Inspection on 16/06/06 for Merrie Meade

This inspection was carried out on 16th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Merrie Meade 15/12/09

Merrie Meade 13/10/09

Merrie Meade 02/07/09

Merrie Meade 09/07/08

Merrie Meade 18/07/07

Merrie Meade 20/10/05

Merrie Meade 05/04/05

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

CARE HOMES FOR OLDER PEOPLE Merrie Meade 3 Watergate Road Newport Isle Of Wight PO30 1XN Lead Inspector Liz Normanton Unannounced Inspection 15th June 2006 13:30 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 Merrie Meade DS0000060991.V288990.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. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merrie Meade Address 3 Watergate Road Newport Isle Of Wight PO30 1XN 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) 01983 520299 01983 520299 merrymeade@btconnect.com Merrie Meade Residential Home Ltd Janice Gibson Care Home 31 Category(ies) of Dementia - over 65 years of age (19), Mental registration, with number disorder, excluding learning disability or of places dementia (10), Mental Disorder, excluding learning disability or dementia - over 65 years of age (2) Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th October 2005 Brief Description of the Service: Merrie Meade is a large detached two-storey property with a two-storey extension, set in reasonable sized grounds with a summerhouse and two storage sheds available for use by service users. The home is located on the outskirts of Newport within walking distance of the town centre shops and amenities. There is off road car parking to the front. Residents’ accommodation is provided on both floors. The home provides long stay care of older people with mental frailty and illness associated with dementia and long-term care/support for younger adults with mental health problems. Since the last inspection the plan to move residents has gone ahead. The older people are now cared for in the purpose built extension, which provides a suitable environment for their care needs. There is a lift in the extension to provide access to the first floor. There is also ramped access into the garden leading from a side entrance of the ground floor. The younger residents have been accommodated in the main building, which better suits their needs. Weekly Fees: £354.90-£435.05. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 15th & 16th June 2006 over a fifteen-hour period by one inspector. The inspection audited twenty-six standards, twenty-two of which are core standards. The home had complied with two requirements made at the last inspection with one requirement outstanding. The outcome of this inspection was that eighteen standards were met and eight were unmet. Ten requirements and two good practice recommendations were made. Information in this report was gathered from a number of sources and included a tour of the building, discussion with the manager, care staff, residents and visitors and consultation with two health professionals and a care manager who supports residents at the home. The inspector had full access to resident and staff files and the home’s policies and procedures. Staff files did not contain identification as required. Details in residents’ care plans could be improved upon. There were serious discrepancies in medication procedures. The home is being maintained to an acceptable standard with maintenance work in progress. There were issues with regard to infection control and cleanliness of en-suite facilities. Overall the home was very clean and tidy. The inspector spoke to eight residents individually and in small groups, and received written feedback, all of which generally reported a high degree of satisfaction with the care they were receiving. The home provides a homely environment that is conducive to the well being of the service users in residence at the time of the inspection. What the service does well: The home provides prospective residents and their representatives with written information about the home to enable them to make an informed choice. Residents are provided with contracts of the home’s terms and conditions. The manager undertakes a comprehensive needs assessment of prospective residents and does not admitted people to the home until she is satisfied that the home can meet their needs. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 6 The home ensures that residents’ health needs are documented, known, understood and catered for. The privacy and dignity of residents is upheld. The home provides a range of activities for the older residents and plans to improve upon this area with more opportunities for people to go out into the community. The home welcomes visitors at all times. Younger residents are encouraged to access leisure activities and community services. The home ensures the protection of the residents from potential abuse. The staff team are experienced, qualified and trained to meet the individual care needs of the residents. The manager is committed to improving the service and continues to implement changes and support the staff team. What has improved since the last inspection? What they could do better: Include details of residents’ individual fees on to the contract. Provide additional detailed information in care plans using the information gathered on the needs assessment. Ensure that care staff responsible for the administration of medication are competent to undertake this role. Pay greater attention to the prevention of the spread of infection, with the purchase of paper towel dispensers. Greater attention needs to be paid to the cleaning of WCs in residents’ private accommodation. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 7 The manager must ensure that all staff comply with the home’s health & safety policies and procedures. Comply with the requirement to improve the standard of decoration in three residents’ bedrooms. Replace worn bedroom carpet and repair damage to plasterwork in one ensuite. 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. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to choose a home, which will meet their needs. They have their needs assessed and a contract which clearly tells them about the service they will receive. EVIDENCE: There was evidence that the home had undertaken to update the statement of purpose, which was a requirement from the previous inspection. This document is in the process of being altered again due to internal changes within the home’s environment. The younger residents were aware of having received a statement of purpose and service users’ guide whilst the older residents did not know or were unsure. Relatives who were contacted confirmed that they had received information about the home prior to admission, except for one, and this had been due to the placement being arranged as an emergency admission. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 10 Six residents’ files were viewed and there was evidence that the home provides residents with a contract of the terms and conditions of the home. The amount of fees due to be paid monthly was not written on to the contracts. This information should be included on all contracts as it is a regulatory requirement. One recently admitted resident stated that they had not received a contract yet, this was discussed with the manager who reported that this was because the person was on a trial period. It was explained to the manager that all residents must have a contract at the start of them being accommodated. There was evidence on residents’ files that comprehensive needs assessments had been undertaken prior to admission. These documents were extremely thorough and looked at all aspects of an individual’s needs which included, physical needs, mental health needs, likes, dislikes, hobbies, interests, etc. Prospective residents or their representatives are encouraged to visit the home prior to moving in. One resident confirmed that they had visited prior to being admitted. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The health and personal care which residents receive is based on their individual needs, however their needs to be more detail in the care plans to enable care staff to provided consistency of care and meet residents’ expectations. There were serious concerns with the recording of medication administration, and the observation of residents taking their medication was being overlooked by some staff, which needs to be addressed and improved. The principles of respect, dignity and privacy were put into practice. EVIDENCE: Individual care plans had been drawn up using information from the needs assessment, however staff described the format as being difficult to read. The information provided was helpful to care staff but lacked specific details in all aspects of a person’s care needs. In discussion with the manager it, was reported that the format and information held on residents’ care plans is currently being reviewed with a view to making improvements. A number of residents’ files did not include a photograph. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 12 In consultation with the younger residents they were able to confirm that they had care plans and were involved in their review of the care plan. There was evidence that care plans are reviewed regularly. The residents’ health care needs are met by the home. There was evidence that residents are registered with a GP of their choice. Those residents with mental health difficulties are supported by Community Psychiatric Nurses, (CPNs) who visit the home regularly. The older residents with dementia care needs are supported by community and district nurses. The younger residents confirmed that they have access to opticians and dentists. The home has policies and procedures in place for the administration of medication. All medication at the home was stored appropriately. Care staff responsible for the administration of medication have had medication training. There were a number of inaccuracies in the recording of the medication. These errors were serious, as staff had signed to state that medication had been given and this was factually inaccurate as the dates signed had been in advance. On occasion there had been no signature or record whether medication had been refused. In discussion with the manager they reported that they believe that a member of staff has not been observing residents taking their medication. The manager has brought this to the attention of the staff member and discussed the seriousness of their actions. The manager will need to consider what action to take if staff continue not to comply with the home’s medication policy and procedures. Inaccurate recording of medication administration was raised by other staff members, who were concerned about the welfare of the residents. The manager reported that she believes some of the errors on the MAR sheets are due to the signature boxes being too small and is in consultation with the local pharmacy to make alterations to these. A doctor, care manager and CPN who support residents at the home were consulted prior to the home being visited and all three were happy with the service provided. All stated that they had been able to meet with people privately in their rooms, however on one occasion a resident was examined by the doctor in another resident’s room. This matter was discussed with the manager who had been aware of the matter but reported that they had not been on duty at the time of this incident. The manager was aware that each resident’s room is private and Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 13 should not be entered by any other person or persons unless their permission is obtained and will cascade this information down to the staff team. All residents consulted confirmed that they were treated with dignity and respect. Care staff were observed during the inspection and were noted to call people by their preferred name, knock on doors prior to entry and had positive relationships with the residents. There are several payphones situated around the home for the private use of the residents. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 &15 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents are able to choose their lifestyle, social activity and keep in contact with family and friends. Social, cultural and recreational activities meet residents’ expectations, however the younger residents would like more home based activities. On the whole residents receive a healthy, varied diet according to their assessed requirement and choice but there is room for improvement. EVIDENCE: The home provides a range of activities to the older residents, which includes art and crafts, slide shows, puzzles and games, ball games, music and dancing, board games and bingo. In discussion with the manager she reported that she has arranged three outings for the summer months with the Red Cross minibus service. Additional staff have also been employed at weekends so that the older residents can go out in the community to the garden centre café, etc. There are plans being made for a resident to attend church. The inspector observed two residents join in a game of Bingo with staff one afternoon and the following morning one of the residents who played Bingo Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 15 had a manicure. The television was on throughout the day with some residents showing an interest in what was on, and others showing no interest at all. It was observed that those residents making the most demands got the majority of the attention from care staff with the quieter ones receiving less direct contact or conversation. From written feedback and discussion with the younger residents they expressed a wish to have more activities made available to them at the home. They believe that there is an expectation made by the home that they should undertake to access activities in the community and not expect the home to provided them with activities, which they disagree with. In discussion with residents they confirmed that they are encouraged to have visitors at the home and are able to maintain relationships with families and friends. Two individuals were observed visiting the home. The visitor book is kept in the entrance to the main house and there was evidence that visitors sign on entering and leaving the home. In discussion with care staff they reported that they welcome visitors, however they will exercise the residents’ right to refuse visitors if required. The younger residents can go out into the community unassisted and people were seen coming and going from the home during the inspection. There was evidence in the meeting minutes that the home holds residents’ meetings and staff/residents’ meetings, where residents can air their views and make requests. In discussion with care staff they reported that the residents could make choices and decisions on a day-to-day basis. The younger residents confirmed that they could make choices in all aspects of their daily living. Older residents were observed making choices of how they wished to spend their time, what they would prefer to eat, whether to join in activities or not. The younger residents had control of their finances, whilst the majority of the older residents required support from relatives or advocates, which included solicitors. There is a menu planned on a four weekly rotating basis. There is a choice of cereals for breakfast with toast and spreads. One visitor commented that the residents were not offered a cooked breakfast and very rarely had eggs. This was discussed with the manager who reported that cooked breakfasts were available, if residents wished, and they only had to ask. The menu offers a set meal at lunch and at teatime. The cook reported that if residents did not want what was on the menu they would offer an alternative choice. All residents consulted were very happy with the meals provided, with a small number stating that the food was excellent. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 16 There was evidence that the meals provided are of a traditional nature, with the menu better suited to the needs of the older residents. The meals are generally balanced and nutritional, with plenty of variety, but could be considered high in fat content. The cook reported that fresh vegetables are purchased twice a week. A visitor stated that “the home buys the cheapest produce”, this was discussed with the manager who reported that they have not been responsible for food purchasing, this has always been the responsibility of the proprietor. However the proprietor has recently transferred this responsibility to the manager who will consider the nutritional value of foodstuffs being purchased by the home. In discussion with care staff and the manager they believed that the younger residents would benefit from the input of a dietician to encourage and promote healthy eating as they can also access food from take-aways, cafes, etc which might be harmful to their health in the long run. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents have access to a robust, effective complaints procedure, are protected from abuse and have their legal rights protected. EVIDENCE: There was evidence that the home has a complaints policy and procedure in place. The complaints log was available to care staff and there was evidence of complaints having been logged and dealt with. Details of how to make a complaint are available in the statement of purpose. Those residents consulted knew how to make a complaint. Written feedback from two of the younger residents indicated that they have not always felt listened to when they have made complaints. The home has a copy of the Isle of Wight adult protection policy and procedures, which it uses. Care staff spoken to felt confident that they would recognise abuse and were clear on how to report issues of concern without delay. Three care staff confirmed that plans had been made for them to attend adult protection training in the next two weeks. There has been an allegation of financial abuse of one resident since the last inspection, this has been investigated and the outcome was that the abuse was Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 18 not happening within the home. Those residents consulted felt safe at the home. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23 & 26 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. In the main the home offers a clean, safe, well-maintained comfortable environment, which encourages independence, however there is room for continued improvement in the area of infection control. EVIDENCE: The inspector undertook a full tour of the extension block. The lounge/dining room in the extension was spacious, well ventilated and had natural lighting. The seating and soft furnishings were of a good quality and the room was clean, safe and free from offensive odours. There were sufficient dining tables and chairs to seat every one at meal times. Two bedrooms had a strong odour, which was unpleasant. Bedding in one of these rooms was slightly soiled and staff had remade the bed. This was pointed out to the manager who stated that she would speak to those persons responsible and arrange for the bedding to be changed. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 20 The bedrooms in the extension were well furnished and pleasantly decorated. There was evidence that residents are able to personalise their rooms. There was however a lack of wall hangings, i.e. paintings, photographs, and this left rooms looking bare and clinical. One room did have wall hangings following the request of a visiting relative. Bedrooms in the extension were not fitted with bedside lamps or overhead lamps situated above beds, this was discussed with the manager who reported that lamps might be a risk to the residents. Details of why individuals do not have bedside lighting needs to be written into the care plans. All bedrooms in the extension are fitted with en-suite facilities. In general the standard of cleaning of the en-suites was poor with a number of toilets and sinks having dried faeces on them. One en-suite had a hole in the plasterwork. A set of drawers in one bedroom had missing drawer handles and handles that were not matching. A carpet in one bedroom was badly stained and had a hole in it. There was evidence that the main home is currently being refurbished and maintenance men were in the home at the time of the inspection. The manager reported that the hallways had been re-decorated and that a new walk-in bath was being fitted. The bedrooms in the main house identified as being in need of re-decoration at the previous inspection have not been done. The manager reported that they are listed as part of the renewal programme but had not been considered to be a priority. The grounds are laid mainly to lawn with a number of fruit trees, and provided pleasant surroundings in which the residents can relax. The garden is not currently secure. Residents with dementia have to be supervised in the garden at all times. The manager reported that there are plans to install a gate. The manager also reported that there are plans to arrange an individual entrance to the extension as visitors using the front entrance of the main building encroach on the younger residents’ privacy. Only one of the younger residents’ bedrooms was seen as others were out and their doors were locked. The room was personalised to meet the resident’s needs. The inspector noted that there was a lack of storage space in the bedroom with boxes being piled up on the floor. In discussion with the resident they informed the inspector that they were happy with the room. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 21 The laundry is situated away from food preparation areas and has an impermeable floor. The washing machine has the specified programme to meet disinfection standards. Labels are sewn into residents’ clothing to prevent them becoming mixed up. A large pot sink is used for the sluicing of soiled items and items are soaked prior to washing. There are no hand washing facilities in the laundry room. The home provides care staff with protective clothing. The communal bathroom in the extension where residents have assisted baths contained liquid soap dispensers but did not contain a paper towel dispenser, staff were expected to use kitchen roll for the purpose of drying their hands. There was no paper towel dispenser in the communal toilet but kitchen towel was provided. Other communal areas where hand washing took place were also noted not to have paper towel dispensers. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 & 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Staff in the home, are trained, skilled and in sufficient numbers to fill the current aims of the home and meet the changing needs of the residents. The manager expressed a wish to improve the service by offering the older residents more opportunities to access the local community and undertake activities. To implement these changes additional staff would be required on duty. EVIDENCE: There was evidence that there are sufficient staff employed by the home to meet the needs of the residents. Staffing rosters showed that there are enough staff employed to undertake personal care responsibilities, however this left little time for them to undertake activities with residents. In discussion with the manager she has identified the need for additional staff to enable residents access to more activities and go out in the local community, and is discussing the matter with the proprietor. There was evidence that care staff have undertaken National Vocational Qualifications (NVQ) in care with one having completed NVQ level 3 and 2 in progress. Two staff have, completed NVQ level 2 with ten others now in progress. Four staff are undertaking two units of an NVQ at present. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 23 Six staff files were audited and were found to contain Criminal Record Bureau (CRB) checks, Protection of Vulnerable Adult (POVA) checks, two references, job descriptions and application forms. There were no identification records available in the staff records as required in schedule 2. The manager has reviewed the training needs of the staff team and a programme of staff training has been implemented. All care staff had undergone basic induction training. Mandatory training includes, infection control training, manual handling, health and safety in the workplace. Further training is available in medication administration, food hygiene, mental health, risk-assessment training, and adult protection. Staff files contained evidence of training certificates and care staff spoken with reported they had been on training courses. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 24 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, 35, 36 & 38 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The management and administration of the home is based on openness between the manager and staff team. There are effective quality assurance systems developed by a qualified competent manager. In the area of health and safety in the workplace this area was poor with many issues that raised cause for concern of the welfare of the residents and the staff. The manager is aware of the shortfalls and is undertaking to improve practices in this area. EVIDENCE: The manager is a qualified Registered General Nurse (RGN). She has undertaken training in professional practice and will only have to undertake a number of units to complete the Registered Managers Award. The manager is Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 25 also a trained NVQ assessor. The manager is committed to life long learning and encourages and promotes staff development within the home. The manager is aware of the conditions associated with age and has also worked in the area of mental health. The manager reported that they have begun a process of quality assurance by undertaking a review of the home’s practices and measuring these against the national minimum care standards for homes for older people and younger adults to ensure that the home is meeting these standards or surpassing them. The home has quality assurance systems in place, which include resident satisfaction questionnaires. Feedback is also sought from relatives, health professionals with the use of questionnaires. There are regular residents’ meetings held with the younger residents these meetings are minuted and records kept. The home has recently undergone a major change following the views of the younger residents not being happy with the accommodation. This has led to the older residents moving to the extension which was purpose built for older residents with dementia, and the younger residents moving into the main building which they feel suits them better. The home dealt with complaints made by two older residents about the move by ensuring they got what they requested. In discussion with the manager, residents and staff the general feeling was that the move has been a success although it was chaotic on the day, even though a lot of planning had gone into the move. The younger residents are in receipt of a personal allowance and manage their own finances. There was evidence that residents had bank or building society accounts. Older residents with dementia who have limited capacity have their finances managed by relatives, solicitors or court of protection. Formal supervision had not been undertaken for some time. It was apparent, whilst speaking with staff that morale was low and several issues were raised. In discussion with the manager they reported that three senior staff have been trained in supervision and will be taking on the responsibility for supervising the junior staff and the manager will be responsible for supervising the senior staff. The manager endeavours to ensure safe working practices within the home with the provision of training in moving and handling, fire safety, first aid, and food hygiene and infection control. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 26 There was evidence that electrical systems and electrical equipment is regularly serviced. Gas central heating systems are inspected. The home has been experiencing some difficulties with the provision of hot water. It was recorded in the complaints book and staff communication book that on three occasions in June no hot water was available. In discussion with the manager they reported that the shortage of hot water was only a problem in the main building, and that arrangements have been made to have the matter looked into. The bedroom windows on the first floor are not fitted with restrictors. The manager had not been aware of this, she had assumed that with the extension being, recently built that restrictors would have been fitted at the time of building. The manager was advised to undertake a risk-assessment of the windows until window restrictors are fitted. The home has had a routine inspection from environmental health in May 2006 and one of the requirements made was for the kitchen walls to be tiled, as they are currently painted and the paint is peeling off in some areas. Another was the purchase of a portable Bain Marie to take plated-up meals from the kitchen to the dining room in the extension. The manager was able to show the inspector the model the home hopes to order. Current practice of food handling is poor, with food being taken down to the dining room in a domestic “hostess trolley”. Two care staff were observed pushing the trolley which was very low causing them to stoop over which was clear health and safety matter. Care staff spoken to explained that they have to dish the meals out on to plates in the staff room, which has minimum work surfaces, and are using the staff seating to put plates on to enable them to get meals out at the same time. The purchase of the Bain Marie will put a stop to this practice. Care staff reported that there had been an outbreak of diarrhoea at the home recently, as rice cooked the previous day had been re-heated. This has not been reported to CSCI as an event in the care home, which adversely affects the well-being or safety of any service user. There are policies and procedures in place to ensure that staff are compliant with relevant legislation. Care staff spoken to have read the policies and procedures and knew where they were kept if they needed information. The Control of Substances Hazardous to Health (COSHH) did not meet the COSSH regulations 1988. Harmful cleaning materials were kept in the staff toilet, which is situated in the staff room to which residents can have access. The manager reported that although there is an accident policy and procedure in place some staff are reluctant to use this when they obtain a minor injury. They had explained to staff that all incidents must be recorded. As the injured Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 27 person refused outright to make an entry in the accident book a colleague who witnessed the accident made an entry. All staff receive a formal induction which meets the Social Skill Council specifications. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 28 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 3 2 3 x x 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 x x 2 x x 2 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 2 x 2 Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 (b) Requirement The registered person is required to include the amount of fees paid on each individual’s contract. You are required to review and update care plans to include all aspects of an individual’s care needs using information provided by the needs assessment form. You are required to ensure that records of the administration of are accurate. You are required to ensure that where staff sign that medication has been administered they have observed that it has been taken at the prescribed time. You are required to replace the bedroom carpet with a hole in it and to repair the hole in the plasterwork in the en-suite of the same room. You are required to decorate the three bedrooms identified as in need of redecoration in the last inspection. (This was a requirement from the previous inspection dated 20th October 2005. DS0000060991.V288990.R01.S.doc Timescale for action 30/09/06 2. OP7 15 (1) 30/09/06 3. 4. OP9 OP9 !3 (2) 13 (2) 16/06/06 16/06/06 5. OP19 23 30/06/06 6. OP24 23 30/09/06 Merrie Meade Version 5.2 Page 30 7. OP26 13 (3) 8. OP29 19 (4) (b) Sch 2 9. OP36 18 (2) 10. OP38 13 (4) (a) 11. OP38 37 (1) (e) 12. OP38 12 (1) The registered person is required to provide paper towel dispensers in all areas of communal hand washing facilities to minimise the risk of cross-infection. You are required to obtain identification for all current employees and a copy of identification should be obtained for all new employees. You are required to commence with the formal supervision of staff, which should be undertaken at least six times a year. You are required to ensure that all COSHH products are stored safely following their use in the home. You are required to notify CSCI of any event in the care home which adversely affects the wellbeing or safety of any service user. The registered person must undertake a risk assessment of all first floor windows within the home and provide window restrictors where a risk is identified. 30/09/06 30/09/06 30/09/06 16/06/06 16/06/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP8 OP12 Good Practice Recommendations The younger female residents would benefit from advice from a well-woman clinic and should be encouraged to self examine for possible breast cancer. The older residents would benefit from additional staff on duty as required to enable them to be supported out in the DS0000060991.V288990.R01.S.doc Version 5.2 Page 31 Merrie Meade 3. OP15 community. Residents would benefit from the input of a dietician consulting with the cook and residents to promote a healthy eating programme. Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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. Extracts may not be used or reproduced without the express permission of CSCI Merrie Meade DS0000060991.V288990.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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