Inspection on 09/07/08 for Merrie Meade

This inspection was carried out on 9th July 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Merrie Meade 15/12/09

Merrie Meade 13/10/09

Merrie Meade 02/07/09

Merrie Meade 18/07/07

Merrie Meade 16/06/06

Merrie Meade 20/10/05

Merrie Meade 05/04/05

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Merrie Meade 3 Watergate Road Newport Isle Of Wight PO30 1XN Lead Inspector Janet Ktomi Unannounced Inspection 9th July 2008 10:00 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 Merrie Meade DS0000060991.V365449.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.V365449.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 (14), Mental registration, with number disorder, excluding learning disability or of places dementia (14), Mental Disorder, excluding learning disability or dementia - over 65 years of age (3) Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate one named individual in the OP category Date of last inspection 18th July 2007 Brief Description of the Service: Merrie Meade is a registered residential home and provides long stay care and accommodation for older people with mental frailty and illness associated with dementia and long-term care/support and accommodation for younger adults with mental health needs. The older people are cared for in the purpose built extension, which provides a suitable environment for their care needs. The younger people are accommodated in the main building. 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 people who live at the home. 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. All but one room is for single occupancy, many have en-suite facilities. Separate communal facilities are provided for each service user group. 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 home is owned by Merrie Mead Residential Home Ltd and managed by Ms Janice Gibson. Weekly fees are in line with local social services rates with information available from the home. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This report contains information gained prior to, and during, an unannounced visit to the home undertaken on the 9th July 2008. All core standards and a number of additional standards were assessed. Compliance with the requirements made following the previous inspection in July 2007 were also assessed. The visit to the home was undertaken by one inspector and lasted approximately seven and a half hours commencing at 10.00 am and being completed at 5.30 p.m. The inspector was able to spend time with the registered manager and staff on duty. The inspector was provided with free access to all areas of the home, documentation requested and people who live at the home. Prior to the inspection visit the registered manager had completed the home’s Annual Quality Assurance Assessment (AQAA). This was received at the Commission within the required timescales and information from it is included in this report. The inspector briefly met the responsible individual at the start of the inspection. Information was also gained from the home’s service file containing notifications of incidents in the home. Following the inspection visit the inspector telephoned local health and social care professionals who regularly visit the home. What the service does well: All people are assessed prior to moving into the home to determine that their individual needs can be fully met. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. The home has adapted well to meet the changing needs of one person, although their care plan and risk assessments have not been updated. People’s health care needs would appear to be met at the home. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 6 The home provides sufficient care staff to meet people’s needs. What has improved since the last inspection? What they could do better: The home was crushing (using a pestle and mortar), some medication in the older persons’ part of the home. Crushed tablets were then mixed with icecream sauce and given to people. The practise of altering medication was discussed with the registered manager who was aware of the potential risks this poses. The registered manager must ensure that no medications are Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 7 given in an altered format unless the individual persons GP has agreed to this and that it has been confirmed that this will not affect the action of the medication. Where possible medication should be dispensed in a format suitable for the person such as a liquid if the person is unable to swallow tablets. There must be clear instructions from the GP on the medication label regarding the method of administration, which should be documented on the Medication Administration Record. There are few activities for people living in the older persons’ part of the home and the home should consider how the older people’s social and leisure needs can be better met. Staff have not completed all mandatory or service specific training to ensure that they are able to meet people’s needs. The home must ensure that staff who are involved in food preparation have a food hygiene certificate and that all mandatory training is completed by staff. The home must ensure that written references are obtained prior to staff starting work. The manager must complete the Registered Manager’s Award or relevant management course. 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. Merrie Meade DS0000060991.V365449.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.V365449.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. All people are assessed prior to moving into the home to determine that their individual needs can be fully met. People, or their representatives, are able to visit the home prior to admission to assess the quality, facilities and suitability of the home. Standard 6 is not applicable, as the home does not provide intermediate care. EVIDENCE: The registered manager explained the home’s admission procedure and the pre-admission assessment for two people (one in the older persons and one in the younger adults sections of the home), admitted shortly before the inspection visit were viewed. The inspector discussed admissions with care staff and people who live at the home. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 10 The pre-admission assessment had been undertaken by the manager for both new admissions and provided comprehensive information enabling a decision to be made as to whether the person’s needs could be met at the home. Information from care managers and health professionals was also seen with pre-admission information and in other care plans viewed. Discussions with the manager indicated that admissions to the younger adults part of the home involved several visits to the home, providing the opportunity for prospective people to meet existing people and vice versa. Younger people the inspector spoke with confirmed this. For older people the opportunity of a visit is also there however this is not always practical and the manager stated that it is more often that relatives visit the home and view available rooms and facilities. Discussions with the manager indicated that she was clear about the level of need the home could accommodate. Discussions with care staff confirmed that they felt they had enough information about new people admitted to the home and that they felt they had the skills to meet people’s needs. People living at Merrie Mead tend to be long term, however the home could provide day, respite or short stay accommodation if a suitable room were available. The registered manager stated that the same admission procedures would be used for respite or short stay admissions as for long-term admissions. The home does not provide dedicated accommodation for, intermediate care or specialised facilities for rehabilitation. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs are set out in an individual plan of care. Medication is correctly stored with full records maintained. There are not adequate checks in place to make sure that service users receive their medication in the most suitable and safe form. People are generally treated with respect and their dignity maintained. Staff must have training in manual handling and medications administration. EVIDENCE: Four care plans were viewed, two for people admitted to the home in the months prior to the inspection visit and the other’s for people who have been living at the home for a longer time. Two care plans were for people who live in the older person’s part of the home and two for people who live in the younger persons part of the home. The inspector discussed with staff and people who live at the home how care needs are met. Following the inspection visit the inspector telephoned health professionals who regularly visit the home. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 12 Everyone living at the home has a plan of care that relates to the person’s assessment. The care plans are individualised and written in plain language providing information as to how needs should be met. Photographs were seen in most care plans. The care plans for the younger adults contained more detailed information than those for the older people whose format was different and space for specific information limited. Care plans contained relevant risk assessments and management plans including nutrition, falls and any individual risks such as those resulting from age related memory loss and how inappropriate behaviours should be managed. Risk assessments viewed appeared appropriate to the person’s needs. The manager stated that the home monitors peoples weight on a monthly basis, however the records for this could not be found on the day of the inspection visit. People living in the younger adults part of the home confirmed that they are regularly weighed. Care staff spoken with said that communication about residents needs was good, with regular shift handovers. One care plan viewed was for a person whose needs had increased in the weeks prior to the inspection visit. This care plan had not been updated nor had manual handling risk assessments been updated. The inspector spoke with the person who stated that their needs were being met. The inspector heard a telephone call between a senior carer and a health professional in respect of this person. This showed that staff at the home were aware of their needs and were taking action to meet them even if the care plan had not been updated. Following the inspection the inspector was able to speak with a health professional involved in this person’s care who also stated that she had been impressed with how the home had adapted to the change in care needs and that in their opinion the person’s care needs were being met at the home. Health professionals who regularly visit the home were telephoned following the inspection visit. They stated that they had no concerns about the home and felt that staff had knowledge about the people who live there and that people’s health needs were met. The health professionals also felt that the home consulted them when necessary and followed the advice and guidance given. Care plans contained individual manual handling assessments. Manual handling equipment was viewed in the home. Some care staff stated that they had received manual handling training however the majority of staff have not had manual handling training and those who have completed initial manual handling training have not had update training. Health professions stated that they felt that staff treated people who live at the home with dignity and respect. This was confirmed by the younger adults who said that they could lock their bedroom doors and that staff respected their privacy. Although it was not possible to have an indepth conversations with the Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 13 people who live in the older persons’ part of the home, those able responded that the staff were nice and observations of staff interactions indicated that people are treated with respect and their right to dignity maintained. The home has one twin bedroom. The inspector spoke with a person who occupies this room who confirmed that they were happy to share and that there were no issues re privacy. The inspector noted an unpleasant aroma in the home’s lounge/dining room in the older persons’ part of the home. This was discussed with the registered manager who stated that the carpet had been professionally cleaned however this had not resolved the problem and the responsible individual had now agreed to replace the carpet with an alternative floor covering. The inspector noted that a carer who was sitting with a person in the lounge (not undertaking any care tasks) was wearing disposable gloves. Care staff confirmed that they had sufficient time to meet people’s needs. The registered manager stated that she has employed a retired registered nurse who provides training for staff, both theoretical and practical as to how peoples’ care needs should be met. The registered manager identified in the homes AQAA that they could do better by motivating the younger adults to take a more active part in their general health. Discussions with a new member of staff in the younger adults section confirmed that this was one of his roles and that work had already commenced in this respect. Discussions with a health professional confirmed that the younger adults are supported to attend health appointments. Following the previous inspection undertaken in July 2007 two requirements were made in connection with medication. These being that the medication administration records must be fully completed with no gaps and that medication that must be kept at cooler temperatures is stored securely. The inspector viewed medication administration records in both parts of the home and these had been fully completed. Since the previous inspection the home has purchased a lockable medications fridge that was seen in the homes office. These requirements have therefore been met. Discussions with care staff indicated that staff had not undertaken external medications training or updates. Two staff stated that they were responsible for administering medication and that their training had been in house, observing other staff and then being observed in administering medication. Medication was seen to be appropriately stored under secure conditions. The home uses a blister pack system where possible. The home has the necessary storage and recording books for controlled medications. Some of the people living in the younger adults part of the home self-administer their medication. One showed the inspector the number operated safe he has been provided with to store his medication in. Within care plans seen there were risk assessments for people who are self-administering. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 14 The inspector noted that the home was crushing (using a pestle and mortar), some medication in the older persons part of the home. Crushed tablets were then mixed with ice-cream sauce and given to people. The inspector discussed this practise with the registered manager who was not aware which medications were being crushed, or for whom. A list was requested from the senior on duty and this named six people for whom medication was being given in an altered format. The inspector and registered manager looked at the pestle and mortar whilst checking the medication storage arrangements and this had not been cleaned after the lunchtime medications having white powder still attached to both parts. Clear guidance is needed on how to safely crush medications individually. Within the medications administration records there was a letter from a GP dated March 2002 giving permission for medications to be crushed. However this did not specify a named person or the medication to be given in an altered format. The practise of altering medication was discussed with the registered manager who was aware of the potential risks this poses. The registered manager must ensure that no medications are given in an altered format unless the individual persons GP has agreed to this and that it has been confirmed that this will not affect the action of the medication. Where possible medication could be dispensed in a format suitable for the person such as a liquid if the person is unable to swallow tablets. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are provided with choice about aspects of their lives, visitors are welcome and an appropriate diet is provided. The home must consider how activities can be provided in the older persons part of the home, to provide people with a more stimulating and varied quality of life. EVIDENCE: The inspector spent time talking with people in the home’s lounges, met people who had chosen to remain in their bedrooms and observed part of the lunchtime meal. The inspector discussed activities with the manager, staff and people living in the younger adults and older persons part of the home. The inspector also spent time sitting in both of the home’s lounges. The report following the previous inspection identified that there was a lack of activities and staff support for the people living in the younger adults part of the home. A requirement was not made as the manager stated that the provider had agreed to increase the staffing levels in the younger persons part Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 16 of the home to facilitate more activities both in and out of the home. The home now provides two staff to work in the younger persons part of the home supporting the fifteen people who live there. In addition the home has recently appointed a new staff member who is specifically responsible for activities and motivating/supporting the younger adults to enjoy a more varied and active lifestyle. People living in the younger persons part of the home confirmed that they were being supported to try new activities and that external activities were being organised. The staff member is also trying to encourage more in house activities with the younger adults. The inspector spent time in both the morning and afternoon sitting in the lounge in the older persons part of the home. Throughout the day the television was on, although this was not being watched by anyone in the room. Most people were sleeping or just sitting in their chairs. One staff member was present most of the time, as one person requires a high level of support due to inappropriate behaviours. However the staff member was not undertaking any activities or interactions with people other than encouraging the person she was supporting to sit down. Within care plans there was some information about life histories and social and leisure interests however there was no evidence as to how this information was being used to provide stimulation and activities for the older people. The manager stated that the home has a visiting reminiscence slide show once a month and some indoor games. The manager and care staff confirmed that there are not a lot of activities for the older people and the inspector observed none during the day she spent at the home. Daily records seen contained no information as to social and leisure activities undertaken in the older persons part of the home. People living in both parts of the home confirmed that they are able to have visitors whenever they wish. The home does not have a separate room for private visits. Discussions with the younger adults confirmed that they are able to make decisions and that staff respect these. Some younger adults showed the inspector their bedrooms and these had been individualised with many personal items. Within the older persons part of the home bedrooms had also been individualised with personal possessions brought into the home. The inspector observed the lunchtime meal and discussed meals and menus with the people who live at the home and staff. The registered manager informed the inspector that the homes chef had left suddenly and that the assistant cook was now undertaking this role. Until another cook has been employed several care staff are covering the kitchen duties on the cooks day off. This was the case on the day of the inspection. The inspector spoke with the person who had cooked the meal on the day of the inspection. They confirmed that they did not have a food hygiene certificate or training. People were very complimentary of the meal on the day of the inspectors visit and stated that generally the meals are good with choice available. The inspector Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 17 noted that people were provided with alternatives to the main meal choice and that special diets had been catered for. Information was seen in care plans in the older persons section of the home as to the need for food to be provided in a suitable format for those with eating and swallowing problems. At lunchtime people were provided with food in the format described in their care plans. Fresh fruit was seen freely available in the lounge in the younger persons home and the younger people stated that they could have hot or cold drinks when they wished. The inspector did notice that with one exception people in the older persons section of the home did not have drinks freely available. The manager stated that people are provided with drinks if they are requested and at regular intervals throughout the day. The home has been awarded the maximum five stars by the local environmental health department for food hygiene. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 18 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Staff have not received training in safeguarding adults or related issues and were unclear as to the action they should take should they suspect that a person has been abused. EVIDENCE: The home has a complaints policy and procedure. Discussions with staff confirmed they were aware of what to do if a person or their relative complained or raised an issue. The manager identified in the homes AQAA that the home had received one complaint in the past year. The inspector spoke with people living in both parts of the home and they confirmed that they would raise any concerns to the staff or manager. Resident meetings are held in the younger adults section of the home, which also provides an opportunity for people to raise and discuss issues before they may become complaints. Minutes of a recent resident meeting were viewed. The home has a safeguarding and whistle blowing policy and procedure, which the manager stated is discussed with staff during induction. Discussions with new and longer term staff indicated that they were not clear about the action they should take should they suspect that abuse had occurred. Most stated that they would discuss this with the manager but were unsure of what they Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 19 would do should the manager not take any action, or if the manager was the person they suspected of being abusive to people. Care staff stated that they had not received safeguarding training and the manager confirmed that this was part of the training planned for the home. Staff have also not attended training to meet the specific needs of people with dementia, mental capacity act training, challenging behaviour or some aspects of mental health which may make people more vulnerable. Whilst spending time in the older persons lounge the inspector observed that one person was receiving a high level of support (one-to-one) most of the time. At one point, whilst the staff member was present, the person was verbally abusive to the person sitting next to her. The staff member did not comment however the manager was also present and reminded the person that this was not nice. At another time the staff member left the lounge for a short period of time, during this time the service user was again verbally abusive to several other people in the lounge, waking one person up. This was discussed with the manager who stated that she had spoken with external health professionals regarding the person’s behaviour and that this was therefore being monitored and acted upon to protect other people living in the home.. Since the previous inspection the manager has taken the necessary action when abuse of a person living at the home was suspected. The manager worked with the local social services department and took appropriate action. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 20 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 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The provider continues to invest in the upgrading and improvement of the home with people living in a clean, safe, generally well-maintained home that meets their individual and collective needs. EVIDENCE: As identified at the previous inspection the provider is continuing to invest in the home’s environment and evidence of ongoing improvements in the original part of the home were seen during the inspection visit. The inspector was informed that since the previous inspection the roof on the original part of the home has been replaced. The home consists of an older building in which the younger adults live and an extension completed several years ago which is occupied by the older people. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 21 The extension has a large lounge/dining room with ramped access to the good sized rear garden. Seating and soft furnishings are appropriate for the people with sufficient dining room tables and chairs for all people should they wish to sit to table for meals. All bedrooms in the extension are for single occupation with en-suite facilities. Appropriate bathing facilities are provided and a passenger lift affords access to the first floor. The younger adults occupy the older part of the home. This has a lounge, quiet sitting room and separate dining room. With the exception of one room all rooms are for single occupancy and some have en-suite facilities. The manager stated in the homes AQAA that there are plans to convert a bathroom to provide two shower rooms and to modernise another bathroom. At the time of the inspection work was underway to change a bedroom in the younger persons part of the home to provide an office, staff WC and sleepin room for staff. People living in the original part of the home have access to a good sized patio area and were aware that smoking is restricted to the patio or summerhouse in the rear garden. Suitable handrails have been provided for the three steps that access the patio from the younger adults lounge. Since the previous inspections a number of bedrooms in both parts of the home have been redecorated and some have been provided with new washbasins incorporating a vanity unit and new bedroom furniture and curtains. The inspector saw these whilst viewing the home. During the previous inspection one bedroom in the original part of the home had a musty aroma. This has been investigated and now, following the replacement of the homes roof, is being redecorated and refurbished. The home employs cleaning staff and overall the home was found to be clean and with the exception of the older persons lounge/dining room free from offensive odours. The manager stated that the carpet in the lounge/dining room has been professionally cleaned however this has not resolved the problem and the responsible individual has agreed that alternative floor covering replace the current carpet. The home has the necessary equipment in the laundry to ensure that clothes may be washed to the necessary standards. Merrie Meade DS0000060991.V365449.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home employs care staff in sufficient numbers; recruitment procedures are not currently adequate to fully protect people living in the home staff and staff have not received all the necessary training to meet people’s specific needs. EVIDENCE: The inspector viewed staffing rotas, recruitment and staff files, spoke with care staff and the people who live in the home. The inspector observed how staff spend their time in both parts of the home. All comments from people who live at the home and external professionals were positive about care staff. Duty rotas were seen during the visit to the home. The home is run as two sections with staff teams in both areas. The older persons part of the home has three staff throughout the day and two at night. The younger adults part of the home has two staff and a part time activities person during the day and a sleep-in person at night. In addition cleaning staff are provided in both sections of the home and the registered manager is supernumerary in the home throughout the weekdays and available on call at weekends. The home Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 23 has a part time maintenance person and a cook. During the inspectors visit staff on duty corresponded to those on the duty rota. Care staff stated that they generally have sufficient time to meet people’s needs and throughout the inspection care staff appeared to have time to meet people’s needs. The manager provided training and qualification information during the inspection and on the AQAA. The home employs twenty-four care staff of whom twelve have at least an NVQ level 2. Discussions with care staff confirmed that they had NVQ’s. Care staff stated that they generally felt they had the necessary skills to meet people’s needs. Care staff stated they had not received all mandatory or service user specific training. Staff training was discussed with the manager who confirmed that people had not undertaken all mandatory or service specific training. Within staff files viewed there was no evidence of recent training having been completed. The manager stated that the responsible individual had agreed funding for all mandatory and some service specific training and that an appointment had been organised for later in July with a training coordinator from the Isle of Wight college, train to gain, to identify the homes training needs and book staff onto courses. The appointment was seen in the home’s diary. The home has a fire awareness DVD and the in house fire officer has provided fire awareness training and updates. The home has also recruited a retired qualified nurse who has provided in house training to care staff re specific practical care tasks and specific medical issues such as diabetes. There has also been some training provided by an external mental health worker. The recruitment records for three people recruited shortly before the inspection visit were viewed. All files contained evidence of Criminal Records Bureau and Protection of Vulnerable Adults checks prior to commencing employment at the home. The home must ensure that when telephone references are taken that the manager records these and written references taken prior to commencement of employment in accordance with the relevzant regulations. Within one file the references were provided by the applicant and were addressed as to whom it may concern dating back to 2002. There was no evidence that more recent references either professional or personal had been sought. The home has an induction checklist. However this had not been completed in one file viewed. There was no evidence of training undertaken by new care staff since employment at the home. The inspector spoke with new staff who confirmed that they had attended interviews and that checks had been undertaken. Care staff stated that they felt their induction had given them the information they required and also that they had not received mandatory or any service specific training. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 24 The inspector discussed new staff selection with people in the younger adults part of the home. They stated that if they were at home they would meet potential staff however it was not clear how people’s views of potential staff were used in determining if they were employed. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 37 and 38 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The lines of accountability between the registered manager and the provider are not clear and this has resulted in conflict. People’s financial interests are safeguarded. Records are generally well maintained. The health, safety and welfare of people and staff are generally promoted. EVIDENCE: The home is managed by registered manager Ms Janice Gibson, who has managed the home for three years. Observations of the manager’s interactions with and responses from the people who live in both parts of the home were positive, open and friendly. The manager has not yet commenced the Registered Managers Award and has not completed regular update training. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 26 The manager is aware of issues relating to the care of older people and younger adults with mental health needs. The registered manager identified on the homes AQAA that ‘there is no business and financial plan for the home, the registered manager has no budgets to work from i.e. for training. The lines of accountability within the home are not clear where the registered manager and the proprietor are concerned’. The manager also identified that a senior member of staff has recently been promoted to assistant manager. Following the previous inspection a requirement was made that the manager must have access to funds when the provider is not available as she had had to use her own money to purchase additional food supplies. The manager stated that she now has access to some money when the proprietor is not available. The manager informed the inspector of the quality assurance processes used in the home. The manager stated that there are meetings with the people who live in the younger persons part of the home. The inspector viewed the minutes from a recent meeting. The manager showed the inspector the quality assurance file that contained questionnaires completed by people who live at the home and other people with an interest in the home. There was evidence that the manager had reviewed these. People living in the younger adults part of the home confirmed that they have access to their own money and are able to spend this as they wish with some support from staff. For people who live in the older persons part of the home their families manage their money if they are unable to do so. The provider was previously the appointee for some people who live at the home however the manager stated that the local social services department are now in the process of taking over this role. Where additional services are provided such as hairdressing and chiropody the home invoices these to the person responsible for paying the bill. A requirement in respect of staff supervision was repeated at the previous inspection. Care staff stated that they do now have supervision and the manager confirmed this in the AQAA and to the inspector. Generally records viewed had been well completed and were appropriately stored. One care plan viewed had not been updated following significant increases in the persons care needs. Records of the checks of the homes fire detection equipment were viewed and showed that this is generally checked weekly however there were some weeks when the cheeks had been missed. Whilst viewing the home the inspector identified that the laundry door is not locked and substances potentially hazardous to health were stored in the laundry and therefore accessible to people who live at the home. The manager agreed to move these therefore a requirement is not made. Other substances hazardous to health were stored correctly under secure conditions. Whilst in Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 27 one of the homes lounges the inspector observed care staff using a stand aid. The inspector noted that they failed to apply the breaks on the wheelchair into which the person was being moved and again not used when the person was returned to the lounge and transferred back to the lounge chair using the stand aid. The environment is generally safe for people however staff must have infection control training, those handling food must have food hygiene training and staff must have all the necessary mandatory and service specific training to ensure they can meet people’s needs. Merrie Meade DS0000060991.V365449.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 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 2 3 3 2 2 Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 29 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. 1. Standard OP9 Regulation 13 (2) Requirement Timescale for action 01/09/08 2. OP29 19 (1)(b) 2. OP30 18 (1)(a) 3. OP31 9 (2)(b(ii)) The registered manager must ensure that no medications are given in an altered format unless the individual persons GP has agreed to this and that clear instructions are provided and followed to protect people receiving the medicines. The home must ensure that 01/09/08 suitable written references are taken up prior to staff strarting work in the home, ensuring that they are suitable to work with vulnerable people. The registered person must 01/10/08 ensure that all staff undertake mandatory and specialist training to enable them to meet the needs of people living at the home. The registered manager must 01/01/09 have the necessary qualifications for managing the care home. Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 30 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 Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Merrie Meade DS0000060991.V365449.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!