Inspection on 28/02/08 for Melville House Nursing Home

This inspection was carried out on 28th February 2008.

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

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 24/07/07

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 Amanda Lyndon Key Unannounced Inspection 10:00 28th February 2008 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.V356515.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.V356515.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) none 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.V356515.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Categories have been reviewed and awaiting new registration certificate 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 July 2007 Date of last inspection Brief Description of the Service: Melville House is a care home providing accommodation for up to 26 residents requiring nursing care. This includes a number of residents who have dementia care needs. The Home is situated in a quiet residential area approximately 4 miles from Birmingham City Centre. There is easy access to local amenities. A number of good public transport options are available and there is a bus stop directly outside. The property comprises of two Victorian residences joined by a bridge type construction providing access beneath to the large garden and car parking at the rear of the Home. Limited off road parking is also available to the front of the building, however the access is via a very steep incline and may not be suitable for people with mobility difficulties. There is a range of single and double rooms each with wash hand basin and call bell. There is a range of equipment for moving and handling residents plus a passenger lift in house 70 that gives access to the first floor. There is no lift facility from the ground to the first floor in house 68. The Home provides accommodation for residents from a variety of cultural and ethnic backgrounds and this is reflected in the staff group working in the Home. There are notice boards located throughout the Home displaying information of interest to residents and their visitors and a copy of our last report was on display. Written information about the services and facilities provided was available Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 5 however details of accommodation fees were not included. This information and can be obtained from the home manager. Extra charges are made for newspapers, chiropody, hairdressing and toiletries. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The focus of our inspections is upon outcomes for the people who use the service and their views of the service provided. This process considers the service’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. This is our second key visit to the Home within the last twelve months and it is recommended that this report be read in conjunction with the previous visit report dated 24th July 2007 in order to identify any progress made. Prior to the inspection, questionnaires were sent out to residents and staff in order to obtain their views about the service provided at Melville House, however these had not been returned. It was unfortunate that these had not been returned as we were unable to seek the views of a number of residents on the day of the visit due to limited communication of a number of these people. Four Inspectors, including a Pharmacy Inspector undertook the inspection over one day and the Home did not know that we were visiting. There were twenty six residents living at the Home on the day of the visit. As part of the inspection four residents were “case tracked”. This involves establishing their individual experiences of the service provided by talking to them and their visitors about the care they receive and talking to the staff providing their care. We looked at care files, focusing on the outcomes for residents using the service and the staff files of the people providing their care. A tour of the Home relevant to the residents “case tracked” was undertaken. No immediate requirements were made on the day of the visit. Shortly following the visit the registered manager sent us a detailed action plan addressing requirements made in a timely manner. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 7 What the service does well: Residents have the option of retaining their own Doctor on admission to the Home (providing the Doctor is in agreement) and they have access to a range of other Health and Social Care Professionals Residents are cared for in a respectful manner by staff and this ensures that their self- esteem and dignity are maintained. One resident met during the visit said “Staff are good. They come at night when you need them, I like living here”. Residents are able to exercise control over their daily lives and this promotes their independence and individuality. There are no rigid rules or routines and residents can choose where they spend their day and where they are served their meals. Residents’ individual religious beliefs and cultural preferences are respected and opportunities for religious worship are provided as requested. The cultural backgrounds of staff reflect that of residents living at the Home so that care should be provided in an understanding manner. There is an open visiting policy and residents have the choice of where they entertain their guests so that they can meet in private if they wish. One visitor said “We can visit at any time”. Residents are served a variety of healthy meals that meet any special dietary requirements for reasons of health, cultural background or taste. One visitor said “The Cook does her best to provide cultural food”. Complaints are investigated in an appropriate and timely manner so that people are confident that their views are listened to. Staff training is provided so that staff should have the appropriate skills and knowledge to work safely and effectively in order to provide a good standard of care to residents. Staff meetings are held regularly ensuring that important information about residents’ care and the services provided are conveyed and discussed amongst the staff team. Aids and adaptations are provided so that the independence, choice and dignity of residents are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure that they are safe to use. Alarm pads are used for residents deemed to be at risk of falling in order to alert the staff team if they get out of bed on their own, thus prevent the risk of accidents occurring. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? The Statement of Purpose and service user guide had been reviewed so that it contained up to date information about the services and facilities provided at the Home. This means that prospective residents can make an informed decision about whether they would like to live there. Prior to coming to stay at the Home, individual assessments of prospective residents’ care needs are undertaken and the home manager confirms in writing to them that their care needs could be met at Melville House. Some residents are involved in the writing of their care plans so that care and support should be provided to them in the ways that they prefer. Residents who are deemed to be at risk of malnutrition receive additional snacks to ensure that they receive adequate nutrition. Arrangements have been made so that all residents have the opportunity to be examined by a dentist on a regular basis in order to improve their oral health. The adult protection and whistle blowing procedures had been reviewed and staff had undertaken recent training in this area. This should ensure that residents are protected from harm. A number of improvements had been made regarding the internal and external living environment of the Home so that steps have been made to enhance the comfort, privacy and safety of residents. These include: • Exterior windows had been replaced with double glazing. • Two large screen televisions had been purchased. • Worn bed linen and towels had been replaced. • Suitable safety locks had been fitted to all toilet and bathroom doors. • Bedroom furniture had been replaced, over bed lighting had been fitted and extra electrical sockets had been provided in bedrooms. One resident met during the visit said “I’m happy with my bedroom”. • Suitable seated weighing scales had been purchased. • Pendant style call bells had been purchased so that residents could summons assistance from staff when required. • A rolling programme of fitting radiator covers had commenced. • A rolling programme of fitting magnetic closures to bedroom and communal doors has begun so that doors can be held open, however will close automatically in the event of a fire. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 9 • • • New dining furniture and comfortable chairs had been purchased for one of the lounges. The communal toilet on the ground floor was spacious and had recently been redecorated and refurbished to a good standard. The rear garden had been cleared so that it is a pleasant and safer area for residents to use. Systems have been put into place and some equipment has been purchased to reduce the risk of infection spreading at the Home thus promote the health and safety of residents and staff. Additional specialist equipment has been purchased to support residents who are unable to walk unaided. This means that residents should be supported safely and the risk of staff injuring themselves whilst doing this should be reduced. Senior external managers undertake quality monitoring visits at the Home and residents are involved in these visits so that their views of the service provided are put forward. What they could do better: A copy of the service user guide should be distributed to all residents so that they are aware of the information within this. Detail of the fees incurred to stay at the Home should be included within this. Arrangements must be made during trial periods to ensure that the Home can meet the needs of new residents living there in order to ensure the safety of all residents. Each resident must have an up to date care plan so that care and support can be provided to residents in the ways that they prefer and require. Comprehensive records must be kept in relation to food and fluid intake so that care can be monitored effectively and the appropriate care provided. Personal risk assessments must be available for individual residents in order to reduce the risk of harm and uphold residents’ health and safety. The medicine management is good within the Home but further work is needed to ensure that all the residents have their medicines available to administer at all times. At least four hours should elapse between drug rounds to ensure that the potential for overdose is reduced. Activities and excursions should be provided that meet the needs and expectations of all residents living at the Home. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 10 The programme of redecoration, refurbishment and repair must continue so that the premises are fit for purpose, meet residents’ needs and ensure residents’ safety. Suitable ramped access should be provided to the main entrance so that the Home is easily accessible to residents and visitors who may have limited mobility. There is a need for additional mechanical disinfection equipment for the hygienic cleaning of commodes in order to reduce the risk of cross infection at the Home. A system should be introduced to ensure that residents’ personal toiletries are for single person use only in order to reduce the risk of cross infection. Arrangements must be made to ensure the safety of residents whilst in the communal lounges. A review of staff allocation and daily routines must be undertaken in order to improve staff availability so that residents receive care, supervision and support at the times they require. One visitor met during the visit said “Staff are friendly and try their best but there are not enough staff on duty because a lot of people need one to one care”. Arrangements should be made to ensure that all staff are aware of the importance of good interactions with residents in order to promote a homely and happy living environment for residents. Systems should be in place to ensure that any information missing from prospective workers’ job application forms and recruitment records be sought in order to safeguard residents. A report based on the findings of service satisfaction questionnaires should be written so that residents and relatives are aware of any actions to be taken. This should include time scales for the actions to be taken. Following risk assessments, remedial action must be undertaken to ensure residents are protected from scalding injuries from the hot water outlets in their bedrooms. In order to maintain the health and safety of residents, wheelchairs must not be used without foot plates unless a risk assessment states otherwise. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 11 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.V356515.R01.S.doc Version 5.2 Page 12 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.V356515.R01.S.doc Version 5.2 Page 13 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admission processes are thorough and prospective residents know before admission that their care needs could be met at the Home. EVIDENCE: The statement of purpose identified the services provided at Melville House including that residents with dementia care needs could live there. The service user guide was produced in a large print format and was available on audio on request so that all residents could access this information. This included interesting and relevant information about what it would be like to live at the Home and was written in an easy to read style. Detail of the fees incurred to stay there were not included within the service user guide and these had not been distributed to residents, preventing them from having this information. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 14 Pre admission assessments had been completed for residents who had recently come to live at Melville House. These included all information required in order to determine whether their individual needs could be met at the Home. A number of these were recorded on a hand written piece of paper, however the home manager advised that an assessment document was being introduced. Prospective residents and their families are invited to visit the Home in order to sample what life would be like to live there and ask any questions they may have. Following this letters are sent out confirming that their individual care needs could be met there. Residents come to live at the Home for a four- week trial period and following this time care reviews are undertaken involving residents, their representatives, social workers and the Home’s staff. This provides all present with the opportunity to put forward their views about the care provided and whether the resident would like to continue to live there. One resident who had recently come to stay at the Home had been exhibiting difficult to manage behaviour however the Home’s staff had not addressed this with the Social Worker. This may place other residents at risk of harm and prevent this person’s care needs from being met. Intermediate care is not provided at Melville House. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 15 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. Residents receive person centred care and the systems in place for health provision are generally good however there are inconsistencies regarding the content of care recordings and this may prevent residents from receiving appropriate care. Overall the medicine management was good and the manager has installed good systems to ensure that all the medicines are administered as prescribed. EVIDENCE: On admission to the Home an assessment of individual residents’ care needs are undertaken including their physical, medical, emotional and social care needs. We found that the current documentation being used for this caused confusion as it is called a “residents care plan” instead of a “care needs Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 16 assessment”. A number of these had not been signed or dated by the staff member on completion, the resident or their families and one did not identify the name of the resident to whom it was referring to. Care plans are then derived from this information. These are written plans outlining the specific support required by staff in order to meet the identified needs of individual residents. For example regarding their personal hygiene and emotional care/support needs. Since our last visit, improvements had been made regarding the content of these and they included good detail of residents’ preferences in respect of their daily lives based on their individual abilities and cultural backgrounds. This should ensure that residents receive care at the times they require in the ways that they prefer. There were instructions within the care plans to promote the dignity and independence of residents so that they could lead fulfilling lives. Care plans had not always been written about medical conditions that residents have and this may prevent staff from providing the care they require in these areas. Daily records provide basic information only and do not identify how residents have spent their time. We examined the care records of one resident who has a PEG (tube) feed. Records relating to this were poor and contradicted the instructions identified on the PEG feed regime chart. Instructions were given by the dietician for the staff to maintain a detailed oral intake chart in addition to the PEG feed. The recordings on this were poor, didn’t always identify the amounts or types of diet taken and identified that foods had been given that had not been recommended by the dietician. This poses a serious choking risk for the resident. This was discussed with the home manager who confirmed that as this person’s swallowing reflex had improved recently, a further assessment of this had been undertaken since the assessment recorded in the care file had taken place, however a written report of the outcome of this had not been sent to the Home and the staff had not updated the care plan. A risk assessment had not been written to identify the support required by staff to reduce the risk of this person choking. Since our last visit, additional risk assessments had been completed regarding the moving and handling needs of residents. These were comprehensive and included detail of any specialist equipment required so that both residents and staff should be safeguarded. We observed the equipment being used during the visit. Other personal risk assessments undertaken included the risk of falls, developing sore skin and nutrition. There were some inconsistencies regarding the content of the recording of these and not all included the actions to be taken to reduce the risks identified. The home manager stated that a revised Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 17 risk assessment tool was due to be implemented in order to provide the required information for staff to follow. Observations made demonstrated that residents appeared to be supported to maintain their personal hygiene and choose clothing that was appropriate for their age, gender, culture and the time of year. The home manager stated that new residents could retain their own General Practitioner on admission to the Home (if the GP was in agreement), He stated that a local GP would visit new residents at the home in an emergency whilst a permanent GP was being found. Residents have access to a range of health and social care professionals who visit the home including wound care specialists, dieticians and a dentist. The pharmacist inspection took place at the same time as the key inspection. Eight residents’ medicines were looked at together with their medicine charts and some care plans. The nurse in charge and one resident was spoken with. The home has installed a good system to check the dispensed medicines into the home. However they do not have access to the prescriptions before they are dispensed resulting in any discrepancies not being addressed in time and in one instance one resident’s medicines were not actually available to administer for a period of three days while a prescription was ordered and dispensed. Had the home seen the actual prescriptions before they were dispensed they would have seen that the prescription was missing. The manager undertakes weekly audits of the nursing staff and insists on a running balance of the drugs left in the medicine trolley. This should ensure that medicines are being administered as the doctor prescribed. “When required” protocols had been written for any medicine prescribed for occasional use. These had not been removed and filed from the medicine chart folder when the resident was no longer prescribed the medication. This could result in the resident inadvertently being administered medicines that are no longer prescribed. However the quality of the protocols were good. Residents are encouraged to self-administer their own medicines. No risk assessments or compliance checks were found assessing whether the residents can and do safely take their medication. In one instance staff signed to record they had administered the medicine to the resident. However the resident said this did not happen and she took her own medication and wasn’t checked. Some medicines were administered via a PEG (feeding) tube. Staff crushed tablets. This is not recommended and should only be done when there is no alternative preparation available. There were no drug information books available to confirm that tablets could be administered via this route, however there was evidence that a reference book relating to this had been ordered. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 18 The nurse on duty finished the morning medication round very late (11:20am) This runs the risk of not allowing enough time between medication rounds which may result in potential overdose. We were assured that the round is usually finished by 10:30am. The nurse’s knowledge of the medicines was good and she had a sound understanding of the clinical history of the residents who had lived in the home for a while. The care plans supported some of the medicines prescribed but any information about new residents medication and clinical history was sparse. The manager had written supporting information about each residents’ medication. This must be updated on a regular basis to ensure that it records current information to fully support the nurses and the residents. The home manager was keen to improve medication practice further and was to address the issues raised at the end of the inspection immediately. Residents are generally supported in a respectful manner by staff and this should ensure that their dignity and self esteem are maintained. Residents have the option of a private telephone line installed in their bedrooms or they can use the Home’s portable phone to make/receive calls in private. Residents’ preferred names were recorded within their care plans and during the visit we observed staff greeting them by these. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Residents at the Home would benefit from a wider range of leisure and recreational opportunities to meet their needs, interests and abilities. Residents exercise some control over their daily lives and healthy meals are provided that meet any special dietary requirements for reasons of health, taste and cultural/religious preferences. EVIDENCE: The Home do not employ an activities organiser and activity records identified a limited choice of activities, namely, television, radio and conversation. The Home Manager stated that a staff member who had previous experience of working within an activities role, had recently arranged for a bingo machine and compost for indoor gardening to be purchased in order for residents who may be interested to be involved in these. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 20 In addition since our last visit, an Organisation called “Timeless Partnership” had recently begun to visit the Home in order to develop individualised activity programmes for residents. This includes those people who are unable or who choose not to participate in group activities. This includes therapies, for example hand massages and exercises and plans are in place for the staff team to develop the skills to provide individualised support in this area. They were at the Home on the day of the visit doing hand massages and gentle exercises. A hair dresser visits the home every fortnight. Due to the size and care needs of residents, we would recommend that additional designated time is allocated to provide activities for residents on a daily basis so that their needs are met in this area. Holy Communion is held at the Home regularly and residents are able to go out to church as they choose so that they are supported in this area. There is an open visiting policy and residents can choose where they meet with their visitors. One visitor met during the visit said “We can visit at any time”. Menus identified a variety of nutritious meals, made with fresh ingredients. A light lunch is served at 12:15 followed by the main meal in the evening. On the day of our visit cheese and potato pie, baked beans and a choice of brown or white bread was served for lunch and home made beef stew and dumplings or fish was being prepared for the evening meal. Special diets can be prepared for reasons of health, taste or cultural/religious preferences. Diabetic, gluten free, soft diets and Afro Caribbean options are currently being prepared. One visitor said “The Cook does her best to provide cultural food”. In addition, since our last visit, residents’ dietary intake has been supplemented by the introduction of an increased variety of foods being available at bed time, for example, toast, soup and sandwiches and residents can have a cooked breakfast whenever they choose. Food boosters are used in order to increase the calorific value of meals and drinks for those residents who are deemed to be at risk of weight loss. One resident was not enjoying the meal on the day of the visit and said “You don’t get a choice here for food, I didn’t like it today”. Staff asked this person if they would like an alternative, however this was declined. A record of choices made by residents about the food served to them was available and this identified that alternatives to the main menu were available. Another resident said “Lunch was good”. Residents have a choice of where they are served their meals. Some residents choose to sit at one of the dining tables however a number of residents choose to have their meals in their rooms. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 21 The most recent environmental health report, dated 2007 gave a “Good” outcome, so that meals should be prepared in a safe and hygienic manner Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. People are confident that their views are listened to and there are systems in place that should protect service users from harm EVIDENCE: Since our last visit we have not received any complaints about the service provided at Melville House. The complaints procedure was not on display for residents or visitors to refer to should they need to raise any concerns. This was brought to the attention of the home manager who stated that he would rectify this without delay. The complaints procedure was included within the service user guide, however these had not been distributed to all residents. There was however, evidence that residents had the opportunity to raise any concerns via service satisfaction surveys. The complaints register identified a small number of complaints received since our last visit however most were relating to negative feedback identified on resident surveys. Complaints received included issues raised by residents Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 23 about the living environment and one resident complained about limited choices offered regarding food available. A detailed record of actions taken in response to any concerns raised was available and it was evident that issues raised had been resolved in an appropriate and timely manner. The adult protection procedure was on display and this included the contact details of CSCI and Social Care and Health so that people would know how to raise any concerns of an adult protection nature. The adult protection procedure reflected Birmingham Multi Agency Guidelines and included the types of abuse. Staff had undertaken recent training about this so that they should have the necessary skills and knowledge to safeguard residents. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 24 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, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are provided with a generally clean, comfortable and homely place in which to live. However, there continue to be a number of identified areas that require improvement in order to provide good quality facilities for residents. EVIDENCE: Since our last visit there have been ongoing improvements regarding the internal and external living environment for residents. A rolling programme of redecoration and refurbishment was in place however a number of areas within the Home remained in a poor state of decoration and repair. The exterior of the Home still required some work as it was visually unappealing. The home Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 25 manager stated that plans were already in place to rectify this. Since our last visit external windows had been replaced with double glazing so this should improve the temperature within the Home and new curtains had been ordered. The home manager stated that residents had been involved in choosing these. Ramped access is provided at the front of the building however the main entrance of the Home is only accessible via steps. The front door is alarmed into the nurse call system so that vulnerable residents should be safeguarded. There is ramped access to the rear garden and this is a secure area. Since our last visit work has been undertaken to clear the rear garden so that it is a pleasant and safer area for residents to use. There was no facility provided within the building for residents that chose to smoke so residents that chose to do this did so outside. Information about this is not recorded in the statement of purpose. Since our last visit a key code has been fitted to the external door leading in to the other side of the building and the door has been widened so that independent residents can access this as able at the times they choose without the need for staff assistance. Since our last visit one corridor has been redecorated and radiator covers have been fitted to a number of radiators throughout the Home so that residents do not scald themselves on these. Plans are in place to continue with the redecoration programme using colour coding to orientate residents with dementia. Residents have a choice of three lounges, and two large screen televisions have been purchased recently. The lounges were decorated in a homely style and small enough to promote social interactions between residents. Since our last visit new dining furniture and arm chairs had been purchased for one of the lounges so that residents can dine and spend their time in a comfortable environment. Residents are encouraged to personalise their bedrooms so that they feel comfortable and relaxed in their surroundings. One resident met during the visit said “I’m happy with my bedroom”. A number of bedrooms were sampled and there was a stark contrast between the rooms that had recently been decorated compared to the rooms that were due for redecoration. Since our last visit new bedroom furniture had been purchased and although this was of a good quality, did not include a lockable storage facility for the safe keeping of personal items. This was discussed with the home manager who stated that he was already aware of this and was looking into alternative safe facilities. Two handles had come off a chest of drawers in one bedroom and sharp screws were sticking out of this. This was also brought to the attention of the home manager. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 26 Since our last visit, appropriate locks that could be overridden in the event of an emergency had been fitted to bedroom doors so that residents could lock their doors if they chose. Over bed lights and extra plug sockets had recently been fitted in the majority of bedrooms. New bed linen and towels had been ordered and arrived on the day of the visit. There were a number of shared bedrooms and the privacy curtains in these rooms had been extended to promote residents’ privacy and dignity. It was noted however that the personal toiletries of two residents sharing a room had not been separated or labelled and this may result in cross infection. Since our last visit, work has begun to refurbish and update one of the communal bathrooms in order to make this a safe and comfortable facility for residents’ use. Other bathrooms are in urgent need of refurbishment as unappealing and old assisted bathing and shower equipment was being used. The communal toilet on the ground floor was spacious and had recently been redecorated and refurbished to a good standard. A raised toilet seat and grab rails surrounding the toilet were provided for residents that required these. New safety locks have recently been fitted to toilet and bathroom doors to promote residents’ privacy and these can be over ridden by staff in the event of an emergency. Since our last visit additional specialist equipment had been purchased, for example nursing care beds, pressure relieving mattresses, seated weighing scales and slide sheets (in a variety of sizes), to safely assist residents with limited mobility. In addition, a new transfer hoist had recently been purchased and disposable slings of varying sizes were being used so that each resident had their own sling. This is considered to be very good practice and will reduce the risk of cross infection. The home manager stated that there were now enough pressure relieving mattresses available for residents who had been assessed as requiring these. Other equipment includes pressure mats that are activated should a resident fall/climb out of bed and since our last visit, some nurse call cords have been replaced with that of a pendant style so that residents can summons the assistance of staff when required. The Home was generally clean and fresh with exception of one communal toilet that was not clean and ready for residents’ use. This was brought to the attention of the home manager who alerted the cleaning staff to this without delay. There was an odour in one bedroom and the home manager explained that this was due to an ongoing problem and was being looked into at the current time. It was pleasing that since our last visit, personal protective equipment, for example, disposable aprons, gloves and disposable hand towels were Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 27 strategically located throughout the Home. This ensures that staff can easily access these thus reduce the risk of cross infection at the Home. A hygienic system was in place for the laundry of residents’ personal clothing and bed linen. As identified as a concern during our previous visits, there is just one mechanical sluice disinfector at the Home. Due to the size and layout of the Home, the absence of en suite toilets and the dependencies of residents living there, remedial action must be taken to provide additional equipment thus reducing the risk of cross infection. One visitor met during the visit said “Hygiene in the Home could be better but they are getting there”. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 28 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. Residents may not receive care and support from staff at the times they require. Staff recruitment and training are generally robust and should ensure that residents are safeguarded and should receive a good standard of care. EVIDENCE: The staffing rota identified that there is one registered nurse and five care workers on duty during day time hours and one registered nurse and two care workers overnight. Housekeeping, laundry and kitchen staff are employed in addition to this so that residents are supported in these areas. During the visit we noticed that there were periods of time when vulnerable residents were unsupervised in one of the lounges. This was brought to the attention of the home manager who stated that he was currently reviewing the job routines of the care staff team and looking at housekeeping tasks being taken away from them so that they had more time to spend supervising residents. He also stated that he was reviewing whether the current staffing levels were adequate based on the internal layout of the building in order to Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 29 improve resident supervision. We will assess this further during our next visit to ensure that there are an adequate number of staff provided. One visitor met during the visit said “Staff are friendly and try their best but there are not enough staff on duty because a lot of people need one to one care”. During the visit staff interacted with residents in a friendly manner, however we observed two occasions where staff failed to communicate with residents at the appropriate times. This does not promote a homely environment and may result in vulnerable residents being unsure about what support staff are about to provide to them. The cultural backgrounds of residents reflected that of the staff team so that support could be provided in an understanding manner. There were a number of male residents living at the Home and only two male staff employed however, negative comments were not received about this. One resident met during the visit said “Staff are good. They come at night when you need them, I like living here”. Three staff files of new workers were examined and these contained the majority of pre recruitment information required by regulations in order to safeguard residents. There was evidence that health declarations are completed, references are obtained and criminal record checks are undertaken. There was evidence that the registered nurses working at the Home were eligible to do so. A number of shortfalls were identified including: • The start date of new employees was not always recorded • There was no evidence that any gaps or anomalies in previous employment histories had been explored and dates of previous employments were recorded in years instead of specific months • No contracts of employment were on staff files. New workers undertake comprehensive induction training so that they should have the necessary skills and knowledge to work in a safe manner. There was not, however evidence within the three staff files examined to confirm that the staff members had undertaken an induction. This was discussed with the home manager who stated that the staff members kept hold of their work- books until they had been fully completed. We looked at six staff training records and a number of these had not been updated to identify individual staff members’ training needs. There was, however evidence that staff undertake a rolling programme of training in mandatory areas including food hygiene, emergency first aid, infection control, moving and handling and fire safety. The majority of staff had received refresher training in these areas recently and any outstanding training was scheduled. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 30 Other training undertaken by staff recently included falls awareness, diabetes and nutrition. Further training is planned for tissue viability and dementia care awareness. The home manager stated that 85 of staff had completed NVQ Level 2 training so that they should have the skills and knowledge to work in a competent manner. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 31 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, 32, 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. The Home is generally run in the best interests of the residents living there and further support for the manager should ensure the best outcomes for residents. Health and safety checks of equipment ensure that they are safe to use however residents’ health and safety may be at risk until remedial action is taken regarding identified hazards. EVIDENCE: Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 32 The home manager has been in post for five years and has completed the Registered Managers Award so that he should have the necessary skills and knowledge to lead the staff team. He is currently working towards further management qualifications. The staffing rota identified that, as identified as a concern during previous visits, the home manager continues to work two to three shifts each week as the registered nurse on duty. We were advised during the visit that an additional registered nurse with experience of working with people with dementia care needs is due to commence employment at the Home within the next couple of days and this will enable the home manager to allocate the required time to his managerial duties. Service satisfaction questionnaires are sent out to a group of residents every three months on a rolling basis. These were seen during the visit and included mixed feedback. Positive comments included “Happy with the staff”, “The staff give me a good bed bath every morning” and “I’m happy with the care the staff give me”, however negative comments received about having the same food more than once a week, staff don’t always take time to listen and the need for more activities. A report based on the findings of the surveys had not been produced therefore residents were not able to find out what actions had been taken in response to comments made. The home manager had recorded all negative comments made in the complaints register and there was evidence that actions had been taken to rectify issues raised. Any issues raised must be included in an annual report identifying the shortfalls and any actions to be taken to address these. The home manager stated that he had tried unsuccessfully to arrange “residents’ meetings”, however he had found that residents preferred to discuss matters during smaller group meetings and by completing surveys. There were no records available about the smaller group meetings. Staff meetings are arranged regularly so that staff have the opportunity to put forward their views about working at the Home, suggestions for improvements to residents’ daily lives and to be informed about forthcoming training opportunities. External senior managers undertake quality-monitoring visits at the Home on a regular basis and reports based on the findings of these were available. There was evidence that residents were involved in these visits however no evidence that different residents were spoken with each time. The home manager stated that the report format used for these visits would be reviewed as they were not specific enough, did not evidence that different residents were spoken with during each visit and did not identify specific details if any shortfalls were identified whilst examining records. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 33 Other systems in place for quality monitoring include the undertaking of audits of work procedures in place. These records included details of any corrective actions to be taken in order to improve the services provided. The administrator stated that there had been no changes regarding the management of residents’ money since our last visit. She stated that no money is held at the Home on residents’ behalf and residents or their families are invoiced for additional services, for example, hairdressing and private chiropody. She stated that any records relating to this were temporarily being held at head office as she had just returned from a period of extended leave. This will be assessed further during our next visit to the Home. Since our last visit a new system for formal staff supervision has been introduced so that staff should be supported within their job roles. Senior staff had recently received training in this area so that they should have the necessary skills to supervise staff in a competent manner. Maintenance checks of equipment were undertaken regularly so that they should be safe to use. Any work outstanding had been scheduled for completion. Accident records involving residents were well maintained and there was evidence that medical advice was sought as required. The Home had, however, failed to notify us of the majority of accidents or incidents involving residents that had occurred during recent months as required by regulations so that we can monitor or investigate further as required. Since our last visit, risk assessments had been undertaken for individual residents to assess the risk of scalding injuries from hot water outlets in their bedrooms, the temperatures of which are above safe limits. Despite risk assessments being undertaken for the majority of residents, remedial action had not been taken to ensure that the hot water temperature was lowered to within safe limits and this poses a serious problem of vulnerable residents scalding themselves. This was discussed with the home manager who stated that he would discuss this with the registered provider without delay in order for remedial action to be taken. During the visit we noticed that the flooring above the cellar between connecting doors from one side of the building to the other was uneven and this poses as a fall hazard for people in this area. A staff member was observed pushing a resident in a wheelchair without foot rests being used. On questioning there was no medical reason why the foot rests were not used and this was brought to the attention of the home manager who advised that he would take this matter further to ensure residents’ safety. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 3 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 3 2 3 x 2 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 2 3 x 2 Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 35 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP5 Regulation 14(2) Requirement Arrangements must be made during trial periods to ensure that the Home can meet the needs of new residents living there in order to ensure the safety of all residents. Each resident must have an up to date care plan outlining the specific support required by staff in order to meet their care needs in the ways that they prefer and require. Comprehensive records must be kept in relation to food and fluid intake so that care can be monitored effectively and the appropriate care provided. Personal risk assessments must be available for individual residents in order to reduce the risk of harm and uphold residents’ health and safety. All medicines must be available to administer at all times Any resident that wishes to self administer their own medication must be risk assessed as able and compliance checks should be done to ensure they safely take DS0000024869.V356515.R01.S.doc Timescale for action 01/04/08 2 OP7 15(1) 31/05/08 3 OP7 12(1) 01/04/08 4 OP7 13(4) 01/05/08 5 6 OP9 OP9 13(2) 13(2) 25/03/08 25/03/08 Melville House Nursing Home Version 5.2 Page 36 7 OP19 23 8 OP26 13(3) their own medicines The programme of redecoration, 01/10/08 refurbishment and repair must continue so that the premises are fit for purpose, meet residents’ needs and maintain their safety Arrangements must be made to 01/10/08 ensure that there are suitable mechanical sluice facilities in all area/floors of the Home in order to reduce the spread of infection. Timescale of 30/3/07 not met. 9 OP27 18(1) 10 OP35 20 A review of staff allocation/staffing levels and daily routines must be undertaken in order to improve staff availability so that residents receive care, supervision and support at the times they require. Suitable systems must be in place for dealing with residents personal money and valuables in order to safeguard residents Systems must be in place for records and money held in respect of resident’s finances to be accessed when the administrator is absent. Timescale of 28/2/07 not met. This was not assessed in full on this occasion as records were not available 15/04/08 01/04/08 11 OP38 13(4) 12 OP38 37 Following risk assessments, remedial action must be undertaken to ensure residents are protected from scalding injuries from the hot water outlets in their bedrooms. Systems must be put into place DS0000024869.V356515.R01.S.doc 30/04/08 01/04/08 Page 37 Melville House Nursing Home Version 5.2 to ensure that we are informed about all accidents and incidents affecting the health, safety and well being residents. Timescales of 30/1/07 and 30/07/07 not met 13 OP38 13(5) Arrangements must be made to ensure that wheelchairs are used correctly unless a risk assessment states otherwise in order to safeguard residents. 01/04/08 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 3 4 5 6 7 Refer to Standard OP1 OP7 OP9 OP12 OP19 OP26 OP27 Good Practice Recommendations The service user guide should include detail of the costs involved in living at the Home so that prospective and existing residents are aware of this information. Daily records should include detail of how residents have spent their time and how their social and emotional needs had been met in order to review the care provided. At least four hours should elapse between drug rounds to ensure that the potential for overdose is reduced. Activities and excursions should be provided that meet the needs and expectations of all residents living at the Home. Suitable ramped access should be provided to the main entrance so that the Home is easily accessible to residents and visitors. A system should be introduced to ensure that residents’ personal toiletries are for single person use only in order to reduce the risk of cross infection. Arrangements should be made to ensure that all staff are aware of the importance of good interactions with residents in order to promote a homely and happy living environment for residents. Systems should be in place to ensure that any information missing from prospective workers’ job application forms and recruitment records be sought in order to safeguard DS0000024869.V356515.R01.S.doc Version 5.2 Page 38 8 OP29 Melville House Nursing Home 9 10 OP30 OP33 residents. Up to date individual staff training records should be kept so that any training needs can be easily identified. A report based on the findings of service satisfaction questionnaires should be written so that residents and relatives are aware of any actions to be taken. This should include time scales for the actions to be taken. Melville House Nursing Home DS0000024869.V356515.R01.S.doc Version 5.2 Page 39 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.V356515.R01.S.doc Version 5.2 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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