Inspection on 11/06/07 for Merry Hill House

This inspection was carried out on 11th June 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

Merry Hill House 15/02/07

Merry Hill House 08/06/06

Merry Hill House 15/09/05

Merry Hill House 06/06/05

Merry Hill House 19/10/04

Merry Hill House 10/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Merry Hill House Langley Road Merry Hill Wolverhampton West Midlands WV4 4YT Lead Inspector Rosalind Dennis Unannounced Inspection 11th June 2007 10:00 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 Merry Hill House DS0000036001.V337958.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. Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merry Hill House Address Langley Road Merry Hill Wolverhampton West Midlands WV4 4YT 01902-553397 01902 553397 john.lem@wolverhampton.gov.uk www.wolverhampton.gov.uk Wolverhampton City Council 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) Mr John Lem Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 50 years and above Date of last inspection 15th February 2007 Brief Description of the Service: Merry Hill House opened in 1983; it is one of four residential homes for older people managed directly by Wolverhampton City Council Social Services Department. Merry Hill House is a purpose built, single-storey establishment, registered to provide care to 35 people over the age of 50 years. The building is divided into five separate units and there is a combined sitting/dining room with a small kitchenette facility in each unit and a conservatory provides an additional area for people to relax. All bedrooms are single rooms and have the facility of a wash hand basin, with bathrooms and toilets located nearby. A central area houses an office, kitchen and staff facilities. The Home has equipment such as wheelchairs and hoists to assist people with all aspects of daily living. The home is located off a main road on the southwest side of the city in close proximity to shops, a public house and the bus route into the City. All people living at the home are funded by the local authority-the home is not aware of individual fees. Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was conducted by one inspector over a period of around 5 hours. The inspection involved speaking with staff, people living at the home and their visitors, as well as looking at records and observing staff in their work. The home also provided information to CSCI in the form of an annual quality assessment, which provided information to supplement the inspection process. All ‘key’ standards were assessed during the day- that is those areas of service delivery that are considered essential to the running of a care home. Comments and views were collated from ten people living at the home, staff on duty and visitors, and the content of these is reflected within the individual outcome groups in the report. What the service does well: What has improved since the last inspection? What they could do better: The home needs to improve the way it stores medication as it was found that the drugs fridge and a medication trolley were faulty. The home is also required to ensure that medication, including creams, are given as prescribed. Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 6 Risk assessments were not in place for people who require the use of bed rails and for three people who had bed rails in place on their beds, the type of mattresses in use had not been taken into account which resulted in the bed rails being of insufficient height to reduce the risk of the person falling out of bed. The home is required to ensure that bed rails are assessed, fitted and maintained by a competent person in accordance with MHRA/HSE guidance. During a tour of the home it was seen that the home had not fitted magnetic closures to the lounge doors and a number of door wedges were seen around the home. As a result of these findings the home is strongly recommended to undertake an audit of all areas accessible to people living at the home and where it is identified that the current door opening mechanism reduces the person’s access, then advice should be sought from the local fire officer regarding a suitable door closure device. 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. Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this home. Quality in this outcome area is good. The home has a good assessment and admission procedure and this ensures that the home is able to meet people’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three people’s care files which were seen showed that the home only admits people after a full assessment of need has been undertaken by the person’s social worker with staff from the home obtaining additional information at the time of admission. A discussion with two people who had recently been admitted to the home spoke of their satisfaction with the admission process. To enhance the referral and admission process the manager confirmed that the local authority is intending to review documents such as the statement of Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 9 purpose, service user guide, terms and conditions and implement a new preadmission document. Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. Care plans and risk assessments are generally well written and provide staff with information to meet people’s needs, however to ensure that people’s safety is not compromised risk assessments regarding the use of bed rails should be completed. The home has a comprehensive policy regarding medication procedures, but by not adhering to this policy people are placed at risk of receiving medication that has not been stored correctly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the inspection time was spent on all of the units, observing staff working and speaking with people living at the home-all people spoken with confirmed that the staff treat them well and with respect. Staff spoken with Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 11 were able to give accounts of the varying needs of people living at the home and how they meet those needs. All members of staff on duty were seen to treat people with respect and their approaches to people showed kindness and empathy. One individual visiting their relative commented that the staff show ‘kindness, compassion and attention to detail, not just looking after physical needs but all needs’. Observation of three people’s care files showed that staff plan care on an individualised basis taking into account people’s preferences including whether people have specific cultural and religious needs and/or issues associated with disability. Care plans had been reviewed by staff on a monthly basis and information was available to show that ‘formal reviews’ of care are also undertaken involving the person living at the home, their significant other, home staff and the person’s social worker. The home seeks additional support from health care professionals, such as district nurses-and observation of a person’s risk assessment confirmed district nurse involvement in meeting their diabetic needs. Documentation for another person who is diabetic was less informative and although a discussion with staff indicated awareness of meeting this person’s needs, supportive written guidance should also have been in place to show how all care needs are met. It was also established during a tour of the home that risk assessments were not in place for people who require the use of bed rails. This lead to a discussion with staff and observation of new assessment, care planning and risk management documentation and it was agreed that this should enhance these processes. The manager provided confirmation that all staff involved in administration of medication have received specific training in this area and a newly updated administration of medications policy provides guidance for staff. However observation of medication storage room and medication administration record (MAR) sheets showed that some areas of practice did not conform to the policy. During the inspection the medication fridge was seen to be leaking water and did not appear to be functioning adequately-records showed that the temperature of this fridge had consistently exceeded the maximum required temperature of 8°C for sometime. A trolley used to take medication to people in two of the units was also seen to be broken. The manager confirmed that the home is awaiting a new drugs fridge and trolleythese need to obtained without delay. The home does not monitor the temperature of the medication storage areas and although these temperatures appeared satisfactory the home needs to start monitoring the temperature to ensure that it does not to exceed 25°C. One person’s eye drops had not been dated or signed on opening and for one person case tracked the cream observed in their bedroom and currently used by the person was a different cream to the one prescribed on their MAR chart. Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. Daily routines are flexible with people offered and provided with a range of activities to enhance well-being. The home provides meals that offer variety and cater for different nutritional needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The last inspection found that a shortage of staff was impacting on the level of activities provided-meaning that very little was on offer in the way of stimulating activities. At this inspection people living at the home and their visitors confirmed that activities have improved and described quizzes, musical entertainment and visits to the shops taking place. Staff also confirmed that an increase in staffing levels has enabled more ‘quality time’ to be spent with people. The manager recognises the need to oversee that suitable activities are provided on an ongoing basis. Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 13 All people spoken with during the inspection confirmed that meals provided by the home are good, with a range of choices available to meet individual needs. Menu’s provide pictorial guidance for people who may experience difficulty communicating their preferences. People confirmed that they can choose whether to eat in their own rooms or in the dining areas-which were seen to be attractively laid out with fresh flowers on dining tables. Throughout the day staff were seen to provide prompt and sensitive assistance to people who needed help with their eating and drinking. Three people who visited their relatives during the inspection described how they had a good rapport with staff and comments provided included ‘carers are kind, compassionate’ ‘the care and food is very good’. ‘ Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 14 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): 16 and 18 Quality in this outcome area is good. The home ensures that people have access to a clear complaints procedure and provides an environment, which enables and encourages people to express their views and concerns. Staff are provided with training to equip them with the knowledge and skills to safeguard adults from the risk of abuse or neglect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information on how people can raise complaints is clearly displayed within the home and people spoken with confirmed their awareness of the complaints procedure and that they would feel comfortable about approaching the manager or other staff with any concerns they may have. The manager showed where complaints are recorded and this process enables close auditing of any complaints and the action taken to address them. The home confirms that it has not received any complaints in the last twelve months. The manager confirmed that staff receive training in adult protection and abuse awareness and that the home works within the framework of the local area safeguarding adults procedure. Two members of staff spoke confidently about the importance of safeguarding people from the risk of abuse. Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 15 Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 16 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): 19 and 26. Quality in this outcome area is good. The home provides people with an attractive and clean place to live and further planned refurbishment will continue to enhance the appearance of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoke of their satisfaction with their bedrooms and the lounge areas. A random selection of bedrooms and communal areas were observed and these appeared clean and the décor satisfactory, in rooms which had recently been refurbished the standard of décor was excellent. Personal possessions, photographs and pictures create a ‘homely feel’ to the living areas. The manager confirmed that there is a planned programme of re-decoration and a Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 17 re-furbishment of toilet areas-which has have been an outstanding requirement for sometime. A conservatory and patio provides alternative places for people to relax. A small garden is located outside of Windsor Unit and the manager spoke of intentions to develop this area –which might be further enhanced if the area was fully enclosed. All parts of the home were clean, and infection control systems in place to reduce the risk of healthcare-associated infections. Information provided by the home provides confirmation that the majority of staff have received training in infection control prevention and management. Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29 and 30 Quality in this outcome area is good. Training opportunities within the home ensure that staff are appropriately skilled and competent to carry out the duties for which they are employed. Staffing levels are sufficient to meet the needs of the people currently living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection staffing levels within the home have increased during the day to include between one to two ‘floating members of staff’ who are able to assist in any one of the units on request. On the day of inspection this new system appeared to be working well with people living at the home confirming that activities within the home have improved and that staff respond to their requests and provide assistance promptly-although it is recognised that at the time of this inspection the home was not full. Staff spoke of how the increase in levels has had a positive impact on the people living at the home. The manager confirms that people’s care plans will be used to assist the home in identifying how and when to make best use of staffing resources-which is good practice as peoples’ needs and dependency change. Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 19 The home has not appointed any new staff since the last inspection, when the home was assessed as having an efficient recruitment procedure. Information pertaining to recruitment and selection is held centrally and an assessment of these processes will be undertaken in the near future. Discussion with staff confirmed that regular training opportunities are provided and all care staff have either attained or are in the process of attaining NVQ Level 2 in care. Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 20 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): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. The manager has the skills and knowledge to lead the staff team and manage the home. The home has systems in place to protect people from harm however by not adhering to current guidance regarding the safe use of bed rails the health, safety and welfare of residents is not fully promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 21 People living at the home spoke of how the home appears well-run and the management and the staff approachable. The manager has considerable experience of caring for older people and has the supportive qualifications and skills to manage the home. Minutes of meetings held for people living at the home shows that people are consulted on a regular basis to obtain their views on the service and care provided, and the manager confirmed that this is supplemented by a more ‘formal’ process of obtaining feedback through questionnaires which results in the development of an action plan. For the purpose of this inspection the manager had responded to a request by CSCI to complete an annual quality assessment document (AQAA) and this shows that the home and provider are looking at ways to improve the quality of the service and in particular in the area of equality and diversity-such as in the provision of a new loop system and signage to assist people who may have hearing and other communication difficulties. Observation of one staff file and discussion with staff confirmed that the home operates an effective supervision and appraisal programme, enabling and encouraging staff to reflect and improve on care practice. Financial records were not seen at this inspection; the manager confirmed that the process remains the same as at the last inspection where it was assessed that the home has good accounting practices. Maintenance and servicing records were not checked at this inspection although confirmation that checks of equipment are undertaken and health and safety policies are in place is provided within the home’s AQAA. Staff confirmed provision of training and updates in all safe working practice topics. During a tour of the home it was seen that the home has not yet achieved the recommendation to fit magnetic door closure devices to the lounge doors, a number of door wedges were seen lying around the home and some people’s doors were held open by furniture. People living at the home confirmed that their bedroom doors are closed at night-the manager discussed that the process of fitting magnetic closures is going through a course of approval-it is strongly recommended that an audit of all areas accessible to people living at the home is undertaken and where it is identified that the current door opening mechanism reduces the person’s access, then advice should be sought from the local fire officer regarding a suitable closure device. Three beds which had bed rails attached also had pressure relieving mattresses in place on top of another mattress, this meant that the bed rails were not high enough to reduce the risk of the people falling out of bed. Individualised risk assessments for the safe use of bed rails had not been completed and a discussion with the manager indicated that staff involved in the fitting of bed rails had not had access to relevant training or guidanceinformation was given at the time of inspection about where this guidance could be obtained and the manager was informed that action needed to be taken immediately to ensure that people assessed as needing bed rails were adequately protected from the risk of harm. Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 22 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 23 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 OP9 Regulation 13 (2) Requirement Medication including creams must be given as prescribed and all medication must be stored and given in accordance with manufacturers’ instructions. This is to ensure that medication is stored correctly to prevent people being placed at risk of harm and from receiving ineffective medication The registered person must ensure the refurbishment of toilets on Hanover, Windsor and Stuart Units must take place. (Previous timescales of 01/08/05 and 01/04/07 not achieved). Timescale for action 01/08/07 2. OP21 23 (2) b 01/10/07 11/06/07-Assessed as in progress as evidence suggests refurbishment is planned) 3 OP38 13 (4)(c) Bed rails must be assessed, fitted and maintained by a competent person in accordance with MHRA/HSE guidance. This is to protect the person from the risk of harm and promote their safety 01/08/07 Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 24 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 OP19 Good Practice Recommendations That magnetic door catches are fitted to all doors from the lounges (11/06/07 Assessed as not achieved). 11/06/07-It is strongly recommended that an audit of all areas accessible to people living at the home is undertaken and where it is identified that the current door opening mechanism reduces the person’s access, then advice should be sought from the local fire officer regarding a suitable door closure device. That extra fencing and a gate are provided to create an enclosed garden by Windsor unit. 11/06/07-Not yet achieved but evidence to suggest that attention to this area is under consideration. 2. OP19 Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Merry Hill House DS0000036001.V337958.R01.S.doc Version 5.2 Page 26 - 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. 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