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Inspection on 09/01/06 for Melville House Nursing Home

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

This inspection was carried out on 9th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Home is run and managed by a Registered Nurse with many years experience working in elderly care and he is service user focussed. Service Users generally appeared satisfied with the care. Some comments from residents included: `I am happy here, staff are good and they are kind to me-I have no complaints` `Everything is in order for me here and I have no complaints` `I am quite comfortable here, and have no complaints` Resident`s health care needs appear to be mostly met and there is evidence that the Registered Manager accesses Community Health Services when required. Service Users are enabled to maintain contact with family/friends and/or advocates and exercise choice and control over their lives where possible. Complaints are taken seriously and acted upon and records show that the Manager follows the homes own complaints procedures. There was evidence that staff had received a range of training to include the required statutory training. Individual training records for staff were in place

What has improved since the last inspection?

There are measurable improvements to the environmental standards in some areas of the Home and there was demonstrable evidence to suggest the Provider is committed to ongoing improvements in this area. It is crucial however that there is continued measurable progress.

CARE HOMES FOR OLDER PEOPLE Melville House Nursing Home 68 - 70 Portland Road Edgbaston Birmingham West Midlands B16 9QU Lead Inspector Yvonne Reay Unannounced Inspection 09 January 2005 09:00 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.V273470.R01.S.doc Version 5.0 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.V273470.R01.S.doc Version 5.0 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.V273470.R01.S.doc Version 5.0 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. August 2005 Date of last inspection Brief Description of the Service: Melville House is a registered Care Home with Nursing and has the capacity for 29 residents, 26 nursing and 3 residential over 65 years of age. The Home is situated in a quiet residential area approximately 4 miles from Birmingham City Centre and close to local amenities. A number of good public transport options are available and a bus stops directly outside the Home. The property comprises of two Victorian residences joined by a bridge type construction providing access underneath to the large garden and car parking spaces at the rear of the Home. Off road parking is also available at the front of the Home however the drive has a steep incline to access this parking area. En-suite facilities are not provided. Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was carried out over one day and the Manager was present throughout the process. There were 25 residents in the Home during the inspection and two residents were in hospital. Three care plans were examined and the Inspector spoke with two visitors to the Home, and seven residents. Information was also gathered by observing staff performing their duties and informal discussions. Ongoing discussions throughout the inspection process took place with the Manager. A partial tour of the premises was carried out and the rooms were inspected for those resident whose care was looked at in detail. Requirements made following the last Inspection in June 2005 were assessed for compliance. What the service does well: The Home is run and managed by a Registered Nurse with many years experience working in elderly care and he is service user focussed. Service Users generally appeared satisfied with the care. Some comments from residents included: ‘I am happy here, staff are good and they are kind to me-I have no complaints’ ‘Everything is in order for me here and I have no complaints’ ‘I am quite comfortable here, and have no complaints’ Resident’s health care needs appear to be mostly met and there is evidence that the Registered Manager accesses Community Health Services when required. Service Users are enabled to maintain contact with family/friends and/or advocates and exercise choice and control over their lives where possible. Complaints are taken seriously and acted upon and records show that the Manager follows the homes own complaints procedures. There was evidence that staff had received a range of training to include the required statutory training. Individual training records for staff were in place Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The needs and requirements of any prospective service user are assessed prior to admission. EVIDENCE: Information supplied by the Manager and from examining records indicated that no service user moves into the Home without having his/her needs met. A person trained to do so carries out pre admission assessments and records are kept. Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 The standard of care plans was variable and did not consistently reflect residents current care needs. Residents appeared to be mostly satisfied with the care provided by the Home and any identified health care needs appear to be mostly met. EVIDENCE: There were no residents who had pressure sores on the day of the visit. Some residents had wounds/leg ulcers, which were being treated, and advice had been sought from the Tissue Viability Specialist Nurse. The Manager informed he Inspector that the Primary Care Trust had secured the services of a local GP to treat all residents requiring medical attention. The daughter of a resident, who has been in the Home for seven years, was spoken to. She informed the Inspector that it is her mothers choice to stay at the Home and that she was ‘happy here’. She also informed the Inspector that she was a very regular visitor to the Home. Another relative informed the Inspector that ‘Some things are good, some not so good’. She clarified this by stating that staff did not always pay attention to detail and that she had to constantly remind staff about basic care matters. Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 10 This resident had a short-term memory loss and would benefit from regular reminders from staff to perform basic tasks. There also appeared to be issues with a carers attitude toward this resident and this was addressed with Manager on the day of the Inspection. In this residents room there were a number of notices pinned up informing staff about care needs. This was also evident in other resident’s rooms. It would be better, if staff do require a prompt to perform specific tasks for residents, that the care plan be located in residents rooms and these notices removed. A sample of comments from residents included: ‘I am happy here, staff are good and they are kind to me-I have no complaints’ ‘Everything is in order for me here, I have no complaints’ ‘We are quite comfortable here, and have no complaints’ One resident did have very dirty fingernails engrained with faeces. This was addressed with the Manager during the Inspection. Two care plans were looked at in detail and one briefly examined. The Home has comprehensive paperwork in place for staff to use to formulate care plans. However it was clear however that staff are not utilising this paperwork or completing the documents appropriately. One resident who had recently been admitted to the Home did not have any care plans in place. An initial assessment had been carried out which was comprehensive and had detailed some identified problems, requiring specific attention. However no further development had taken place to these plans and there were no detailed instruction for staff to carry out their duties in relation to this resident. This resident did inform the Inspector that ‘I am OK here, and I am comfortable enough and I get a choice of food. Some staff are better than others though’. One resident had been at the Home since August 2005 and did have care plans in place. There was some information available which gave an indication of his care needs and risk assessments had been carried out. On admission he had MRSA and the Manager informed the Inspector that this had cleared. This information had not been updated in the file/care plan. Information recorded on the initial assessment form did not relate directly to his identified needs. For example on the initial assessment under nutrition there was no indication he may be underweight. However this issue had been recorded elsewhere in the file but there was no record of his weight. There was no plan in place to manage this identified problem. The social care needs for this resident were very brief in content. The resident did inform the Inspector however that he ‘was very comfortable at the Home and had no complaints’ Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 11 One resident,who had been at the Home for some time and appeared to be nearing the end of her life was receiving care appropriate to her needs. She had the required equipment in place on her bed to reduce the risk of pressure sores and a ‘turn’ chart was in place. Her room was warm and clean. Care plans were in place for this resident but some required updating to reflect current care needs. The records in place in relation to nutrition were not sufficiently detailed to show appropriate actions were being taken by the Home to monitor this aspect of the resident’s condition. The Home does have a system of named nurse and keyworkers however this was not detailed on any of the care plans. Care plans examined were mostly not signed or dated and had not been evaluated since September 2005. There is a contract in place for the safe disposal of Medication. Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 Service Users are enabled to maintain contact with family/friends and/or advocates and exercise choice and control over their lives where possible. EVIDENCE: There were photographs on display of a recent ‘Halloween Party’ and there had been a number of Christmas events and celebrations held. The Manager has always ensured that residents are helped to exercise choice and control over their lives where possible and within individual capabilities. One resident visits a local hospital to attend a day centre. Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Complaints are taken seriously and acted upon and records show that the Manager follows the homes own complaints procedure. EVIDENCE: Three complaints had been received since the last inspection and whilst one did not have all the required paperwork in place to support a full investigation, there was ample evidence to suggest that the most recent complaint had been fully investigated and records supported this. The home’s policy on Adult Protection requires some further development in line with Local Authority procedures to ensure a multi disciplinary approach to investigation. Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 25, 26 There is demonstrable evidence to suggest the Provider is committed to ongoing improvements to the environmental standards in the Home. It is crucial however that there is continued measurable progress in this area. EVIDENCE: There are measurable improvements to the environmental standards in some areas of the Home for example: *The laundry has been renovated and new equipment purchased; *The ground floor dining room has been renovated and new flooring fitted; *All armchairs have been replaced; *The Registered Provider has committed to purchasing 15 high risk pressure mattresses as recommended by the Tissue Viability Nurse; *New stair carpet has been fitted throughout; *In room one on the ground floor a new carpet has been fitted and some new furniture purchased; *New flooring has been fitted to the lounge on the first floor; Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 15 *Two rooms, which have recently been vacated, are to be refurbished before occupied by another resident; *The ground floor lounge in number 68 is to be completely refurbished by the end of January 2006; *Rooms inspected for two of the residents whose care was looked at in detail were warm, clean and personalised to taste. With the lack of investment over a number of years in the property by the Provider there are still many areas requiring attention. Some areas in the Home remain cluttered and in need of redecoration and refurbishment. Despite this there is demonstrable evidence to suggest the Provider is committed to ongoing improvements to the environmental standards in the Home. It is crucial that there is continued measurable progress in this area. The temperatures in the Home were very hot on the day of the visit and some thermostat valves on radiators were not working to allow residents to control the temperature in their own rooms. The Manager informed the Inspector that central heating engineers were scheduled to visit the Home this week to look at this problem in particular in one residents room. Air temperatures must be monitored regularly and appropriate action taken to ensure temperatures are maintained at an ambient level for residents and staff comfort; In one room the television aerial was not working and it would appear this had been like this for some months. The Manager assured the Inspector that this matters was to be addressed as a matter of importance; One room inspected for a resident whose care was looked at in detail was drab and required completely redecorating. A maintenance log is in place for staff to use to record any problems/issues identified in the absence of the Maintenance Person. It would be useful if the Maintenance Person were to have a checklist to assist him on his weekly round of the Home. Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 Staff are trained and competent to do their jobs. EVIDENCE: Staff rotas were not inspected on this occasion. A training matrix was examined which was cross-referenced with some training certificates and this demonstrated training had taken place. There was evidence that staff had received a range of training to include the required statutory training. Individual training records for staff were in place. The Manager has not taken on any new staff since the last inspection. Staff files and Induction records were not inspected on this occasion. There was evidence that the Home does in fact have a formal Induction programme in place and records are kept. The Manager must ensure this programme is in line with ‘Skills for Care’. Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 38 The Home is run and managed by a person who is fit to be in charge and is service users focussed. Staff are appropriately supervised however the Manager is developing this process and tailoring supervision to the needs of the individual staff member. EVIDENCE: The Registered Manager is a trained nurse who has many years experience working in elderly care. He is currently undergoing the Registered Managers Award and is due to complete this by the end of March 2006. The Home does not employ a Deputy Manager but there are Senior Nurses identified who do take on some extra responsibilities from time to time. There is a supervision agreement in place and some staff had received formal documented supervision and appraisal. Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 18 However there was no plan or schedule for future supervision of staff. A full discussion was had with the Manager and it was agreed that a plan will be formulated and implemented however the style and type of supervision for staff will be dependent upon the individual staff member.’On the job’ supervised practice will form the basis of this programme. A Service User survey had been conducted in December 2005. The results of this Quality Assurance survey were not available on the day of the visit and will be forwarded to this office as soon as they are available. Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 3 2 X 2 3 STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 2 Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 20 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 OP7 Regulation 15(1)(b) Requirement The Registered Person shall ensure all care plans are evaluated and brought up to date to reflect residents current care needs. The Registered Person shall draw up and implement care plans for the identified resident (MG) and these plans must reflect current care needs. The air temperatures throughout the Home are to be regularly monitored. Appropriate action is to be taken in order to maintain correct temperatures for residents and staff comfort. The Registered Person shall ensure that the television aerial in the identified room is repaired. The Registered Person shall ensure it is reinforced with all staff the importance of treating residents with dignity and respect at all times. The Registered Person shall ensure the home’s policy on Adult Protection is development DS0000024869.V273470.R01.S.doc Timescale for action 31/01/06 2 OP7 15(1) 13/01/06 3 OP25OP38 23(2)(p) 13/01/06 4 OP19 12(1)(a) 23(2)(b) 13/01/06 5 OP10 12(4)(a) 31/01/06 6 OP18 13(6) 28/02/06 Melville House Nursing Home Version 5.0 Page 21 in line with Local Authority procedures to ensure a multi disciplinary approach to investigation. 7 OP23 23(2)(d) The Registered Person shall ensure that the room identified for a resident whose care was looked at in detail is redecorated according to taste and preference. 31/03/06 8 OP19 The Registered Person shall 23(2)(a,d) ensure that sustained and measurable progress is made to improving the environmental standards of the Homes. 23(2)(n) These requirements from the last inspection are carried forward. The Registered Person shall ensure the call bell system is adapted so that all areas can be cancelled at the point of call. 12(1)(a) 30/04/06 9 OP22 31/03/06 10 OP22 23(2)(n) The Registered Person shall 28/02/06 ensure that the call bell in the downstairs toilet adjacent to the staff kitchen is modified so that a resident is able to reach the bell in the event of an emergency (19/08/05 previous timescale) The Registered Person shall ensure bedroom doors are fitted with suitable automatic closures where a resident wishes to have their bedroom door open. 30/04/06 11 OP38 23(2n) (4a) 13(4a) Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP10 Good Practice Recommendations It was suggested that the care plans be located in resident’s rooms. The results of e recent Service User survey are to be forwarded to this office as soon as they are available. The supervision programme is to be developed further to ensure all staff receive supervision appropriate to their needs. The induction programme is to be developed further in line with the new Skills for Care standards. It would be useful if the Maintenance Person were to have a checklist to assist him on his weekly round of the Home. OP33 OP36 OP30 OP37 Melville House Nursing Home DS0000024869.V273470.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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