CARE HOMES FOR OLDER PEOPLE
Merrill House Merrill House Queensferry Gardens Shelton Lock Derby Derbyshire DE24 9JR Lead Inspector
Steve Smith Unannounced Inspection 24th January 2006 01:30 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.V281617.R01.S.doc Version 5.1 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.V281617.R01.S.doc Version 5.1 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.V281617.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th 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 Residents, 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 Residents 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.V281617.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place in just over 3.5 hours. Discussion was held with the Home’s Manager, a Deputy Manager and with two Residents, who were seen separately. Some of the Home’s records were looked at, and the public areas of the Home were examined. What the service does well: What has improved since the last inspection?
Since the last inspection the Manager had provided information to Residents in the statement of purpose, and in the Residents Guide, on the physical environmental standards met by the Home. Residents’ views of the Home had also been provided within the Residents Guide to the Home. New Residents and their relatives were appropriately informed, by staff, before admission, of whether the Home was able to meet the new Resident needs.
Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 Page 6 The Manager and other staff assisting with the admission of new Residents ensured that all new Residents were fully assessed before admission took place. Each Residents file now had a confidential section within it, to be used when necessary. Residents were also given access to their files, on at least a monthly basis, if they were well enough to take part in this activity. The Quality Assurance measures, mentioned in the section above, had been completed ready for this inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 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.V281617.R01.S.doc Version 5.1 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): These Standards were not examined during this inspection of the Home. EVIDENCE: Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 10 & 11. The care provided to Residents, according to Residents comments, was of a good quality. EVIDENCE: Standard 7 was not examined during this inspection of the Home. However, while reviewing the Requirements and Recommendations of the last inspection it became apparent that the Manager had not discussed with the Residents or their relatives the limitation of each Resident concerning their ability to make choices, have freedom of movement around the Home, and their ability to make decisions. This issue has now been outstanding since June 2004. Two Residents were interviewed, separately, concerning the operation of the care facilities. They said that staff were very good at listening to their views on how they wished to be cared for and always carried out their wishes. They said that their care needs were always met with dignity and respect. As a result, they said they felt very safe in the Home, and appeared to have a strong sense and appearance of well being. Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 Page 10 Both Residents were asked what plans had been made with the Home about their wishes following their death. They both said that this had all been planned with their families, but as far as they were aware this had not been discussed with staff at the Home. Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 Page 11 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): Standards 12, 13, 14 & 15. Residents’ preferred lifestyles were respected by the Home. They were able to receive visitors and to exercise choice and control over their lives. Residents were also provided with a wholesome and appealing diet. EVIDENCE: The Residents spoken to during the inspection said that they felt very safe in the Home. Staff respected their confidences and all their needs were always met with dignity, respect and choice. The Residents said that they could go to bed and get up at times of their own choosing. They could also choose or change their bath times, having a bath at least once a week. The two Residents were aware of activities provided within the Home, but both said that there were few organised activities. However, one did say that she had enjoyed the trips organised to visit places within Matlock and a second trip to Bakewell. Both Residents also enjoyed the barbeque that was arranged during the summer months. The Residents also said that they were unable to visit shops now, due to their ill health. However, Residents were unaware of whom their keyworker might have been, who could have done occasional shopping for them. Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 Page 12 The Residents said that at times of local or general elections the management team provided opportunities for postal voting. Relatives and friends of the Residents were able to visit at any time, and could always be seen in private. Residents said that staff always knocked and awaited an answer before entering their bedrooms. They said that their mail was always delivered unopened, and the Residents were aware of the arrangements for those Residents who wished to smoke. The Residents spoken to said that there was always a good choice provided at all mealtimes in the Home. They said that there was always a choice of at least three items at each mealtime. Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 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): These Standards were not examined during this inspection of the Home. EVIDENCE: Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 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): These Standards were not examined during this inspection of the Home. EVIDENCE: Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 Page 15 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): Standard 27 & 30. 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 2 January to the 16 January 2006, were examined. This showed that weekly care staffing for day and night shifts was provided at 605 hours, 469 hours and 601.5 hours respectively. The Residential Forum figure for staff time provided at the ‘Low Dependency’ level for 40 Residents was 676 hours each week. This meant that the Registered Providers were providing between 70 hours and 206 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. Staff induction and foundation training was provided for all new staff that came to work in the Home. The Manager also said that all care staff were provided with at least three paid days training a year. All staff also had an individual training and development assessment and profile. Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 Page 16 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): Standards 31, 33 & 38. The Manager was appropriately qualified and the Registered Providers regularly inspected the Home, to ensure good standards were maintained for Residents. The Home also met the Quality Assurance issues that ensured Residents’ care was maintained at a positive standard. EVIDENCE: The Manager was able to say that she had now completed her training to NVQ level 4 in Management and Care. It was also found that the Registered Providers undertook an inspection of the home on a monthly basis, reporting any concerns to the Manager. 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. The Manager said that staff would be able to demonstrate
Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 Page 17 a commitment to lifelong learning for each Service User, and the views of family, friends and stakeholders, such as Doctors Nurses etc, were sort on how well the Home was achieving goals for Residents. The training provided for staff was examined. This showed that the Registered Providers had ensured that all but one member of staff had received the three yearly training in Moving and Handling. Fire Safety training was also examined and this found that 6 members of staff had not received the required amount of training. The Home lacked any record of those staff members who had undertaken Infection Control training. The Manager clearly stated that some staff had this qualification, but not all of them. It was pleasing to find that all staff were up to date with their qualifications in both Food Hygiene and First Aid. However, none of the senior staff in the Home were qualified as First Aiders. The Fire Insurance Certificate displayed within the Home became out of date in March 2005. All Residents have been risk assessed to determine their vulnerability and measures had been put in place to provide protection where necessary. The Home has complied with all necessary legislation, such as Health and Safety at Work Act 1974, and the Manual Handling legislation of 1992. Risk assessments had been carried out for all safe working practices in the Home, although the Manager had not provided a written statement of the policy, organisation and arrangements for maintaining those safe working practices. The Manager ensured that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant government bodies. She also had ensured that fire safety notices were posted in relevant places around the Home. Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 Page 18 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 2 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 2 Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 Page 19 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 Each file must contain details of the limitations placed on Residents, as agreed by each Resident or their representative, on the Resident’s ability to make choices, their freedom of movement and decision-making capability. (This issue should have been addressed from the inspection report dated 16 June 2004) The Manager must ensure that the wishes of Residents following their death, with respect to their funeral arrangements, must be obtained shortly after they are admitted to the Home. The member of staff, identified during the inspection, must receive training in Moving and Handling. The Registered Providers must provide Fire Training at least twice a year for all care staff who work throughout the night, and once a year for all other staff. The Registered Providers must ensure that the Home has up to date fire insurance.
DS0000035949.V281617.R01.S.doc Timescale for action 1 OP7 17, Sch 3 21/03/06 2 OP11 12 21/03/06 3 OP38 13 & 18 30/06/06 4 OP38 23 30/06/06 5 OP38 23 21/03/06 Merrill House Version 5.1 Page 20 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 OP12 OP12 Good Practice Recommendations The Manager should try to provide additional activities for Residents within the Home. The Manager should ensure that Residents are aware of who their keyworkers are, make sure that Residents and keyworkers are aware that the keyworker could go shopping for the Resident. 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. (This issue should have been addressed from the inspection report dated 16 March 2004) The Manager should ensure that all necessary staff receive training in Infection Control. Sufficient senior members of staff should be trained as First Aiders to ensure that at least one First Aider can be on duty, on each shift, both day and night. The Manager should provide a written statement of the policy, organisation and arrangements for maintaining safe working practices in the Home. . (This issue should have been addressed from the inspection report dated 2 November 2004) 3 OP27 4 5 OP38 OP38 6 OP38 Merrill House DS0000035949.V281617.R01.S.doc Version 5.1 Page 21 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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