CARE HOMES FOR OLDER PEOPLE
Merrill House Merrill House Queensferry Gardens Shelton Lock Derby Derbyshire DE24 9JR Lead Inspector
Steve Smith Unannounced Inspection 20th September 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Merrill House Address Merrill House Queensferry Gardens Shelton Lock Derby Derbyshire DE24 9JR 01332 718400 01332 718400 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) Derby City Council Christine Ann Flower Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20 September 2005 Brief Description of the Service: Merrill House Care Home is located in the south of Derby. It provides care for up to 40 Service Users, who are all aged at least 65 years or older. The Home was purpose built across two floors. Access to the first floor can be gained via a passenger lift, a stair lift or via the stairs. All Service Users are provided with their own bedroom, although none of these have ensuite facilities. The Home has three combined lounge/dining rooms, and a central lounge area onto which the three-lounge/dining areas converge. Well-maintained gardens/lawned areas are provided for the Home, and staffing in the Home appeared to be relaxed and friendly. Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place in just over 4 hours. Discussion was held with the Home’s Manager. Some of the Home’s records were examined, and the public areas of the Home were looked at. What the service does well: What has improved since the last inspection?
Since the last inspection the Registered Providers had provided a Residents Guide to the Home and a complete statement of terms and conditions or contract for living at the Home had also been provided. Care Management assessments were provided for all Residents whose files had been examined. Staff of the Home regularly reviewed all files. All care staff now carried master keys to Residents bedrooms. Medication issues were now well addressed by the Home. The Registered Providers had improved the complaints procedure to ensure that Residents were informed that all complaints would be investigated within 28 days. They had also ensured that all Residents were informed of their right to have any issue examined by the Commission.
Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 6 Senior Managers of the agency now carried out monthly unannounced ‘inspections’ of the Home. They also ensured that electrical equipment and appliances used in the, by both staff and Residents, were checked at annual intervals of time. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 1 and 3. The Registered Providers had provided a statement of purpose, although not all details had been completed to fully inform Service Users and their relatives of the provisions made. New Service Users moving to the Home were always provided with an assessment of need to ensure all needs of Service Users could be met by the Home. EVIDENCE: During this inspection the statement of purpose was not examined. However, while reviewing the requirements made following the inspection of November 2004, the Manager said that she had not extended the statement of purpose to ensure it included the physical environmental standards met by the Home nor had these been summarised in the Residents Guide. This issue has been outstanding since at least March 2004. The review of the Recommendations made in the last inspection report of November 2004 also revealed that the Manager had not included in the Residents Guide Residents views of the Home.
Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 9 When new Residents were admitted to the Home, the Manager was provided with a summary of needs of each person, completed by the Care Manager supporting each Resident. She also visited those potential Residents and undertook her own assessment of need before agreeing to their admission to the Home. However, copies of the assessment carried out by her were not kept. Standard 6 does not apply to this Home. Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 7, 8 & 9. Service Users’ health and personal care needs were being fully met, as demonstrated within care plans. Medication was also appropriately distributed to meet Service Users needs. EVIDENCE: To help assess Standard 7, the Resident’s Plan, the records of four Residents were examined, for the purpose of case tracking. Almost all of the basic information concerning each Resident was found to be in the files examined. However, all of the files lacked details of the keyworker allocated to each Resident. All of the files contained the initial assessment completed by the Care Managers placing each Resident at the Home. The Manager had also completed her own initial assessment of needs for the four Residents. There was also a copy of the ongoing care plan and risk assessment available in each file examined. Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 11 The Manager had not provided details of each Residents limitations of choice, freedom and decision making ability. The Manager carried out annual reviews of care on each Resident, although the Commission recommends that this is carried out at six monthly intervals as the average stay in a Home is now less than three years. The Residents Guide had been made available to all Residents. The files showed that good recording was carried out, on a regular basis, and these were kept securely in the Home. All of the files examined were found to be well organised, and contained a photograph of each of the Residents. The files also showed that the Manager had read each file at regular intervals, but none of the files contained a confidential section. The files also contained monthly entries from the keyworkers to show progress being made in meeting the goals of the individual’s care plan. However, at these times keyworkers did not show the files to Residents. Lastly, none of the files contained a copy of a letter given to the Resident, before admission, to say that the Home was suitable to meet the Resident’s needs in respect of their health and welfare. Staff of the Home were appropriately maintaining the records of Service Users health needs, which included a record of meals provided for Service Users. All medication and the method of distributing it to Service Users were examined, and a good record was found to be maintained. Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were not examined during this inspection of the Home. EVIDENCE: Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18. Complaints made to the Registered Providers were appropriately addressed to meet Residents needs. The protection policies and procedures provided by the Home meant that Residents were well protected. EVIDENCE: Records of complaints were examined and good records of both verbal and written complaints were maintained. The procedure to follow was also looked at and this showed that all complaints were to be completed within 28 days. The Manager said that the Home had details of the Derby Adult Protection procedure to ensure that Residents were protected from abuse. The Manager had a Whistle Blowing policy and had the relevant information on the Public Interest Disclosure Act of 1998, and on the Dept of Health guidance ‘No Secrets’. The Manager said that all allegations and incidents of abuse would be followed up and action would, if necessary, be taken. The Manager agreed to refer any incidents of abuse by her staff to the Protection of Vulnerable Adults register, but to date this had not been necessary. The policies and practices of the Home ensured that physical or verbal aggression by a Residents was understood by staff and that staff would only intervene as a last resort to protect the Resident, other Residents or staff. The Home had satisfactory policies and procedures to deal with Residents money and financial affairs. The Manager said that the Home had a policy to inform staff that they could not benefit, in any way, from Residents wills.
Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26. The Home was very well maintained throughout, providing all Service Users with a safe, comfortable environment in which to live. EVIDENCE: A tour of the public areas of the Home was made, and the Home was found to have three wings and three lounge/dining areas that were maintained to a high standard. In each wing doorways to some bedrooms were to be widened to allow easier access for wheelchair users. Adaptations were planned to the outside of the home to provide easier access to garden areas for disabled Service Users. The Home was well decorated throughout. The Home was provided with single bedrooms for all Service Users, and a small number of bedrooms were large in size. However, the majority of bedrooms were found to provide limited space, and so could not accommodate two armchairs or a table to sit at. Each Service User’s record of care acknowledges
Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 15 this and the Service User had been encouraged to say whether they insisted on having all of the furniture listed in the National Minimum Standards or were happy with the furniture provided by the Home. All Service Users could lock their bedrooms, and each also had a lockable space within their bedroom, in which they could keep valuables. Each wing of the Home had a sluicing facility, and the laundry was able to wash clothing and bedding at least at 650 C for at least ten minutes. Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27. The Registered Providers were not providing sufficient care staffing, when compared to the Residential Forum, to meet the assessed needs of Residents. EVIDENCE: Staffing provided in the Home was compared with the details provided by the Residential Forum. The three weeks beginning the 8 August 2005 were examined. This showed that weekly staffing for day and night shifts was provided at 555 hours, 436 hours and 520 hours respectively. However, on 17 August 2005 no one was recorded as being on night duty, and on 21 and 28 August only one person was recorded as covering night duty for each of these nights. The Residential Forum figure for staff time provided at the ‘Low Dependency’ level was 676 hours each week. This meant that the Registered Providers were providing between 240 hours and 121 hours less than the figure recommended by the Commission. If some Residents fell within the ‘Medium Dependency’ level then the staffing provided would be even less favourable. The Manager’s time was not included within this calculation, as recommended by the Residential Forum. Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 33, 35 & 38. Service Users benefited from a well run and managed establishment. However, quality assurance systems had only been partially established, and so the security of Service Users could not be guaranteed. EVIDENCE: The work undertaken by the Manager to meet the Quality Assurance standard was examined. It was found that the Home had an annual development plan, and Residents had been surveyed and took part in Residents’ Meeting and Amenities Meetings. However, the Registered Providers and Manager did not provide an annual quality assurance review, the Manager said that staff would not be able to demonstrate a commitment to lifelong learning for each Service User, and the views of family, friends and stakeholders, such as Doctors Nurses etc, were not sort on how well the Home was achieving goals for Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 18 Residents. This was the situation at the times of the inspections that took place in March, June and November 2004. The Manager and Registered Providers took note of good practice advice issued by the Dept of Health and other professional organisations and ensured that the policies and procedure of the Home were, if necessary, adjusted accordingly. The Manager ensured the safety of Residents personal allowances. Two of these amounts were examined during this inspection and all was found to be in good order. In the report of November 2004 it was also recommended to the Manager that she should complete a written report on the policy, organisation and arrangements for maintaining safe working practices in the Home. At the time of this inspection she had not addressed this. Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 3 Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement The Registered Providers and Manager must provide information to Residents in the statement of purpose, and in the Residents Guide, on the physical environmental standards met by the Home, as detailed in Standard 1.1. (From the inspection report dated 16 March 2004 Each file must contain details of the limitations placed on Residents, as agreed by each Resident or their representative, on the Resident’s choice, freedom and decisionmaking capability. (From the inspection report dated 16 June 2004) Each Resident’s file must contain a copy of a letter sent to the Resident, from the Registered Providers, to say that the services provided in the Home are suitable to meet the Resident’s needs in respect of their health and welfare. (From the inspection report dated 2 November 2004) The Registered Providers must ensure that staffing levels are maintained to meet the health and
DS0000035949.V250945.R01.S.doc Timescale for action 1 OP1 4 15/11/05 2 OP7 17, Sch 3 15/11/05 3 OP7 14 15/11/05 4 OP27 18 15/11/05 Merrill House Version 5.0 Page 21 5 OP23 24 welfare needs of service users. The Registered Provider must establish and maintain a system for reviewing and improving the quality of care provided in the Home. This must be done by ensuring that Standards 33.3, 33.5 and 33.7 are addressed. (From inspection report dated 16 March 2004) 15/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP1 OP3 OP7 OP7 OP7 OP7 Good Practice Recommendations Residents’ views of the Home should be provided in the Residents Guide. When completing assessments of new Residents the Manager should follow the issues laid down in Standard 3.3 of the National Minimum Standards, and keep the assessment on the Resident’s file. Each Residents file should contain details of the keyworker who is currently working with each Resident. The Manager is encouraged to formally review each Resident at six monthly intervals. The Manager should provide a confidential section within each file, to be used when appropriate. Service Users should be given access to their files, and encouraged to sign them, at the time the monthly update is provided by care staff. (From inspection report dated 2 November 2004) The Registered Providers should provide day care and night care staffing at least in line with that required by the Residential Forum. This figure should not include the Managers working time. The Manager should provide a written statement of the policy, organisation and arrangements for maintaining safe working practices in the Home. (From inspection report dated 2 November 2004) 7 OP27 8 OP38 Merrill House DS0000035949.V250945.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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