle blowing procedures should be reviewed and updated and all staff provided with training in respect of adult abuse to ensure residents are safeguarded. Timescale of 30/11/06 not met An audit must be undertaken of the exterior of the home and all damaged windows and doors replaced and re-decoration undertaken. Timescale of 30/10/06 not met The clinical waste bins should be kept locked or enclosed to reduce the risk to residents. Timescale of 30/9/06 not met Mesh should be provided to the kitchen window and door to ensure adequate food hygiene conditions in the kitchen. Timescale of 30/9/06 not met Fire doors should not be propped open as they pose a risk in the event of a fire. 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. Suitable ramped access should be provided to the front of the building in order to meet DS0000024869.V338204.R01.S.doc 10/08/07 30/09/07 30/07/07 30/09/07 30/03/08 30/08/07 30/08/07 30/07/07 30/03/08 Melville House Nursing Home Version 5.2 Page 31 17 18. OP24 OP25 16(2) 23(2)(p) 19 OP25 13(4) 20. OP26 13(3) 21 OP27 18(1) 22. OP30 18(1) 17(2) 23 OP33 26 24. OP35 2017(2) resident’s needs and DDA. Timescale 30/1/07 not met All frayed/ worn linen and towels must be replaced. Timescale of 30/10/06 not met Hot and cold water must be available from all outlets to ensure adequate hygiene and infection control procedures. Timescale of 15/12/06 not met Suitable arrangements must be put in place to ensure residents are protected from radiators and hot water from all outlets to reduce the risk of scalding. The registered person must ensure there are suitable sluice facilities in all area/floors with a sluicing disinfector to reduce the risk of infection. Timescale of 30/3/07 not met. There must be adequate staff on duty at all times to ensure all residents’ needs are met and they are adequately supervised. All staff must undertake training required to meet residents needs and systems must be in place to ensure good practice is implemented. A nominated person must visit the home once a month and write a report on the conduct of the home. A copy of the report must be left with the manager and a copy forwarded to the Commission, so that regular monitoring of the home is undertaken by an external person. Timescale of 30/9/06 not met 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 DS0000024869.V338204.R01.S.doc 30/09/07 10/08/07 30/10/07 30/03/08 30/07/07 30/12/07 30/08/07 30/09/07 Melville House Nursing Home Version 5.2 Page 32 must be kept in the home. Ensure cheques are banked in a timely manner. Timescale 28/2/07 not met. Systems must be in place for records and money held in respect of resident’s finances to be accessed when the administrator is absent. The following servicing of 30/08/07 equipment must be undertaken and records retained in the home to ensure the equipment is safe for used. All hoists Bath seat The passenger lift. Timescale of 30/11/06 not met 25. OP38 13(4)17(2 ) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The Statement of Purpose and service user guide should be reviewed to ensure it is up to date, reflects the services and facilities in the home and is in a format accessible to residents. This is to provide them with information about the home and enable them to make an informed decision about moving into the home. Daily records should include details of resident’s feelings, moods, activities etc. Records of visits by all health professionals should be recorded in a manner that enables easy retrieval of information to demonstrate that resident’s health needs are met effectively. Arrangements should be made for all residents to see a dentist on a regular basis to ensure residents oral care needs are met. DS0000024869.V338204.R01.S.doc Version 5.2 Page 33 2 3 OP7 OP8 4 OP8 Melville House Nursing Home 5 OP8 6 7 8 OP8 OP9 OP12 Suitable tools for monitoring pressure sores should be in place to enable staff to determine if wounds are healing satisfactorily with prescribed treatments or is further interventions are required. Reviews must be regularly undertaken where footplates are not used with wheelchairs to ensure resident’s safety is maintained. The minimum and maximum temperature of the drug fridge should be recorded daily to ensure medication is stored at the correct temperatures and is safe for use. An assessment of residents past interests and hobbies should be undertaken and a plan of activities (individual or group) drawn up and implemented to meet resident’s preferences and provide adequate stimulation. The television in the first floor lounge is changed for one that is more suitable to meet resident’s needs. Arrangements must be in place to enable residents to make choices about aspects of care, meals etc. so they have some control over their lives. The menu should be reviewed and provided in a format that is more accessible to residents and they should be provided with a choice of meals at all times. Suitable safety locks should be fitted to all toilet and bathroom doors to indicate when in use, but can be accessed in the event of an emergency to enhance resident’s privacy. The bathing facilities should be upgraded in order to provide residents with a range of assisted bathing facilities to meet their needs. The programme of decoration should be completed to enhance the environment for residents. The provision of extra electrical sockets, over bed lighting, locks to doors and replacement of furniture should be completed to enhance the environment for residents. All staff records should include the number of hours worked and the date employment commenced. Also up to date records of all nurses’ registration numbers should be available to demonstrate they are fit to practice. The quality assurance system should include feedback from relatives and other stakeholders regarding the home and a plan drawn up indicating outcomes for residents to ensure continuous improvement in the home. 9 10 11 OP14 OP15 OP21 12 13 14 15 OP21 OP24 OP24 OP29 16 OP33 Melville House Nursing Home DS0000024869.V338204.R01.S.doc Version 5.2 Page 34 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. 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