Inspection on 29/05/07 for Merrivale

This inspection was carried out on 29th May 2007.

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 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 Unannounced Inspection 29th May 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.V333467.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.V333467.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.Millhouse@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.V333467.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th April 2006 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 48 service users and three long-stay and five respite available beds, although 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, to service users and other stakeholders. Merrivale DS0000010518.V333467.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 29 May 2007 and was unannounced. This inspection was the first 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 2 March 2007. The inspection took eight hours to complete. The inspector focused on three long-stay and one respite unit, for older people and 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 inspector also met a relative who spoke to the inspector about the service received by her mother. 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 part of the day. What the service does well: Many of the people living in the home and their relatives were full of praise about their lives at Merrivale and the care they receive from the staff. The home has an enthusiastic senior management team that are focused on providing a good service to the people who live in the service. The home was clean and homely throughout and residents had been able to bring with personal possessions for their bedrooms. The lunch that was served during the inspection was tasty and nutritious and where it needed to be pureed this was done separately in an appropriate manner. The people living in the home said they liked the food and could always ask for an alternative if they wanted. 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 resident. The people living in the home were observed interacting with the staff and clearly felt comfortable asking for assistance or drinks when they wanted something. Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Thirteen requirements and one recommendation have been made at this inspection of which eight have been restated from previous inspections. In some cases these requirements had been restated up to three times because whilst work had started to meet the requirement it had not been completed. A requirement was made under the heading choice of home for the staff to all receive the training to enable them to meet the specific needs of the people living in the home including understanding how to support people who have Parkinsons disease, have had a stroke or have a mental illness. Five requirements were made under the heading health and personal care. These were to ensure each resident is supported to have an annual review Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 Page 7 meeting with their care manager. They also need to be supported to have a dental check. The medication creams must have clear instructions for staff about where they need to be applied and medication profiles must be up to date. The staff must have training on pressure care. It is also recommended that staff have training and supervision to ensure they communicate appropriately with the people living in the home. A requirement was made in the daily life and social activities section to ensure that a full time activity co-ordinator is provided to ensure all the residents have access to a range of stimulating activities suitable to meet their individual needs. In the section on staffing one requirement was made. This is to implement a recruitment programme to fill the vacant staff hours and reduce the use of agency staff. Four requirements were made in the section called management and administration of the home. Firstly to undertake an annual quality assurance exercise. Secondly the staff need to be supported to have regular individual supervision. From a health and safety perspective the home needs to have the electrical installation check completed and the water checked for legionnaires disease. 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.V333467.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.V333467.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 1,2,3,4 and 5 were inspected Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users can be assured that they will be assessed prior to their admission to ensure the home can meet their needs and this assessment will be reviewed and updated throughout their stay in the home. They will also be offered a contract between the home and the service user. Some staff need to receive additional training to ensure they can meet the specialist needs of the service users. Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 Page 10 EVIDENCE: I read the homes statement of purpose and this contained all the necessary information about the home. I read four residents case notes to see if they had a contract available between themselves and the home. They all had contracts and these included appropriate information about the fees and had been signed. 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 and an assessment prepared by the home covering all the main areas of need. I could see that these assessments had been updated to reflect the changing needs of the service users. I also looked in detail at the assessment for the most recent long-stay person to move into the home and very comprehensive assessment information was provided by social services and the home had also undertaken it’s own assessment. 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. I inspected the staff training records for the whole staff team. There are 38 care staff employed at the time of the inspection of which 24 had received training on dementia, 15 had received training on mental health and 11 had received training on Parkinsons disease and strokes. This represents significant progress but further training needs to be booked to meet the training needs of the rest of the staff team. The home does not provide an intermediate care service and so this core standard has not been inspected. Merrivale DS0000010518.V333467.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 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People living in the home are receiving an adequate standard of personal care. They are also being supported to have their healthcare needs met, although some residents still have not had dental checks. Staff need to receive training on pressure care. Service users are protected by improved medication systems in the home but not all the medication profiles are up to date. Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 Page 12 EVIDENCE: I inspected four care plans 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. They all 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 residents. All three of the long stay residents had a record of an annual care plan review meeting although for one person this had not included their care manager. The resident case notes were well organised and easy to follow. Daily reports are also completed for each person living in the home. The health care records were inspected for four people living in the home. There is a clear record, of the healthcare input received by each person and these reflected their individual needs and demonstrated close working with other care professionals. Only one of the three long stay residents whose case notes were checked had a record of having a dental check. The manager explained that they have a dentist and he has so far seen 22 of the 46 long stay people living in the home and appointments are not yet available for the remaining residents. The people living in the home 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 residents 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. I spoke to two staff on Colinwood Unit where people with very high care needs are being supported. They were unclear about whether one of the residents had a pressure sore on his back and both said they had not received formal training on pressure care. The medication was inspected in four units. The long stay units use the Boots blister pack system. 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. The senior staff check the administration records on a daily basis and this had improved the accuracy of the records. The medication administration records were completed correctly but the medication profile in one unit was not up to date. Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 Page 13 In each of the units inspected, cream was being administered to service users and there were clear directions on how this should be applied in some cases but in others the medication administration records just say to give “as directed”. It is suggested that the correct administration guidance is recorded on the medication profiles. One person on Eastview Unit had run out of one tablet. The manager confirmed that this had been discussed with the GP and a revised prescription was being prepared as the medication was no longer available. The medication for one person who was in the home for respite care was inspected. All the medication was in an appropriately named and labelled packet and the home had used its own correctly completed medication administration record. The home has a list of the staff trained to administer medication and a copy is available in each unit. Twelve care staff are receiving medication training or having their training updated in June 2007. Throughout the inspection the inspector generally observed that the staff were supporting the service users to receive care and support in a manner that respected their privacy and dignity at all the times. Service users who spoke to the inspector said they found the staff were very kind and helpful. The inspector did however see a couple of examples of poor practice. In Mapleview Unit in the morning the staff moved a person out of her chair whilst she was half asleep without communicating with her about what was going to happen. One of the staff concerned was interviewed afterwards and understood that you should prepare people before they are moved, by speaking to them. In the same unit in the afternoon one member of staff was observed speaking to a resident in a rather loud and directive manner. The inspector feels that actions such as this can be addressed through training and supervision. Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were inspected. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People living in the home will be supported to enjoy a healthy and nutritious diet that meets their individual needs. Additional staffing is 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 dementia unit in the morning they were trying to play a ball game and the behaviour of one resident with the ball was upsetting all the other people living on the unit. The staff member who was supervising the activity was having difficulty managing the situation. In the afternoon a couple of staff were trying to play a game of bingo with a few residents. However for most of the inspection, throughout the home the residents were observed mainly watching the television. The home management are implementing a new system where the manager of the day centre, which is located on the ground floor of the Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 Page 15 home, draws up a programme of activities for each unit and provides them with the resources such as the appropriate equipment so the staff in each unit can undertake the activities. 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 still of the opinion that a full time activity co-ordinator is 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. The home also has a monthly residents meeting which includes representatives from each unit. The manager explained that a local church comes to the home to conduct services on a weekly basis and Catholic residents receive individual visits from the priest if they wished this to take place. Several residents told me how they choose whether they want to attend the church service. A couple of the people living in the home were able to explain that they chose to practice their religion or culture in a number of ways including the clothes they wear and the food they eat. The staff and residents explained that visitors are made welcome in the home. One relative said she always felt welcome when she came to the home and felt her mother received a good standard of care. At the time of the inspection there were two married couples living in the home and in both cases due to their different needs they were living on separate units. The staff were however seen supporting the couples to spend time together. I spoke to the people living in the home about the food and the feedback was very positive. 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. 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 cook explained that about 6 people need their food pureed and 11 people are diabetic. They can also provide meals linked to a persons cultural or religious needs. I saw that hot and cold drinks were being offered to people throughout the day. I looked in detail as the personal finances for three people living in the home. For two of these people the relatives manage their finances and for the other person social services help them to receive their DSS benefits. They all had money deposited with the company and each persons account is kept up to date and accessed through the computer. I was able to see the financial balances for each person and their record of expenditure. Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were inspected. Quality in this outcome area is good 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. Most staff have received training on the protection of vulnerable adults and more training is planned to ensure the rest of the staff receive the training. EVIDENCE: I looked at the complaints procedure, which forms part of the Fremantle feedback process. I also 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. The outcomes of the complaints were clearly recorded. The home has an appropriate policy and procedure in place for the protection of vulnerable adults including a copy of the Barnet adult protection guidelines. Most of the staff spoken to said they had completed the training. The training records showed that twenty-five of the current thirty-six staff have received training and eight more staff were attending training later that week. Merrivale DS0000010518.V333467.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 19,20,24,25 and 26 were inspected. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The environment and furnishings at Merrivale are in need of refurbishment throughout in order to provide a comfortable and homely environment for the people living in the home. EVIDENCE: At the previous inspection I understood that the home was due to be rebuilt within 12 months. I have now been told that the timescale for this replacement service will take longer and therefore refurbishment work that was not felt to be worth doing if the home was relocating now needs to take place. This includes redecoration and the replacement or furniture and fittings. The manager explained that a programme is in place for this work and this needs to be sent to the CSCI with clear timescales for the work to be completed. Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 Page 18 I did a tour of all the units in the service. The home was clean and there were no unpleasant odours. The home was an appropriate temperature and well lit. Each flat has a lounge and dining area and these were in need of redecoration in some areas. 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 and service users can enjoy sitting outside in the warmer weather. The laundry whilst small for a home of this size was operating effectively and all the service users were observed to be wearing clean clothes. The home has a number of doors that operate with special locks to protect service users who may wander. These were all operating effectively. Merrivale DS0000010518.V333467.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 27,28,29 and 30 were inspected. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People living in the home will be supported by adequate numbers of staff but the use of significant numbers of agency staff can potentially affect standards of care. EVIDENCE: I spent time on all the nine-bedded units and looked at the rota. This showed that there is always a minimum of two staff on each of these units. The manager explained that there are 230 vacant day care staff hours. This does not represent any change from the previous inspection. I asked for the number of agency hours for the last four weeks and the senior carer said that for day staff they used between 227-302 hours per week and at night they used between 30-60 hours a week. Whilst some of the agency staff have worked in the home for a long period of time, others do not know the residents well and have not had the training offered to the permanent staff. I asked about the recruitment taking was place. The manager explained that she had recently spent three days interviewing but when questioned further it appeared that only two new care staff were starting work at the home. No further recruitment campaigns had been planned at the time of the inspection other Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 Page 20 than a sign at the front of the home saying they were looking for new staff. The requirement to recruit more staff is restated from three previous inspections to ensure adequate numbers of staff come into post. I am concerned about the slow rate of recruitment despite an immediate requirement at the last inspection for the home to have a clear recruitment programme with timescales for recruitment targets. The home needs to demonstrate that recruitment is happening, otherwise enforcement action will need to take place. I was pleased to see that since the last inspection the administrator has been moved into the office by the front door and acts as a receptionist and answers the phone. The manager has moved to the first floor and this provides time that is less disturbed to carry out management tasks. The manager explained that the home has a staff team of 38 care staff. At the time of the inspection 9 staff had completed an NVQ in care and 15 staff were undertaking the qualification. This means that the home meets the minimum ratio of 50 staff having completed or undertaking training for an NVQ in care. Four staff recruitment records were inspected for four permanent staff. All the staff had confirmation of a CRB disclosure, a copy of ID and visa where necessary. The induction records were checked for one new member of staff who has transferred from being a domestic to care work since the last inspection. She had completed the internal and corporate induction training. I looked at the training record for all staff in the form of a matrix and this information has been updated for all the staff and provided an accurate picture of the outstanding training needs. Merrivale DS0000010518.V333467.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. Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home has a registered manager with the appropriate skills and experience. Staff would benefit from regular supervision to maintain high standards of work. People living in the home have their health and safety potentially placed at risk by an electrical installation check and legionnaires check that has not yet taken place. 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 the NVQ level 4. Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 Page 22 I was able to see the quality assurance exercise completed in June 2006. This took the form of an internal, audit but had not sought the views of service users, relatives and other care professionals associated with the home. A full quality assurance exercise for 2007 now needs to take place. 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 four staff spoken to during the inspection all said they were not yet receiving regular supervision. The staff training records were inspected for the whole staff team by looking at the training matrix to see if their health and safety training was up to date. Out of the current 36 staff, 33 had completed food hygiene training, all had completed moving and handling training and two more staff were booked to do the assessors course, all the staff had completed fire safety training and a number of staff including seniors had undertaken first aid training and two more staff were booked to undertake this training, 26 staff had completed infection control training with 2 more booked to receive the training. This represents very good progress with mandatory training. 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 and the last one happened in the evening. The fire risk assessment was in place and had been reviewed. An emergency fire plan had been prepared. Certificates to confirm the portable electrical appliances and gas equipment had been checked were available. The electrical installation check had been arranged but had not yet taken place. The current documentation for the electrical installations show that they were last serviced in 2002 and had been found to be unsatisfactory. The manager explained that a check had been due to take place sooner but had been cancelled in an attempt to find a company able to do the work cheaper. This had not proved to be possible and the original contractor had been rebooked to undertake the check. The requirement to service the electrical installations is restated from the three previous inspections going back to May 2006. Faulty electrical installations can place people living in the home at serious risk. The certificates show that the water check for legionnaires needs to take place. Merrivale DS0000010518.V333467.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 3 3 3 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 x x x 3 3 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x x 2 x 1 Merrivale DS0000010518.V333467.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 Timescale for action 31/07/07 2. OP7 15(2)(b) 3. OP8 13(1)(b) The registered person must book training dates to ensure all care staff who have not yet received training on the specific needs of the people living in the home including mental health, strokes and Parkinsons disease have an opportunity to receive the training. This is an amended requirement. Previous timescales of 31/10/05, 31/07/06, 27/09/06 and 7/03/07 were not fully met. 30/08/07 The registered person must ensure that all the people living in the home are supported to have an annual review meeting with their care manager and relatives. The care manager must be contacted to arrange the review where necessary. This is an amended requirement. Previous timescale of 31/05/07 was not fully met. The registered person must 31/07/07 ensure that all the long-stay residents who have not yet had a dental check are supported to have dates booked for dental DS0000010518.V333467.R01.S.doc Version 5.2 Merrivale Page 25 4. OP8 18(1)(c) 5. OP9 13(2) 6. OP9 13(2) 7. OP12 16(2)(n) 8. OP19 23(2)(b) checks and if the service user does not wish to attend the appointment then this is recorded in their case notes. This requirement is amended and is restated at this inspection. Previous timescales of 15/05/06, 31/10/06 and 7/03/07 were not fully met. The registered person must ensure that all care staff receive training on the prevention and treatment of pressure sores. The registered person must ensure that all the medication profiles for residents 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 amended and restated. Previous timescales of 1/10/05, 15/05/06, 15/10/06 and 31/03/07 were not fully met. The registered person must ensure that all the people who live in the home have an up to date medication profile. The registered person must employ a full-time activity coordinator to ensure that 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 and 07/03/07 were not met. The registered person must provide a programme for the refurbishment work at Merrivale including the provision of new furnishings and send a copy of DS0000010518.V333467.R01.S.doc 30/08/07 31/07/07 30/06/07 30/08/07 31/07/07 Merrivale Version 5.2 Page 26 9. OP27 18(1)(a) 10. OP33 24(1)-(3) 11. OP36 18(2) 12. OP38 13(4) 13. OP38 13(4) this with timescales for the work to be completed to the CSCI. The registered person must recruit permanent staff to fill the vacant staff hours and reduce the use of agency staff. This requirement is amended and restated at this inspection. Previous timescales of 1/10/05,30/06/06, 31/10/07 and 07/03/07 were not fully met. The registered person must complete an up to date quality assurance exercise seeking the views of residents, relatives and other care professionals. The registered person must ensure that all staff receive regular individual supervision and a record of this is placed in their supervision records file. This requirement is amended and restated at this inspection. Previous timescales of the 31/05/06, 31/10/06 and 07/03/07 were not met. The registered person must ensure the electrical installations have a current maintenance certificate and no remedial work is outstanding. This requirement is restated. Previous timescales of 15/05/06, 15/10/06 and 31/05/07 were not met. The registered person must ensure a current legionnaires water check has taken place. 30/08/07 30/08/07 31/07/07 30/06/07 30/06/07 Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 Page 27 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. Refer to Standard OP10 Good Practice Recommendations The registered person should encourage the staff to communicate appropriately with the people in the home through the use of training and supervision. Merrivale DS0000010518.V333467.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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.V333467.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!