Inspection on 26/04/06 for Merrivale

This inspection was carried out on 26th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 14/11/07

Merrivale 29/05/07

Merrivale 02/03/07

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 26th April 2006 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.V287695.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. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 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.winglodge@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.V287695.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 1st September 2005 Brief Description of the Service: Merrivale is registered to provide care to fifty-six service users over the age of 65, who 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. Plans are advancing for the home to be totally rebuilt on a site adjacent to the existing home and it is anticipated that this will be complete by the end of 2007. On the day of the inspection there were 53 service users and one long-stay and two respite available beds, although referrals were being processed throughout the day of the inspection. The current fees are £492 per service user a week. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 26 April 2006 and was unannounced. This inspection was the 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 1 September 2005. The inspection took eight hours to complete. The inspector did a tour of the whole building and then focused on four units, two respite units for older people and people with dementia and two long-stay units for people with dementia and people with mental health issues. The inspector interviewed one member of staff in each unit and also spoke to service users individually or in groups in each unit. The 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 the feedback. What the service does well: The inspector was satisfied that the service delivers a high standard of care to the service users. Many of the service users were full of praise about their lives at Merrivale and the care they receive from the staff. The service users were observed to be receiving a high standard of personal care. The staff were very positive about their work and when they spoke to the service users they demonstrated a good knowledge of their individual needs and a caring approach. The care plans and risk assessments were up to date and reflected the needs of the service users. They also demonstrated close working with other healthcare professionals when this is needed by the service users. The service users commented that the food had improved and that if they had any particular requests this could usually be accommodated. All the service users said that if they had a problem or concern they felt able to express their views to the staff and were confident that the issue would be resolved. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Twenty requirements were made at this inspection. Requirements were made for all the service users to have a completed contract with the home. Activities need to be provided that meet the needs of people with dementia. Healthcare appointments need to be recorded for all the service users. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 7 Other areas for improvement relate to the medication system where the MAR sheets need to be completed, medication profiles are updated, directions are available for the administration of cream and the list of staff administering medication includes staff signatures. Further requirements are also made for a complete staff training profile to be prepared and then training to be booked on adult protection, health and safety, NVQ training and training on care issues specific to the needs of the service users. In addition all staff need a record of a completed induction. A programme of staff recruitment needs to be completed in the home to provide a stable staff team. Staff need to receive regular supervision. The garden needs to be maintained so that it can be accessed and enjoyed by the service users. The outcome of a quality assurance exercise needs to be available in the home with an action plan in place to address any issues raised. Maintenance certificates for the electrical installations, gas and water legionnaires check need to be available. The fire safety risk assessment must be reviewed. 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. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 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.V287695.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4 and 5 The quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to the service. The service users have their needs fully assessed before they are offered a service at the home. They are also offered an opportunity to visit the home to see if they like the service. Not all the service users have written contracts with the home. More staff need to receive training so they can meet the specific needs of the service users. EVIDENCE: Two service user case notes were inspected to see if they had a contract available between themselves and the home. One had a contract available but this had not been completed to give the current fees and had not been signed by the service user or their representative. The second service user had no contract available. Four service user case notes were looked at in four separate units in the home. They all contained an assessment prepared by the social services department Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 10 and an assessment prepared by the home covering all the main areas of need. In addition at the time of the inspection one senior member of staff had gone out of the home to complete the assessment of a potential service user. The inspector spoke to service users in four of the units in the home. They all said they remembered visiting the home and many of the long stay service users explained that they had originally received a respite service from the home. Two service users said that they had been unable to visit but their relatives had visited on their behalf. The service users at Merrivale have a wide range of individual needs due to the services offered in the different units. The staff work across the different units and therefore need to be familiar with the different service user needs. Areas for training include caring for people with dementia, mental health issues and physical care issues including strokes and Parkinsons disease. The home has a dementia specialist and some staff received training on dementia in 2005. Eight staff have recently received training on mental health issues. Training has not yet been provided on caring for people who have had a stroke or have Parkinsons disease. There needs to be an audit of staff training so that staff who still need training can be identified and a training programme put into place. The home does not provide an intermediate care service and so this core standard has not been inspected. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to the service. The service users all have a care plan that gives clear direction to the care staff so they know what support they need to give to each service user. Service users are supported to access all their necessary healthcare appointments but these need to all be recorded. Service users have their privacy maintained at all times. There are a few improvements that still need to take place with the administration of medication to safeguard the service users. EVIDENCE: Four care plans were inspected in four units. The care plans are based on the identified needs from the assessments. They clearly record what support each service user needs from the care staff. The care plans also include a night care plan. Each service user also has a risk assessment. Most have a moving and handling assessment and other risk assessments are also available if required. The care plans and risk assessments have been reviewed on a monthly basis for the long stay service users. For the two long stay service users there was also a record of an annual care plan review meeting with their care manager and relatives and the outcome of these meetings have been incorporated into Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 12 the care plans. The service user case notes were well organised and easy to follow. Daily reports are also completed for each service user. The health care records were inspected for four service users. The respite service users received less healthcare input although one service user was receiving ongoing input from the community nurse. In addition one service user had received input from the occupational therapist to assist with an appropriate chair. For the long stay service users there was no record of them being seen for a dental and optical check. The care staff explained that the optician came to the home and the staff took the service users to the dentist. One service user was able to explain that he had been to the dentist but there was no record of this visit. It is required that all healthcare appointments are recorded so that this input can be monitored. The service users had Waterlow risk assessments and nutritional risk assessments to monitor if they could be at risk of developing a pressure sore. In addition the records showed that service users are having their weight checked on a monthly basis. The manager explained that at the time of the inspection none of the service users had a pressure sore. The medication was inspected in four units. The long stay units use the Boots blister pack system. The respite units have a separate container for each service users medication and it was observed that all medication is in properly labelled containers. In three units the medication is stored in a cupboard away from where the service users sit and these units now have a trolley to transport the medication to the service users. All the units keep a record of medication arriving in the service and returned to the pharmacist so it is possible to have an audit trail of the medication. Two staff sign for control drugs when they are being administered and a record of this is held in a book kept in the main office. The temperatures are recorded daily in all the medication cupboards. In one unit, Eastview there were gaps in the medication record for an antibiotic medication. There was also one medication on a service users drug profile that was no longer used and the profile had not been updated. In all four units cream was being administered to service users and there was no clear direction on how this should be applied with the medication administration record just saying to give “as directed”. Each unit has a record of staff who can administer the medication. Some of these do not include a sample signature and this needs to be included in the record. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 13 It was observed during the inspection that personal care is given to the service users in a manner that respects their privacy and dignity. The staff were also observed speaking to the service users in a polite and friendly manner and for some they used first names and for others a formal title according to how they wished to be addressed. The staff and service users all said that when they see a healthcare professional at the home this consultation always takes place in private in their bedroom with staff support as required. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to the service. Visitors are welcome in the home to see the service users although there may be scope to improve input from volunteers and community groups. The service users say that they feel the food is much improved and their individual dietary needs are met although some of the staff preparing the food need to update their food hygiene training. EVIDENCE: During the inspection the inspector was able to see activities taking place. In two units there was a game being played with a soft ball. In one unit there was a group discussion, taking place about a painting. The inspector was also able to meet the newly appointed activity co-ordinator who was having her induction training and spending time meeting the service users. Two of the four service users who were spoken to individually during the inspection both said that they would like there to be more activities and one said that he particularly enjoyed going out of the home. From discussions with the manager and staff it was apparent that there are not activities available that specifically meet the needs of the service users with dementia. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 15 It was observed during the inspection that the routines in the home are flexible and based around the needs of the individuals. The care staff said that they liked to take their time in providing personal care as “there was nothing to rush for”. In one of the dementia units the staff clearly understood that each service user has a different sleep pattern. Service users 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. The manager explained that a local church comes to the home to conduct services on a weekly basis and catholic service users receive individual visits from the priest if they wished this to take place. The staff and service users explained that visitors are welcome in the home. Unfortunately on the day of the inspection the inspector did not meet any relatives or friends in the home. The manager explained that a volunteer will be starting at the home shortly to help visit the service users. She acknowledged that there may be scope to encourage volunteers and other visitors into the home and thought this could be incorporated into the activity co-ordinators role. The inspector spoke to service users about food in the home. They all said that they felt the food had improved and that they enjoyed the meals. The home follows a four-week rolling menu and this was inspected and was nutritious. There is always a choice of a main meal and a vegetarian option is also available. The cook explained that they accommodate a number of special dietary needs including 10 people who have a diabetic diet and 4 who need a soft diet. Two service users have individually prepared meals based on their cultural needs and one service user who had these individual meals said she was satisfied with the food. Each unit has a small kitchen and prepares breakfast so there is flexibility about when the service users choose to eat. There are also snacks and fruit available in each unit. The kitchen was inspected and was clean and well organised. The fridge and freezer temperatures are monitored daily. Frozen and fresh food is appropriately stored. The food hygiene certificates were inspected for the cook, assistant cook and kitchen assistant and two of the staff needed the training updated. During the inspection lunch was served and the staff were observed assisting the service users in a slow and discreet manner, sitting with them. The lunch also took place in a relaxed manner and was seen as a social activity. The inspector also observed in all the units that drinks and snacks were offered throughout the day. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to the service. The service users feel able to complain and complaints are handled in an appropriate manner. The service users would be protected more comprehensively from abuse if more staff received training on adult protection. EVIDENCE: The service users in four units were asked if they felt able to complain. They all said that they felt able to express any concerns with the staff working in their units or one of the senior staff. The record of complaints and compliments was inspected. It was positive to note that verbal as well as written complaints had been recorded and there was a record of how the issues raised had been addressed and the timescale for the response to be given. Since the last inspection there has been one adult protection issue reported by the home using the local adult protection procedure. This was unsubstantiated but demonstrated that the home knew how to use the adult protection procedure jointly with social services and CSCI. Four staff were asked about abuse and they all showed an understanding of how to recognise abuse and how to report concerns about abuse. The whistle blowing procedure was also inspected and was of a satisfactory standard and included the appropriate telephone numbers for staff to report abuse. The staff Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 17 training records were inspected and there were records of about 20 staff having been trained on adult protection issues. This needs to be extended to more staff working in the home. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,25 and 26 The quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to the service. The service users live in an environment that is clean and maintained to a reasonable standard. The service users would benefit from the garden being maintained so they can enjoy sitting outside. EVIDENCE: The inspector did a tour of the whole premises. Since the last inspection the home has been decorated and new lighting provided in some areas. The home was clean and there were no unpleasant odours. The home was an appropriate temperature and well lit. On the day of the inspection the main lift was not working and this had been addressed and by the end of the day was working again. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 19 Each flat has a comfortable lounge and dining area and these were all bright and appropriately furnished. Throughout the home it was noted that service users had been encouraged to bring with them personal items for their rooms. The garden was pleasant but overgrown and this needs to be maintained so that the service users can enjoy sitting outside in the warmer weather. The laundry whilst small for a home of this side was operating effectively and all the service users were observed to be wearing clean clothes. The certificate was inspected that showed that the homes hot water thermostatic valves were serviced on a six monthly basis to ensure they worked properly. The home has a number of doors that operate with special locks to protect service users who may wander. These were all operating effectively. Since the last inspection the homes call bell system has been repaired and the service users when asked said that the staff respond in a timely manner when they need assistance. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to the service. Service users needs are being met by appropriate numbers of staff although this needs to be kept under review. There are still a number of agency staff working in the home and this needs to be reduced as permanent staff come into post to ensure consistency of care for the service users. Staff training needs to take place or be updated to ensure all the staff work to a high standard. EVIDENCE: Since the last inspection the needs of the service users in the home have changed with some service users moving to nursing care. At the time of the inspection none of the service users had very high physical care needs, severe challenging behaviour or needed 1:1 staffing. The rota showed that two staff were working in the larger units and one on the smaller units. The rota was inspected and was clear and showed the times that staff were working and if they were agency staff. At night there are still four staff working, one on each floor and one floating. The inspector felt that whilst staffing levels were adequate for the current service users this would need to be kept under constant review to reflect the needs of new admissions and the changing needs of existing service users. Since the last inspection the home has undertaken a lot of recruitment. The manager explained that at the time if the last inspection there were over 500 vacant staff hours and since then over 400 staff hours have been recruited Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 21 although some staff still need to come into post when their recruitment checks are in place. On the day of the inspection 7 of the staff shifts were being covered by agency staff. The requirement to recruit more staff is restated at this inspection to ensure adequate numbers of staff come into post and that recruitment is maintained as an ongoing process in the home. The manager explained that very few staff are leaving the home and so it is hoped that when new staff come into post that the team will become stable. Regular monthly staff meetings are taking place and the records of these meetings were viewed. The manager explained that the home has a staff team of approximately 60 staff. At the time of the inspection three staff had completed an NVQ in care and four staff had almost completed the qualification. Two of the senior managers are training to be NVQ assessors and have both started to assess two new candidates each. This means that the home does not meet the minimum ratio of 50 staff having completed or undertaking training for an NVQ in care. Five staff recruitment records were inspected for permanent staff working on the day of the inspection. Two of the staff had transferred to Freemantle from Barnet Social Services but had retained their original terms and conditions. All the staff had confirmation of a CRB disclosure, a copy of ID and visa where necessary. The staff also had two written references. The recruitment records were also inspected for a new member of staff who is just about to start working in the home. This member of staff had a POVA check but not a CRB disclosure and the manager explained that she will only work with supervision until her CRB arrives. The induction record was checked for one member of staff who came into post in January 2006. This record could not be located and the manager explained some of these records are currently being held by the senior staff and cannot be accessed when they are not at work. The staff training records were inspected. These are difficult to follow as a training grid that aims to show progress with training for all the staff does not include all the training that is taking place. This includes the training that relates to the specific needs of the service users such as mental health issues, dementia, adult protection and care of people who have had strokes etc. A comprehensive training record needs to be prepared that is updated each month and includes the year of training so that training needs can be projected and the training booked. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 The quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to the service. The home has a registered manager with the appropriate skills and experience. Some quality assurance work is needed to ensure that the service users views effect changes in the home. Service users financial interests are promoted in the home. The staff would benefit from regular supervision to ensure they provide a high quality service at all times. Some staff need health and safety training to ensure the service users are safeguarded. EVIDENCE: At the time of the inspection the manager was able to tell the inspector that a quality assurance exercise seeking the views of the service users, relatives and other care professionals associated with the home had been conducted in the last year but the results of this exercise were not available and so it was not possible to see if the outcome of this exercise had been developed into an action plan for the home. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 23 The inspector met the homes administrator who handles the service users monies and looked at the monies for four service users. The respite service users bring money with them into the home and this can be held on their behalf and any expenditure is recorded and receipts are available. The two long stay service users whose finances were inspected had different arrangements. One manages their own money and just deposits cash with the home to pay for expenses such as haircuts and newspapers. The other service user had the administrator acting as an appointee and was helped to manage her pension and all expenditure. The service user monies system is computerized and all expenditure is recorded and receipts are available. The supervision records were inspected for four care staff. They all had a record of being supervised but none had been supported to receive supervision on a regular basis. The manager also felt that supervision notes may be held by some of the senior staff and these all need to be placed in the staff record. The staff training records were inspected for four care staff to see if their health and safety training was up to date. Three of the four had received moving and handling training although for two staff this training had taken place three years ago. Three of the four staff had received infection control training although for one member of staff the training had taken place three years ago. Three of the four staff had received fire safety training although for one member of staff the training had taken place over two years ago. Three of the four staff had received first aid training although two if these staff had been trained four years ago. Three of the four staff had received food hygiene training although for two of the staff the training had taken place four or more years ago. Staff need to receive or have their health and safety training updated. Fire safety measures were in place. The fire alarm and extinguishers had been serviced. The fire alarm had been checked weekly and drills taking place every two months. The fire risk assessment was in place but had not been reviewed for a year. Break glass on emergency door locks have been installed in line with a requirement from the LFEPA. Certificates to confirm other services in the home had been serviced were not available at the time of the inspection and need to be sent to CSCI. This includes maintenance certificates for the electrical installations, gas system, and water legionnaires check. Portable electrical appliances had been checked at different times and the manager needs to ensure that this is updated on an annual basis. Accidents and incidents are recorded and appropriately recorded to CSCI and other professionals as required and these records were inspected. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 24 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 2 3 1 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 2 x x x x 3 3 STAFFING Standard No Score 27 1 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 2 x 1 Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5(1)(b) Requirement The registered person must ensure that each service user has a completed contract between the home and the service user. The registered person must ensure that all staff receive training on the specific needs of the service users including training on dementia, mental health, strokes and Parkinsons disease. This requirement is amended and restated from the previous inspection. Timescale for action was 31/10/05. The registered person must ensure that the service users health care appointments are recorded in the healthcare log in the service user case notes. The registered person must ensure that the medication administration records are fully completed and that there are no gaps. The registered person must ensure that each service users medication profile is up to date DS0000010518.V287695.R01.S.doc Timescale for action 30/06/06 2 OP4 18(1)(c) 31/07/06 3 OP8 13(1)(b) 15/05/06 4 OP9 13(2) 15/05/06 5 OP9 13(2) 15/05/06 Merrivale Version 5.1 Page 26 6 OP9 13(2) 7 OP9 13(2) 8 OP12 16(2)(n) 9 OP15 13(3) 10 OP18 13(6) 11 OP20 23(2)(b) 12 OP27 18(1)(a) 13 Merrivale OP28 18(1)(c) and accurate. The registered person must ensure that the MAR sheets for service users who have prescribed medication in the form of creams stipulate clearly where, how often and how the cream is to be applied to safeguard the service users and staff. This requirement is restated from the previous inspection. Timescale for action was 1/10/05. The registered person must ensure that the list of trained authorized staff to administer medication is reviewed and updated in each medication file. This needs to include the staff signature. This requirement is amended and restated from the last inspection. Timescale for action was 1/10/05. The registered person must ensure that activities are provided that meet the specific needs of people with dementia. The registered person must ensure that the assistant cook and kitchen assistant update their food hygiene training. The registered person must ensure that all staff have received adult protection training. The registered person must ensure that the gardens are tidied and pleasant for the service users to access. The registered person must continue to recruit staff and fill the vacant staff hours. This requirement is amended and restated from the previous inspection. Timescale for action 1/10/05. The registered person must ensure that a minimum of 50 DS0000010518.V287695.R01.S.doc 15/05/06 15/05/06 31/07/06 31/07/06 31/07/06 30/06/06 30/06/06 30/08/06 Page 27 Version 5.1 14 OP30 18(1)(c) 15 OP30 18(1)(c) 16 OP33 24(1)-(3) 17 OP36 18(2) 18 19 OP38 OP38 23(4) 13(3)(4) (5) 20 OP38 13(4) staff have started to study for the NVQ level 2 in care. The registered person must ensure that there is a comprehensive training record available showing what training all the staff have received and the date of this training. This record must be updated on an ongoing basis. This must be used as the basis to plan an ongoing training programme. This requirement is amended and restated from the previous inspection. Timescale for action 31/1/06. The registered person must ensure that each member of staff has a record of a completed induction training programme in their staff training records. The registered person must ensure that a copy of the results of the quality assurance exercise are available in the home and that an action plan is available. The registered person must ensure that all staff receive regular individual supervision and a record of this is placed in their supervision records file. The registered person must ensure that the fire safety risk assessment is reviewed. The registered person must ensure all the staff have updated training on all health and safety topics including moving and handling, fire safety, infection control, first aid and food hygiene. The registered person must ensure the electrical installations, gas system and water system have all been maintained and serviced and that copies of certificates to confirm this work has taken DS0000010518.V287695.R01.S.doc 31/05/06 31/05/06 31/05/06 31/05/06 31/05/06 30/08/06 15/05/06 Merrivale Version 5.1 Page 28 place are sent to the CSCI. 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 OP13 OP33 Good Practice Recommendations The registered person should work with local community groups to look at ways of encouraging volunteers and befrienders to come to the home. The registered person should review and organise the office files to ensure they are more readily available and accessible to the staff who need to use them. Merrivale DS0000010518.V287695.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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