CARE HOMES FOR OLDER PEOPLE
Merlin Park 1 Fort Road Alverstoke Gosport Hampshire PO12 2AR Lead Inspector
Pat Trim Unannounced Inspection 14th November 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Merlin Park DS0000065569.V319508.R02.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. Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Merlin Park Address 1 Fort Road Alverstoke Gosport Hampshire PO12 2AR 02392 524366 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) Serincourt Limited Mrs Dorothy Joan Arthur Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (25) Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th January 2006 Brief Description of the Service: Merlin Park was bought by Serincourt Ltd in November 2005, and is now one of several homes in the area owned by this company. The home is situated in a quiet residential area of Gosport, reasonably close to local amenities and with views across the Solent from the windows at the front of the house. The aim of the home is to provide care and support to older persons, including persons with dementia. There is also provision to care for three people who have a mental disorder, but this category is to be removed at the provider’s request. Those currently accommodated under this category will remain in the home. Accommodation is arranged over two floors, the upper floor being accessed by a passenger lift or stairs. There are twenty single and two shared bedrooms, all with en suite facilities. There is a large lounge that has several seating areas and there are two dining areas. The home has a large secure garden at the rear, which is accessible to residents and has several seating areas. There is a car park at the front of the home. The current fees as given in the pre inspection questionnaire are £327.00 to £400.00 per week. Items not included in the fees are hairdressing, chiropody, optician, personal toiletries, papers and magazines, taxis. Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection carried out by one inspector in 7 hours. The key standards were assessed by case tracking 3 residents and talking with 5 people currently living in the home. Time was also spent observing staff practice and talking with 3 care staff, the cook, the training co-ordinator, the care consultant and the provider. Some time was spent reviewing a random selection of documentation and a partial tour of the premises was carried out. The people living in the home had previously expressed their wish to be called residents. This term is therefore used throughout this report. What the service does well: What has improved since the last inspection?
A programme was now in place that enabled the registered manager to monitor staff training. A training matrix identified when staff received training and when refresher training was required. Regular supervision and staff meetings enabled staff to identify individual training needs. An extensive programme of mandatory training such moving and handling, first aid and food hygiene and training specific to the needs of residents, such as dementia and palliative care had been arranged. Investment in the environment has included the redecoration of all communal and individual areas, the fitting of a new shower room on the first floor, refurbishment of the kitchen and major improvements to the grounds to make them more accessible to residents. Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 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 Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have sufficient information to enable them to make an informed choice about whether to move into the home, and detailed pre admission assessments ensure residents may be confident they will only be offered a place if their needs can be met EVIDENCE: The statement of purpose and residents’ guide gave information about whom the home could care for and said that prospective residents would be visited by a member of the senior management team in their homes or in hospital. An assessment of need would be completed prior to admission. Three residents were case tracked to assess the admission procedure. Two files contained a detailed assessment of what residents were able to do for themselves and what help they needed. These had been completed before admission. The third file contained an assessment completed at the time of
Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 9 admission. This was because the resident had moved in as an emergency placement. Residents said they remembered being visited by someone from the home prior to admission and felt they had been involved in carrying out the assessment. They had been encouraged to visit the home prior to admission and some had been able to do so. Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to receive personal care in the way they like it and can be confident their health care needs will be met. Robust systems and staff training ensure medication is managed safely. EVIDENCE: The care consultant said that new monitoring systems and care plans had been introduced to provide better information about what help residents needed. Completed care plans were seen for two residents. These had been reviewed on a monthly basis. The care plan for the resident admitted as an emergency was being developed. The care plans provided a detailed format for identifying what assistance was required and why it was important this support was given. For example, one contained step-by-step guidance on how to support and encourage one resident to have a bath. The reason for following this guidance was that the resident liked to have a bath but only if their routine was followed. Residents said they were involved in completing and reviewing their care plans and felt they identified what help they needed and how they liked to receive personal care.
Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 11 Assessments were completed for any aspects of care identified in the pre assessment as being a potential area of risk, such as falls or moving and handling. Some actions identified in plans had not been clearly identified as a risk and it was agreed these should be reviewed. For example, staff kept a resident’s lighter, although there was nothing in the assessment or care plan to identify what the risk was of them keeping it themselves. There was evidence that if, following a review, it was identified the service could no longer meet the needs of the resident a request was made for a health care assessment. One resident whose health was deteriorating had been re-assessed and moved to a service that was better able to meet her needs. Individual records were kept of any referrals to medical services or visits from the primary health care team. Residents said they have access to health care and regularly saw the chiropodist. During the inspection district nurses visited residents and rang to make appointments. The care consultant said there was a good relationship between primary health care teams and the home. A range of tools were used to identify and monitor health care issues such as dietary problems or skin care management. Guidance on how to address identified issues was included in the care plan. The home had a medication policy and procedure that gave staff clear guidance about managing medication. The local pharmacist provided the majority of medication in a monitored dosage system. Residents who come for a respite stay bring their medication with them. A record is kept of all medication received into the home, given to residents or returned to the pharmacist. Staff said they were only able to give medication when they had completed a medication course and the care consultant confirmed this was correct. Staff were observed giving out medication by following the in house procedure. The record of one resident who was case tracked was inspected. Information recorded on the medication record matched the amount of stored medication. Residents said they felt staff treated them with dignity and respect when giving assistance and this was observed in practice. Staff assisted residents at their own pace. They were seen reassuring a resident who was distressed and continually assured her it was her right to ask for information. Care plans recorded how people liked to be addressed. Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices about all aspects of their daily living. The activities they are offered provide mental stimulation doing things they enjoy. The food provided offer a balanced diet with choices that residents like. EVIDENCE: Residents said they enjoyed their daily routines and felt they were able to make choices about all aspects of their daily living. One resident said he liked to have a cup of tea very early in the morning. Night staff made this for him before they went off duty. Care plans recorded residents’ preferences in respect of daily routines. For example, what time someone wanted to get up or go to bed. Religious beliefs were also recorded. A minister visited the home regularly and gave communion to those who wished to receive it. The home has appointed a member of staff to plan activities in the home. She has been able to attend a training course to help her develop activities that meet the needs of all residents. Residents said they felt there was enough to do in the home and they could choose whether to join in or not. Residents said recent activities had included a firework night, icing cakes and playing bingo. Records are kept of activities and monitored to see if they are meeting
Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 13 individual resident’s needs and residents are asked for feedback about the sort of activities they would like. They have recently requested more outings and the activities co-ordinator is currently looking for possible trips. Residents said their visitors could come at any time and were always made welcome. Staff were observed greeting visitors and ensuring they were given information. A notice in the entrance hall informed visitors they were welcome at any time. Leaflets about advocacy schemes were available in the entrance hall so residents had information. One resident had an appointment to see a solicitor and was able to do so in private by using the dining room. Residents said they had been encouraged to bring personal possessions with them when they moved into the home. A list of these possessions was kept on individual files. The current menu plan showed that there was a well-balanced and varied diet offered. However, although residents could have an alternative to the main meal if they asked for one, two main meal choices were not available. A recent survey carried out by the providers had indicated that residents would like more choice of main meal. The cook confirmed that there was a new meal plan that would shortly be introduced that would give two choices of main meal. Residents said meals were very good and that they could always have snacks and drinks at any time. Breakfast could be taken in the dining room or in their own rooms, as they wished. Dietary needs, such as diet controlled diabetes, and personal preferences, such as vegetarianism were respected and accommodated. Residents were provided with equipment where required to help them to continue to eat independently. Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the information they need to enable them to make complaints and be confident they will be informed of the outcome of any investigation. A robust procedure and staff training ensure residents are protected against abuse EVIDENCE: Information about how to make a complaint was included in the statement of purpose and residents’ guide. A record was kept of any complaints received, together with actions taken and outcomes. The commission had received no complaints about the service since the last inspection and none had been recorded by the home. Residents said they had not made any complaints but were confident if they did the registered manager would listen to them and try and resolve issues. The home had a policy and procedure for the protection of vulnerable adults. Staff said they had received training, both in their induction and on specific training days. They were able to demonstrate their knowledge of the policy and procedure for reporting any incident of abuse. The training programme showed that staff received refresher training on adult protection annually. Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 15 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to live in a comfortable, clean and safe environment that meets their needs and that they like. EVIDENCE: The home is undergoing an extensive renovation programme and a record of planned and completed maintenance was seen. All communal areas and the majority of bedrooms have been redecorated. Following a risk assessment, radiators are being covered to prevent the risk of accidental burns. All hot water outlets are being fitted with thermostatic control valves. The pre inspection questionnaire stated that recent visits from environmental health and the fire safety officer were satisfactory. Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 16 Residents said the environment had been improved by the redecoration and renovation and felt it had been achieved with minimum disruption. The grounds have also been redesigned to provide safer, pleasant surroundings for residents, who said how much they enjoyed spending time there. The front drive has been paved to provide parking. The rear garden has had new patios laid, the pond filled in and a covered area provided for those who wish to smoke. The laundry is part of the new extension and is easily cleanable with an impermeable floor covering. It is fitted with washing machines that have a suitable programme for disinfecting soiled linen. Staff have access to disposable gloves and aprons and were seen using them when required. The home has an infection control policy and a procedure for managing clinical waste. Staff receive training in infection control. Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by well trained staff in sufficient numbers to meet their needs. A robust employment procedure ensures residents are protected. EVIDENCE: Residents said there were sufficient staff on duty to meet their needs and calls for assistance were answered promptly throughout the day. The care consultant said that staffing levels were determined according to the needs of residents. The rota indicated that there were 3 staff on duty from 7 a.m. to 7 p.m. every day. There were 2 waking night staff working from 7 p.m. to 7 a.m. The registered manager’s hours were in addition to these and the home employed a cook and 2 cleaners to carry out domestic tasks. At the time of the inspection there were 3 care staff on duty. There were also 2 care staff completing their induction training. They said they worked in addition to the staff on the rota and were not allowed to work alone until their criminal records bureau (CRB) checks were returned. The care consultant confirmed this was the usual practice for the home and the rota evidenced this. The care consultant said the home was working towards achieving more than 50 of staff with a National Vocational Qualification (NVQ). The training plan stated that all staff under age 22 would be registered on a course after six months. All staff over 22 would be offered the opportunity to register on a course. Two staff had recently completed NVQ2 and two NVQ3. The pre
Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 18 inspection questionnaire recorded that 27 of staff currently held an NVQ and staff confirmed that more of them were registering to complete the course. The home had a procedure for the recruitment of staff that included taking a thorough previous employment history, obtaining two references, obtaining a Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) check and conducting an interview. One member of staff had recently been employed. Her record contained all the above checks, except a CRB. Because this had not yet been returned, the member of staff said she was not allowed to work unsupervised and was completing her induction programme. A POVA first check had been obtained prior to her starting her induction. Staff files included a record to show they had been given job descriptions and contracts. Staff confirmed they had received these. The provider employs a training co-ordinator who arranges training for staff from all the homes. She explained the induction comprises 3 days training, followed by 10 weeks working with other carers. Staff were expected to complete an induction workbook that complied with Skills for Care guidance on induction. Staff confirmed they had completed this induction programme before working unsupervised. A training matrix identified when training and refresher courses were required and a training plan ensured this training was available. Staff were currently completing a 10 week course in dementia care which they said they were finding very useful. A list of the training provided included palliative care, medication, eating and drinking for older people, catheter care, challenging behaviour and diabetes. In addition staff said they could identify any training they felt was necessary to provide care for specific residents and the care coordinator would try and arrange some. Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and there are systems that enable residents to give feedback about the service they receive. There are systems to make sure health and safety issues are addressed and residents are protected EVIDENCE: The care consultant said the registered manager was undertaking training in dementia care to develop her knowledge and skills. This included doing the same course as the staff, but also a course for managers, which was starting in March 2007. Residents said they felt the change in provider and manager had resulted in improvements in service provision. They felt there had been an investment in the home, which was now more comfortable to live in. Staff felt they were well supported by the management of the home.
Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 20 Residents and staff both thought they were able to give feedback about the service. Feedback is also obtained from the social services department who have a respite bed in the home. A survey had been carried out recently and a written report was being prepared to give to residents. Comments about the lack of choice in the main meal had resulted in a new menu plan. A representative of the provider regularly carries out a review of the service and action is taken where an area of concern is identified. For example, it was noted a resident had a number of falls when sitting in a particular chair. The chair was changed. The home had a policy and procedure for the management of residents’ money. Each resident’s money was held separately and an individual record kept of income and expenditure. Two people were required to check the balance and confirm the record was correct. The registered manager took adequate precautions to ensure the health and safety of residents and staff. The pre inspection questionnaire gave a list of mandatory training attended by staff. The training matrix also listed this training and how frequently staff were expected to attend. Training records showed that staff attended training such as food hygiene, first aid and moving and handling. New staff confirmed they had training sessions booked and were not allowed to carry out tasks without appropriate training. For example, they could not assist with moving and handling until they had done the training. Records were seen for the safe storage of chemicals and cleaning products were kept in locked cupboards. The pre inspection questionnaire gave a list of service contracts and certificates. During the inspection a random selection of these were reviewed. They evidenced that regular servicing of equipment took place. The fire log book and accident book had been completed satisfactorily. A risk assessment had been completed for the building and individual risk assessments for residents in relation to specific activities, for example, helping make cakes. Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 21 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Merlin Park DS0000065569.V319508.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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
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