Inspection on 14/11/07 for Merrivale

This inspection was carried out on 14th November 2007.

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

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

Other inspections for this house

Merrivale 10/11/08

Merrivale 29/05/07

Merrivale 02/03/07

Merrivale 26/04/06

Merrivale 01/09/05

Merrivale 25/04/05

Merrivale 09/11/04

Merrivale 02/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Merrivale 90 East Road Burnt Oak Middlesex HA8 0BT Lead Inspector Jane Ray Key Unannounced Inspection 14th November 2007 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 Merrivale DS0000010518.V350948.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. Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merrivale Address 90 East Road Burnt Oak Middlesex HA8 0BT 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) 020 8952 7639 020 8951 5310 Manager.ladyelizabeth@fremantletrust.org The Fremantle Trust Miss Gillian Frances Smith Care Home 56 Category(ies) of Dementia - over 65 years of age (56), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (56), Old age, not falling within any other category (56) Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 29th May 2007 Brief Description of the Service: Merrivale is registered to provide care to fifty-six older people, who may also have a mental health diagnosis or a diagnosis of dementia. The home has transferred from local authority responsibility to being run by Fremantle Trust. The home is divided into eight units and includes two dedicated respite units one of which is for people with dementia. The units accommodate between five and nine service users and have lounge, dining room and kitchenette. The units are staffed separately. The building has three floors. The ground floor has one respite unit and one mainstream unit. The second floor has one respite unit and two units for people with mental health needs. The third floor has one mainstream unit and two units for people with dementia. There are mature gardens to the front and rear of the premises. The overall aim of the home is: To provide a high standard of care and support that is tailored to meet individual needs taking account of each service users right to exercise choice and self-determination in pursuing their own lifestyle. On the day of the inspection there were 43 service users and six long-stay and seven respite available beds, although two residents were in hospital and referrals were being processed. The current fees are £492 per service user a week. The provider must make information available about the service, including inspection reports after each inspection, to service users and other stakeholders. Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 14 November 2007 and was unannounced. This inspection was the second annual key inspection and all the core standards were inspected. The inspection also checked how the service was progressing in meeting the requirements from the previous inspection that had taken place on the 29 May 2007. The inspection took seven hours to complete. The inspector focused on four long-stay units, for older people and people with dementia and people with mental health issues. The inspector also spent time on both the respite units. The inspector interviewed one member of staff in each unit and also spoke to residents individually or in groups in each unit. The home also prepared a self–assessment (AQAA) and this was submitted to the Commission for Social Care Inspection prior to the inspection. The manager, deputy manager and other senior staff assisted with the inspection. The care records, staff records and health and safety records were also inspected. The Service Manager who is the home managers line manager also joined the inspection for part of the day. What the service does well: Many of the people living in the home were full of praise about their lives at Merrivale and the care they receive from the staff. One person said “the staff are very kind” and another said, “this is a very good home”. The home has an enthusiastic senior management team and a team of long-standing care staff that are focused on providing a good service to the people who live in the service. There was a lot of interaction between the people living in the home and the care staff and this reflected the fact that people felt able to express their wishes and the staff knew them well and were able to respond appropriately. Despite the fact that the home is old and waiting to be replaced efforts have been made to create a homely environment. The lunch was healthy, nutritious and well received by the residents. The vegetarian alternative and a meal prepared specifically to meet a persons cultural preferences was also observed to be of a high standard. The care plans and risk assessments were up to date and person centred. They also demonstrated close working with other healthcare professionals where the resident needed this. New staff who are working in the home are settling well and being supported by experienced staff. Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are some areas for improvement identified at this report. Some of these relate to work that needs to be completed from previous inspections. This includes the need to extend training to more staff in order to meet the specialist needs of the residents including mental health, Parkinsons, diabetes and pressure care. Additional staff resources need to be provided to ensure activities take place consistently for all the residents in the home. The manager also needs to ensure all the staff receive regular supervision and that adequate senior staff time is available to complete this work. Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 7 The new requirements relate to the staffing levels and the physical environment. The staffing levels must be adequate to meet the needs of the people in the respite units without reducing staffing input on the long-stay units. In terms of the environment the carpets in the front entrance area and corridors and offices must be replaced, new hoists must be provided and worn beds replaced. The door lock for the ground floor units must be reviewed to ensure people who wish to leave the unit to access the garden can do so. A number of recommendations were also made including ensuring everyone has a medication profile, having copies of the menu for each meal available on the tables in the units, arranging for the day centre clients to access chiropody without going into the residential units, arranging regular care staff team meetings, clearing out the managers office and finding a way of distributing continence products without staff leaving the units. 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. Merrivale DS0000010518.V350948.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 Merrivale DS0000010518.V350948.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): Standards 3 and 4 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People moving to the home can be assured that they will be assessed and this will be used to plan their future care. The staff team have great deal experience in caring for the people in the home and have started to be offered training to understand their specialist needs. EVIDENCE: I looked at the assessments for four people who had moved into three units in the home since the last inspection. In addition to the information provided by social services, they all had assessments completed by the home. These Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 10 assessments were person centred and included information about each person’s life history. They provided a good basis for the care plans. The home is making progress towards ensuring the staff have the skills to meet the assessed needs of the residents who are admitted to the home. The training records show that since the last inspection a number of staff have received additional training to support them to meet the specialist needs of the residents. One person received training on Parkinsons and fifteen people received training on diabetes. In addition the home has an ongoing programme of training on dementia and forty six staff have attended training to update their skills in this area. There are however large numbers of staff who still need access to this training or need to be provided with information through internal training within the home. In addition further staff still need training on supporting people who have mental health issues. Merrivale DS0000010518.V350948.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): Standards 7,8,9 and 10 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and wellbeing of the people living in the home is well maintained. Residents are treated with respect by the staff. Medication is generally well managed although medication profiles need to be in place for all the long-stay residents. Further staff training is needed on pressure care. EVIDENCE: Care plans were inspected on three of the long-stay units. These were all person centred and comprehensive, covering all areas of the person’s individual needs. These were being reviewed each month and were up to date. In addition the deputy manager showed us the work he had done on ensuring all the residents have an annual review meeting with their care manager and relatives. Since the last inspection each person has either had a meeting or Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 12 one is booked. A few reviews are outstanding and these are being followed up with the appropriate social service team. This has represented a significant piece of work. The last key inspection highlighted that many of the long-stay residents had not had a dental check up. Since this time the residents have had a dental check, or have stated they wish to continue seeing their own dentist or an appointment is arranged. This is being monitored by the senior care team. At the time of the inspection the senior staff said that none of the residents had a pressure sore. Since the last inspection seven of the care staff have received training on pressure care but this needs to be extended to include more of the staff team. The medication records were inspected on three long-stay units. The medication profiles were all up to date and reflected the medication administration records. Where people had been prescribed a cream the medication profile gave directions on where this cream should be administered. I did however observe that on Mapleview unit three of the residents did not have a medication profile, although their medication administration records were in place and completed correctly. Throughout the inspection the staff were observed to be relating to the people living in the home in a kind and approachable manner. Staff were seen to be taking the time to listen to what people were saying to them even if this was rather muddled and were responding to requests where made. Where staff needed to be more directive in their approach this was done in a kind and supportive manner and the reason for the request was explained. There was a high level of interaction between the staff and the residents and in some units between the residents themselves. This reflected that the staff had a good knowledge and understanding of the people they were supporting. Where staff had physical contact with the residents such as giving a reassuring hug this was done in an appropriate manner. Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 13 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): Standards 12, 14 and 15 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to enjoy a healthy and nutritious diet that meets their individual needs. Additional resources are still required to support the service users to enjoy stimulating activities both within and outside the home. EVIDENCE: During the inspection I was not able to see many activities taking place. On the top floor in the morning they were doing a couple of jigsaws. However for most of the inspection, throughout the home the residents were observed mainly watching the television or listening to music. Two residents on the ground floor mainstream unit said, “we just watch TV and listen to music” and two residents on the first floor said “one member of staff does great craft activities but we have only been out a couple of times this year”. One member of staff said she really enjoys arranging activities when she is working in the afternoon but Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 14 another said, “we don’t really have much time”. The home manager explained that there is a programme of activities and she feels these are being implementing more effectively in the home. She also said there had been a successful summer fete and a Halloween party and entertainments were being booked for Christmas. The area manager also explained that staff were going to receive training on implementing a programme of activities to meet the specific needs of people with dementia. The evidence from the inspection does not reflect a programme of meaningful activities that are taking place in a consistent and ongoing manner. It is my opinion, reflected in comments from the staff that whilst they are willing to undertake activities the limited staffing levels in each flat mean that there is little time for the staff to carry this out. I am of the opinion that additional staff resources are needed to implement a realistic activity programme. It was observed during the inspection that the routines in the home are flexible and based around the needs of the individuals. The people living in the home were observed making choices about what they wanted to eat or drink, whether they spent time in their rooms or the lounge and how they wanted the staff to support them. There was however a concern in relation to one person living in the ground floor mainstream unit. Since the last inspection the respite dementia unit has moved from the first floor to the ground floor. This has meant that the shared entrance to both the ground floor units has needed a security entrance pad fitted to protect the people in the dementia unit in case they wander. One resident in the mainstream unit who liked to walk around the ground floor of the home and go into the garden to smoke has not been able to learn how to use the security entrance pad and has had his movement restricted, which he finds very upsetting. This needs to be addressed as a matter of urgency. Lunch was served during the inspection and this was very tasty and nutritious. Alternatives were available for people who were vegetarian or who wanted food that met their cultural needs. It was observed that people were supported as required and were enabled to eat in a leisurely manner. One person who was reluctant to eat was given appropriate encouragement and we could see this linked in with the guidance in her care plan that also included keeping a written record of her food and fluid intake. The arrangements for the evening meal have changed since the last inspection. This is now prepared in the main kitchen and not on the individual units. Comments from relatives were varied on this with some people saying that the food has improved and others saying they preferred the previous arrangement. The home is preparing cards to go on the table saying what the food is for each meal. So far only cards for breakfast have been prepared and this needs to be extended to all the meals as the old white boards where the food being provided at the next meal was written up have now been removed. Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 15 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): Standards 16 and 18 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that if they make a complaint that this will be addressed in an appropriate and timely manner. Incidents that need to be addressed through the safeguarding adults procedure are being appropriately referred to social services. EVIDENCE: I looked at the record of complaints since the previous inspection. I felt that it was positive that the complaints were being appropriately acknowledged and addressed even those received verbally on the phone or from people making the complaint in person. The outcomes of the complaints were clearly recorded. It was also positive to note the compliments received by the home mainly from relatives. Since the last inspection there have been four allegations made by residents that have been addressed through the safeguarding adult procedures. One is still in the process of being addressed by the police and the others were not substantiated. Two of the allegations relate to agency staff and one to a bank worker. This may also add weight to the need to recruit permanent staff who Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 16 know the residents well. Following on from the investigations Fremantle have made the decision to no longer use one of the agencies for temporary staff as they did not feel the staff were adequately trained and had concerns about the standard of the recruitment checks. The home has however demonstrated a good understanding of the safeguarding adult procedures and the need to work in partnership with other agencies in an open and transparent manner. Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 17 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): Standards 19,20,22,24,25 and 26 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst ongoing environmental improvements are taking place the home needs substantial work on an ongoing basis to provide a comfortable and homely environment for the people living in the home. EVIDENCE: I looked around the home and spoke to the handyman and other staff. Since the last inspections work has taken place that includes replacing much of the lighting, renovating the electrical installations, replacing the main board for the nurse call system, repairing the hot water system, providing a few new beds, decorating a number of bedrooms and other communal areas and replacing Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 18 flooring in parts of the home. In addition new armchairs have been ordered for the top floor of the home. Throughout the inspection the home was being cleaned and any bad odours were being addressed. It is hard for the home to appear properly clean in some areas due to the decoration, old furniture and old floorings that make the environment appear very shabby. The flooring is particularly poor at the front entrance and downstairs corridors and offices and gives a very poor initial impression of the home. I asked staff in each unit about access to cleaning materials, disposable gloves and aprons. They all stated that these were in plentiful supply and were replaced by the handyman as needed. The only issue relates to the use of continence pads as spare pads are held in the duty office. The senior carers explained that this is to avoid pads being wasted or used for people who should be supported to use the toilet. It does however mean that if an extra pad is needed that the staff need to leave the unit and come to the office. The home has two hoists and one standing aid. At the time of the inspection there were two residents who needed this equipment. The hoists were old and cumbersome although both appeared to be working and the deputy manager explained that they were being repaired on an ongoing basis. These need to be updated so they are easier for staff to move and use. At the time of the inspection a chiropody clinic was being held in the second lounge in the ground floor mainstream unit. People were attending this, from the day centre and were constantly walking through the unit. A clinical room needs to be provided for people attending the day centre so they do not need to access residential areas of the home. It was also observed that some of the beds were shabby and stained. An audit of all the beds needs to take place and old beds replaced as needed. It was also observed during the inspection that the managers office needs to be cleared of papers that need to be archived and new linen. The manager explained that they are in the process of creating a new linen cupboard and have also started to make arrangements to archive old papers. Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 19 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): Standards 27,28 and 29 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported by a stable team of staff and new staff are also being recruited. There are however not always enough staff available to meet the needs of the residents. EVIDENCE: I spent time on all the nine-bedded units, visited both the respite units and spent time on the five-bedded dementia unit and looked at the rota. At the time of the inspection one of the respite units had only one resident and one had two residents. This meant that both these units were not staffed and staff from the adjacent nine-bedded units, were overseeing these residents. One respite resident was happy to come and sit with the other residents in the large unit but the other two respite residents wanted to remain in their own unit. This meant that they were on their own for long periods of time and that staff were expected to oversee their care and arrange meals for them whilst also meeting the needs of the long stay residents. Having observed this during the morning and lunch I could see this was hard to achieve. This was particularly the case on the ground floor where the mainstream unit was full Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 20 and the two respite clients had dementia and were confused. Whilst having a member of staff for one resident is not practical there needs to be additional floating support to meet the needs of the respite clients without reducing the care for the long-stay residents. The manager explained that there are 156 vacant care staff hours, which is an improvement on the 230 vacant hours at the last inspection. The manager and area manager also explained that there are three more permanent staff appointed where they are waiting for a reference and further staff interviews scheduled. The use of agency staff has also reduced to about 90 hours a week during the day and 20 hours a week at night. This represents a significant improvement from the last inspection. I discussed the staff leavers with the deputy manager. Their reason for leaving was being monitored and was due to positive reasons such as moving home or childcare rather than dissatisfaction with working at Merrivale. I met the NVQ assessor who was at the home during the inspection. She confirmed the home is making good progress with supporting the staff to complete their NVQ qualification. Seven new care staff have come into post since the last inspection. I inspected the records for two of the new staff and their recruitment checks were all in place. The two new staff were working at the time of the inspection and confirmed they had received an internal induction and were attending the companies five day corporate induction. It was positive to observe that the new staff were working with experienced staff whilst gaining confidence in their role. The record of staff team meetings was inspected. Senior carer meetings are happening regularly but carer meetings are only happening about every three months. Meetings are an important way of maintaining good communication in the service. Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 21 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): Standards 31, 33,36 and 38 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in this home benefit from the service being appropriately managed. They also have an opportunity to contribute their point of view through the quality assurance process. Further work is needed to ensure all staff are adequately supervised to ensure their performance is maintained at a high standard. EVIDENCE: The home has a registered manager and she has a number of years of management experience as well as being a qualified nurse. She is studying for Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 22 the NVQ level 4. She also explained she is undertaking a management and leadership training course with Fremantle. I looked at the quality assurance exercise that had been completed since the last inspection. This consisted of a detailed quality audit completed by Fremantle senior managers looking at all aspects of the operation of the home, and questionnaires that went to residents, relatives, staff and care professionals. The results and comments received had been collated into an action plan. This exercise takes place on an annual basis. In addition monthly regulation 26 visits by senior managers take place to monitor the home and the Operations Manager visits the home on a regular basis. The staff supervision was discussed with the manager. She was able to show how they are monitoring staff supervisions across the staff team. These records were inspected and show that some permanent staff are still not having regular supervision, although the level of supervision has improved since the last inspection. The manager explained that some senior staff are supervising eight or more staff and finding it very difficult to get through the work. They are looking at creating another temporary senior post to create additional time to undertake this work. Since the last inspection extensive work has taken place to update the electrical installations. A record was now available to confirm this work was complete and the system was now safe. There was also a record to confirm the water system was checked for legionnaires. Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 23 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 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 x 2 x 2 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x 2 x 3 Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 18(1)(c) Requirement The registered person must ensure all care staff have access to training on the specific needs of the people living in the home including mental health, strokes and Parkinsons disease. This is an amended requirement. Previous timescales of 31/10/05, 31/07/06, 27/09/06, 7/03/07 and 31/7/07 were not fully met. The registered person must ensure that all care staff receive training on the prevention and treatment of pressure sores. This is a restated requirement. Previous timescale of 30/08/07 not fully met. The registered person must provide sufficient staffing resources to ensure activities are provided that meet the specific needs of people within the service. This requirement is amended and restated at this inspection. Previous timescales of 31/07/06, 31/10/06, 07/03/07 and 30/8/07 were not fully met. DS0000010518.V350948.R01.S.doc Timescale for action 31/01/08 2. OP8 18(1)(c) 31/01/08 3. OP12 16(2)(n) 31/01/08 Merrivale Version 5.2 Page 25 4. OP14 23(2)(a) 5. OP19 23(2)(b) 6. OP22 23(2)(c) 7. 8. OP24 OP27 23(2)(c) 18(1)(a) 9. OP36 18(2) The registered person must ensure the security locks for the ground floor units are reviewed to enable access for all the residents who wish to walk independently to the garden. The registered person must replace all the carpets in the front entrance, hallways and downstairs offices. The registered person must provide new hoists that the staff can move with ease around the building. The registered person must replace all the old worn beds. The registered person must ensure there are always adequate numbers of staff available to meet the needs of the people on the respite units without compromising the care provided to the residents on other units. The registered person must ensure that all staff receive regular individual supervision and that adequate staff are available to complete this work. This requirement is amended and restated at this inspection. Previous timescales of the 31/05/06, 31/10/06 and 07/03/07, 31/07/07 were not fully met. 15/12/07 28/02/08 15/12/07 31/01/08 15/12/07 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 26 No. 1. 2. 3. 4. Refer to Standard OP9 OP15 OP19 OP25 Good Practice Recommendations The registered person should ensure all the residents have an individual medication profile. The registered person should ensure that the menus for the home are available to be displayed on the tables prior to mealtimes. The registered person should ensure that the manager clears out her office to provide an efficient working environment. The registered person should look at where the provision of chiropody to the day centre users takes place so they do not need to go into residential areas to receive treatment. The registered person should look at the arrangements for distributing continence products so that staff do not need to leave the units to collect products when required. The registered person should ensure regular staff meetings for all carers take place. 5. 6. OP26 OP27 Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Merrivale DS0000010518.V350948.R01.S.doc Version 5.2 Page 28 - 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. 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