Inspection on 24/06/08 for Meyer House

This inspection was carried out on 24th June 2008.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Meyer House 28 Meyer Road Erith Kent DA8 3SJ Lead Inspector Wendy Owen Unannounced Inspection 11:00 24th June 2008 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 Meyer House DS0000071550.V366307.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. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meyer House Address 28 Meyer Road Erith Kent DA8 3SJ 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) 01322 338 329 Nellsar Ltd Gillian Ann Redsell Care Home 34 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (34), Old age, not falling within any of places other category (34) Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 34 Random Inspection 14/11/07 Date of last inspection Brief Description of the Service: Meyer House was registered with the Commission in November 2006. Since that time the registration has changed to include nursing and mental health clients (maximum of 4). It offers accommodation for 34 residents. Private accommodation is offered in single rooms, with the exception of six double rooms for those wishing to share. All bedrooms have en-suite facilities. Communal areas comprise of lounge, dining room, conservatory, cinema room, activities room and hairdressing room. Currently all double rooms are being used as single rooms. The home has also seen a change of Provider to Nellsar Ltd in February 2008. Meyer House is located in a quiet residential area with local shops a short bus ride away and the main town centre also a short ride away in the opposite direction. Public transport is easily accessible with numerous buses running along the main route and a railway station in Erith. The home provides information to prospective residents through a brochure and Statement of Purpose. On admission residents are provided with a Service Users’ Guide. Residents are provided with terms and conditions of residency with fees ranging from £423-£682. The fees do not include items such as hairdresser, private chiropodist, toiletries, individual TV licences, private Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 5 telephone charges and newspapers etc. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate outcomes. This inspection is the first inspection since the change of Provider in February 2008. The inspection took place over two days and was undertaken during the first six months of the change of Provider, as is the Commission’s policy. The inspection included an unannounced visit to the home, discussions with residents relatives, staff, the RGN in charge (who is also the Lead Nurse) and the manager. We also toured the home; viewed records and observed practice. As part of the inspection we sent out residents and relative comments cards and received six comment cards from relatives and six from residents, prior to the inspection being carried out. We have also received the Annual Quality Assurance Assessment (AQAA) prior to the inspection. This is information provided each year by the service on the quality of care provided. Outstanding requirements made at previous inspections have not been carried forward due to the change in Provider. People living in the home and some relatives have chosen to be referred to as residents throughout the report. What the service does well: Feedback from residents and relatives was very positive. People feel safe and well cared. We received comments that included: “I am very happy to be looked after at Meyer House.” Another said, “I am very satisfied with the whole set up.” Relatives wrote, “For now I cannot fault the service provided and can only praise the staff who provide it.” People have information about the home and what they can expect from the service to assure them that it is right for them. There are good systems in place that enables the manager to maintain the health, safety and wellbeing of people living there. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 7 The home has an experienced manager supported by a RGN taking the lead on clinical matters. Staffing levels are appropriate with staff receiving training and obtaining qualifications for them to be able to meet peoples’ needs. Residents feel that staff do understand their needs and respond to them sensitively and with great care. One resident told us “the staff are the home”. The food provided is varied, healthy and nutritious and enjoyed by residents. Individual needs are catered for. One person wrote “The staff always give me food they know I like.” All of the feedback received stated that the home is fresh and clean with one person writing, “No smells. Very, very clean.” A tour of the home showed that it is kept to a reasonable standard. The service benefits from comprehensive policies and procedures to enable the manager to provide consistent care to a good standard. What has improved since the last inspection? What they could do better: The Providers have made a number of improvements over the last few months. However there are a number of areas that must be improved to ensure the safety and well-being of the people in their care. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 8 Care plans and risk assessments must provide more information about the needs of the residents to ensure staff provide the care and support they require. Recruitment procedures currently place vulnerable people at risk and must be made more robust to protect them. Systems must be implemented to ensure individuals’ health and safety, including ensuring all staff take part in regular fire drills and dorgards are fitted to ensure appropriate action is taken in the event of a fire. Hot water temperatures must be tested and recorded to ensure people are not placed at risk of scalding whilst bathing. A review of the meal-times routines must take place to ensure all residents benefit from a meal that is hot. People must be further protected by ensuring there are copies of inter-agency guidelines on the protection of adults from all Local Authorities who make placements in the home. There must be a full and accurate record of complaints made including the investigation outcome and action taken to resolve the complaint. This inspection finds the home working well towards the necessary imporvments and finds it has the capacity and resources to improve its current rating. 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. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 9 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 Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The pre-admissions procedures enable people to have the information to make decisions on whether the home is right for them and staff have the information to ensure they are able to provide the care and support required. EVIDENCE: Since the last inspection there has been a change of Provider and with this a change in procedures and documents has been required. There has been progress with this and a Statement of Purpose and Service Users Guide have been developed providing details and information about the new Provider. We were provided with a copy of these although people living in the home have yet to receive their copies. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 11 Both have been produced in a written format and would benefit from other formats for those with specialist needs ie visual impairment. The Statement of Purpose whilst covering the areas required by the Regulations basic and could be improved by a more person centred approach and more specific information. For example details of the admissions procedures, brief description of how to make a complaint, information about development of care plans and how the Providers monitor the quality of care delivered. Contracts have also been developed and provided to residents. These detail the fees including the nursing contribution. The manager and Provider are reminded that the fees should clearly state where nursing contributions are paid by the health authority the amount paid separate to the home’s charges. Files were viewed with one viewed having a contract and Local Authority placement agreement whilst there was no contract on file for the second although the relative said they had received one. We received written feedback from six residents and all but one stated they had received a contract. One relative spoken to told us how they had chosen to visit the home from a list provided to them. They were impressed that when they rang up they did not have to make an appointment and when they visited the staff (manager and Registered General Nurse (RGN)) were extremely helpful and friendly so much so that they looked no further. They brought their relative to have a look also and have not been disappointed with their choice. One comment made on the feedback form said, “having a look made all the difference. Staff were very nice and helpful.” We viewed the personal files of two people who have recently come into the home along with one relative and another relative of the person admitted very recently. We also considered the information provided in the comment cards returned. In viewing the file we found they contained a client assessment form. One of these was completed using the new Provider’s assessment information form whilst the other on previous Provider’s records. The latter one was very basic and we therefore hope that the current assessment information will be used in the future. One file also contained a copy of the Local Authority assessment with comprehensive information that the home could use in making an assessment and confirmation in writing that the home can meet their needs. The second file contained a property checklist whilst the first one did not. They are reminded that all property brought into the home must be recorded. We also noted that on one file the person’s name had been spelt incorrectly. Standard 6 was not assessed on this occasion. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 12 Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 13 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 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is not available to staff to ensure they provide the appropriate care and support to people living there. Risks to people are identified but appropriate interventions are not recorded. This means individuals needs may not be met and therefore may be placed at risk. Medication practices are robust and ensure the health and safety of individuals living there. People are treated with respect and dignity with privacy also respected. EVIDENCE: Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 14 We spoke to the RGN, the person in charge, at the time of the inspection and they told us that there are currently 26 residents in the home with one lady who has just passed away. We were told that there were no residents with pressure sores; one resident who is an insulin dependent diabetic and two residents with MRSA. There are no residents with mental health problems. Meyer House provides care to older physically frail people and those that require nursing care. There is a mixture of both categories on the two floors that mean nursing staff have to ensure they provide care, support and medical supervision to these clients. As part of the inspection we sent comment cards to some residents and relatives, as well as obtaining feedback over the two days. We also observed what was going on in the home. We found that people receiving a service are happy with the care provided and that staff are aware of their individual needs knowing their preferred names, as well as individual likes such as sugar in tea, where one lady prefers to sit in the cinema room for lunch and where they choose not to have the services of the hairdresser. We received six comment cards from residents and five from relatives. All were positive about the care with only one less than positive feedback about the actual care received. One person said, “I am very happy to be looked after at Meyer House.” Another said, “I am very satisfied with the whole set up.” Relatives wrote, “For now I cannot fault the service provided and can only praise the staff who provide it.” With another writing, “We feel it makes the resident feel at home…” We also noted, whilst walking around the home, that people living there were dressed for the weather conditions and looked well presented and groomed. It was positive to note that spectacles were clean enabling individuals to see properly. This shows a good standard of care provided by staff. We spoke to two relatives who were very happy with the care received by their family members. They told us staff knew what their needs are and that they are kind, caring and considerate and that, they, as family, feel that their relatives are safe. We looked at the individual care plans of four people including, two recent admissions. The staff are in the process of changing over to the Nellsar care planning format although most of the care plans and associated documentation is still in the original format. We viewed three files in the current format and one of the “sample” files of the new Nellsar care planning information. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 15 Those files viewed had assessments, risk assessments and, in some cases, some information on care plans. There is still much work to be done in relation to the information provided on the care plans. It is positive to note that the assessment provides information on individuals’ preferred routines such as bathing, dress (eg where a lady prefers to wear trousers). This shows attention to details and ensuring individual needs are addressed. There is also a model care summary that details a number of areas of need such as mobility and personal care. These only summarise the information and do not give full information. The full care plans viewed were limited in giving information about their needs. In one case the person had just two areas identified: mobility and personal care even though there were other issues. The fact that the person had shortness of breath and was on an inhaler had not been documented anywhere. In another case the person had a number of health needs that had not been documented, including regular dialysis and is an insulin dependent diabetic but no care plan. Only two elements had been recorded-safety and mobility and decreased mobility covering personal care. This had been addressed to some extent by the second day of the inspection. However, in another case the person had a skin condition that needs to be addressed though application of cream but his was not recorded. This is an area that is in need of improvement because without this information recorded staff may not provide the care and support required leaving residents at risk. There is some evidence of reviews taking place regularly but this is quite variable in standard. It appears that reviews take place monthly but these often say “no change” even though it is clear there has been. In one case a resident had an ulcer on their toe (March 2008) No evidence of this is recorded in any of the reviews nor is there are risk assessment, wound care chart or care plan in place. Whilst the sore may now be healed the fact is that there are no records in place. There is also little evidence of people being involved in the reviews of development of care plans initially. There is very little information regarding their medication needs, social, cultural/spiritual or financial needs, although this has been recognised as needing improvement in monitoring reports. It is positive that risk assessments are now in place in all but one of the individual’s files viewed. These identify risks to individuals in relation to pressure sores, nutrition and falls. However, where risks have been identified the interventions recorded are also variable. In one case the person had a high risk of pressure sores and nutritional risk assessment that gave cause for concern. In another file viewed the risk Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 16 assessment identified the person to be at risk of developing pressure sores. No interventions or care plan had been recorded. The information regarding pressure relieving used is also variable. The organisation of the file also hinders staff from easy access to the information they need. For example, care plans were often found nearer the back of the file rather than readily available at the front. Important information that is required by staff should be at hand for staff to view when required. Without clear, up to date and easily accessible information there is the potential for a person’s needs not to be met. When speaking to staff they told us how the new Providers had purchased much needed equipment for the home to ensure residents’ well-being. We also noted alarm call systems in place throughout the home; a number of nursing beds with five new ones recently purchased, bedrails, pressure relieving equipment and other mobility aids in place. Staff also spoke of the purchasing of weighing scales to ensure they can monitor individuals weights. This is a positive start by the Providers. It is clear from the documentation that there has been an effort to record individual weights. This should be followed up by recording action taken were there is a significant change in this area. For one person their records showed a change from 51.3 in February 2008 to 46.7 in March 2008 There are records in place detailing individuals’ healthcare access although these were not fully monitored on this occasion. The Liverpool care pathway (a format for meeting the indivudal needs towards the end of their life) is about to be adopted for those requiring palliative care. The RGN has attended the training and is in the process of access a facilitator for other nursing staff to enable this to be adopted in the home. We observed the lunchtime medication administration on ground floor. This was satisfactory, as were the records in place. We also viewed the records relating to the nursing unit. These were generally satisfactory including the records for controlled drugs. Records were well recorded and completed, including photographs and allergies. Any handwritten records had been counter-signed. We noted some good practice including “as required” protocols for medication that need not always be given, although this was not always implemented consistently and this was also true of carried forward medications. Overall the medication practices were robust to ensure the safety and wellbeing of residents. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 17 Some, but not all staff, have received medication training through a distance leaning provider and competency assessed by the manager. There is a need to ensure nursing staff are also provided with training to ensure they meet the Regulations. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 18 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People enjoy relaxed routines and stimulation that meet their preferred needs. However, there is the capacity to improve activities to ensure they receive regular stimulation. Food is of a good quality and varied ensuring individuals receive a nutritious and healthy diet. EVIDENCE: During the course of the visit we observed practices and routines. As part of the inspection we also used the feedback from people spoken to on the day and from written feedback as well as talking to the activity co-ordinator and viewing of the activity schedule. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 19 It is positive that an activity co-ordinator has been employed to work three days a week since the last inspection and at the instigation of the new Providers. People told us that they could choose how to spend their days; for example going to bed or getting up or where to have their meals. We noted residents spending their days in the main lounge, sitting in the conservatory or outside enjoying the sunshine with a couple of residents playing a board game. The activity co-ordinator was working on the day of the inspection, although we did not notice any form of activity or entertainment except for the afternoon when we saw an outside retailer had come into the home to sell dresses. An activity schedule has been developed which shows a range of one-to-one and group activities. Some of the feedback from comment cards and relatives told us that there is not always enough stimulation and particularly external entertainment. Five of the six wrote that there were activities usually or sometimes with one person commenting they “could do with more” and another stating they “would like more entertainment”. The manager told us that they try and arrange entertainment every two weeks or so. This is the area where people were not as positive but could be easily improved with people improving their overall well-being. It is clear from observing what was going on that visitors are made welcome by staff and there appears to be good relationships between residents, relatives and staff with relatives looking relaxed on entering the home. However, one relative who spoke highly of the home and staff did say they were not offered a drink nor were they told that they could “help themselves,” especially if people have travelled a far way. This could be easily remedied. Residents benefit from a monthly visit from a Church of England minister and for Catholics regular visits from the local priest for communion and confession. One lady also visits her family for Sunday lunch and occasionally they take her to Mass. The AQAA shows all people living there are of Christian faith and all, but one, is white British. One person has a first language is Maltese although speaks fluent English. The manager told us that the individual is catholic and has a priest visit regularly to ensure she maintains her faith. We also looked at the meals provided. Menus have been produced over a fourweek period. These were varied and nutritional to ensure people receive a healthy diet. Food provided is of a good standard with five people using the Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 20 service who wrote to us saying they enjoyed the food provided. Three residents were spoken to at the lunch on the second day and all were very positive about the food. On that day there was a choice of scampi and chips or mashed potatoes, fish and mash potatoes or chips or fish in sauce and sausage and chips. One lady told me that you could also have a salad or another alternative if none of these were to your liking. Condiments were placed on the table with the table well presented. Residents are able to eat their meals in the dining room, their bedrooms or wherever else they choose. One person has their meals in the cinema room away from other people, as is their choosing. Staff take their meal to them but forget to bring in condiments etc and other little touches. One person wrote “The staff always food they know I like.” The lunchtime routine works well for those taking their meals in the dining room. However, for those requiring meals in their rooms or needing assistance the routine needs to be adjusted. Currently meals are taken up on the trolley and distributed. However, the meals are cooling down during this period and there are not enough staff available for all people who need assistance. This could be easily resolved by changing routines slightly. Refreshments are provided throughout the day with people having enough to drink. There is a need to ensure that people are offered something to eat at supper-time as the time between tea and breakfast is over 11 hours and people may need a snack to keep their energy levels up. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 21 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service feel that any concerns or complaints are listened to and acted upon, although the lack of clear and thorough records means there is not a clear audit trail to ensure people’s concerns have been dealt with. There are procedures in place for the protection of vulnerable people but the lack of robust recruitment practices means individuals are placed at risk. EVIDENCE: A new complaints procedure has been developed to reflect the change of Providers. Currently the manager is using a complaints book that does not give enough information about the complaint. This is to be addressed by implementing Nellsar’s record keeping system. It is clear from the feedback received from residents and their relatives that they have full confidence that their concerns and complaints will be listened and investigated by the manager. The comments regarding the manager and lead nurse were very positive and shows they have a good attitude and Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 22 approach to ensuring the well-being of the people living in he home and wanting to ensure they receive the care they want. The AQAA details that the home has received 7 complaints in the last twelve months with none substantiated. It is difficult to determine how these have been investigated and outcome reached with the minimal available. The new recording system should address this with changes being made by the new Providers and complaints viewed were made prior to their taking over the home The manager is a non-nurse and the clinical lead is taken by a designated RGN also the Lead Nurse. This means that the manager may not be able to investigate all complaints, especially those raising concerns about nursing care. We were told that any complaints arising in this area would initially be screened by the manager and then passed to the designed lead RGN who will try and investigate with the manager’s support. Support is also available from senior staff within the organisation. Nellsar have comprehensive procedures in place for the protection of vulnerable people. Staff should be given time to read through these and familiarise themselves with them. Three staff were spoken to and two had a sound knowledge of what to do in the event of any allegation or observing practices that may constitute abuse. The third member had only just commenced employment and had not had the opportunity to be provided with guidance in this area. However, we have made comments later regarding recruitment which impacts on this area. The training matrix provided shows that a number of care staff have received training over the last twelve months. However, the training for the nursing or ancillary, staff including the lead nurse has not been as robust. We also noted that people are admitted to the home from not only Bexley Local Authority but also others. They have the Bexley Safeguarding interagency guidelines in place but must obtain the Inter-agency guidelines from other local authorities who have made placements in the home to ensure people are aware of what they should do in the event of any adult protection issues. There has been one adult protection investigation over the last twelve months relating to the health and well-being of an individual. The investigation found the allegation not to be in substantiated although there were with areas requiring improvement. The main area of concern relates to the recruitment procedures. Viewing of staff rosters, staff personnel files and speaking to staff we found that a RGN had commenced the previous day with a POVA1st and no Criminal Records Bureau check. The supervisory arrangements were not satisfactory with the Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 23 member of staff being left responsible for the running of the home on the evening of their first day. There also other gaps that need to be addressed in relation to other files viewed. A requirement was made to address this with immediate effect and complied with by the Providers with assurances that future recruitment practices would be more robust. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 24 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): 19,20,22,23,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The improvements made and that continue to be made provide people with a comfortable, clean and homely place to live. Further improvements and plans ensure the risks to individuals are reduced. EVIDENCE: The accommodation is located over two floors with lounge, dining area, conservatory, WCs and bathrooms situated on the ground floor. The dining room and lunge are of a open plan design giving the ground floor an open and airy feel. The reception, office, laundry, and cinema room are also located on Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 25 the ground floor. Bedrooms are situated over both floors with WC and bathrooms also on first floor. All bedrooms are en-suite and there are six double rooms currently being used as single accommodation. Accommodation and décor is of a reasonable standard. Residents and relatives spoken to told us that they were happy with their rooms and that they had what they needed. A number of rooms were personalised to give a more homely feel. Rooms have alarm call bells in place and, where required, appropriate furniture such as nursing beds, recliner chairs and mobile hoists. Around the home we viewed aids and adaptations to ensure people are able to mobilise and access areas safely. However there are areas that continue to restrict safe access and mobility. The first floor corridor has one area where there is a step and quite a steep metal slope. This should be addressed to make the slope more gradual. This will enable those that are wheelchair bound or have mobility problems able to access areas more safely. This is also true of exiting the conservatory for those in wheelchairs. We also noticed that a gentleman had been seating out in the rear courtyard in his electric wheelchair and could only access the home by going around the side and up the ramp at the front door. The gentleman got stuck and it was only noticed by a resident going out of the home. We assisted the resident but noted that delivery trays had been stored at the side path causing an obstruction. These must be removed to an area that does not cause a hazard to others. We are aware that the Providers have already committed to a number of improvements and are planning further changes in the near future. A copy of the action plan has been requested. It is also positive that a maintenance person is now working on areas requiring attention in the home with oversight by the organisations maintenance manager. Bathrooms and WCs were fitted with hand-washing facilities, as was the laundry area. Gloves and aprons were available around the home. The laundry area itself is quite a large area with separate areas for washing, drying, pressing and storing clothing. Whilst the inspection was being undertaken the laundry was being fitted with a new washing machine and tumble-dryer of industrial standard. Staff were able to demonstrate a reasonable knowledge of infection control procedures although more guidance should be given in relation to clostridium difficile to ensure they are aware of the way in which risks of cross infection with this particular infection can be reduced. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 26 The manager should also provide clinical waste bags, red bags and foot operated bins in each person’s rooms where the person has an infection so as not to transfer the infection to others. The home benefits from courtyard areas for people to enjoy the fresh air as well as a conservatory allowing the outdoors into the home. The front of the premises comprises of a sitting area and car parking with gates allowing access to the premises. The front of the home could be improved by tidying the area up eg putting clinical waste bins and other items out of sight of residents who wish to sit in the paved area at the front. The drive in area also has a plinth area that used to be the base for a statue now longer in place. This takes up a good deal of room and is for some an “eye sore”. All feedback received stated that the home is fresh and clean with one person writing “No smells. Very, very clean.” The Providers are aware of some areas requiring improvement such as arranging deep cleaning of the kitchen. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 27 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are caring, competent and skilled to provide good care for individuals in the home. The lack of robust recruitment and supervisory procedures means that vulnerable people are placed at risk of abuse. EVIDENCE: There are currently 26 residents in the home with ten physically frail (residential) and sixteen requiring nursing care. The majority of people requiring nursing care are located on the first floor and those who are physically frail on the ground. There are two care staff looking after people on the residential unit and two care staff and an RGN looking after those with nursing needs. The AQAA shows total staffing-21 care/nursing staff and non-nursing staff. Since the last inspection change of providers now have dedicated laundry assistant. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 28 On the day of the inspection the manager had taken time off and the home was being managed by an RGN who was working supanummary. The RGN working on the unit had begun working in the home the previous day. On discussion with the Lead Nurse also the RGN in charge, viewing the staff roster for the week commencing 23/6/08 and viewing of the personal file it was clear that the nurse was working with a POVA1st and no Criminal Records Bureau check (CRB). The nurse in charge was aware of the need to put in place supervisory arrangements. However, it is clear that the nurse in charge is undertaken some of these responsibilities there were a few hours the previous day and would be on the day of inspection where the new RGN would be in charge of the home. This is not acceptable nor would it be good practice, even with the CRB in place, to place the person in charge without a more thorough structured induction in place. We issued an immediate requirement to ensure there are supervisory arrangements in place if the person continues to work prior to the CRB being received. On viewing three personal files of staff recently recruited (including the RGN detailed above) we found that there is a need to improve the recruitment processes to make them more robust in order to protect people living there. We were told that that would take action immediately with the RGN working only with supervision. We found there to be an application form or CV; proof of identity and in the case of the RGN, the PIN number and NMC details. There were also references in place although in one case this was not from the last employer although they had obtained a reference from an employer in care. In another case a reference from the previous employer had been obtained with a compliment slip and stamp but signed by a team leader rather than the manager. A references has also been obtained from the administrator but was a personal reference. Where there had been employment in care previous to their last employment there was no evidence of verification as to why they left that employment. We had the opportunity to speak to the recently recruited RGN who told us about their induction the previous day. They were shown around the home and given guidance on the emergency procedures. It is clear from speaking to staff that the training provided has been improved. There is evidence of core training being provided including moving and handling; infection control; food hygiene; fire and managing challenging behaviour. There is a rolling programme for the training of staff to ensure staff are skilled and competent to provide the care required. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 29 We observed practice and had verbal and written feedback from residents and relatives. The feedback was positive and complimentary about the care provided. Observations showed staff had good relationships with the residents and visitors and understood the needs of the people in their care. “the whole system is good. Staff are excellent and do not change which helps the resident to feel comfortable.” It is also positive to note that the Lead Nurse is also working towards the Registered Manager’s Award to enable them to provide appropriate support to the manager. The AQAA states that there are 21 permanent care staff of whom with 14 have achieved the NVQ 2 qualification with 5 currently working towards it. Two staff have NVQ 3 with 4 working towards the qualification. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 30 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, 32, 33,35, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has the experience and capacity to improve the care and health and safety of people living in the home through implementation of the Providers monitoring and auditing systems. EVIDENCE: Meyer House has seen a change of Providers in the last six months. The manager has remained in post and there is a designated RGN who is the Lead Nurse and takes the lead on clinical matters with the support of the clinical Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 31 management team. She supports the manager in the day to day running of the home. The AQAA shows that the policies and procedures have been reviewed and sample viewed during this inspection. The AQAA also showed various service checks on services and equipment all within the last six months, including hoist, lift, fire equipment and system, fixed wiring and gas. The home has also benefited from Environmental Health officer visits in June 2008 and September 2007. Both of these were positive visits stating good standards in place. There are some gaps including lack of evidence or monitoring and recording of hot water temps and lack of fire drills for all staff. We are also concerned with some health and safety issues highlighted under the environmental standards as well as the need to ensure doors have dorgards fitted that close when the fire alarm sounds. Nellsar has some good systems that are currently being implemented into Meyer House and eventually will improve the way in which the home is managed, the service monitored and improved. We will inspect these along with how the service and systems are monitored at the next inspection giving them a opportunity to fully implement procedures. There are concerns about the recruitment practices and with these concerns an immediate requirement was made and responded to by the Providers. The organisation also has procedures to obtain views of those using the service although these have yet to be implemented and will therefore be inspected at a later inspection. There are Regulation 26 monitoring visits completed each month with reports written on the findings. These are very informative and give an objective overview of how the quality of care the service is providing showing where improvements are required. We can see that the home is on an upwards trend and that if the systems are implemented fully with care continuing to improve a three star rating is within the home’s reach. All catering staff have safe handling of food qualification and with 76 of care staff with the training. The training matrix also shows a number of staff in receipt of infection control and moving and handling training. A number of care staff have undergone first aid training although the number of nursing staff attending such training is limited. The manager was made aware of the current CSCI/Health department guidance regarding the provision of first aid qualifications that includes completing a risk assessment determining the first aid requirements of the home. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 32 Supervision is on the agenda for improvement over next few months and will therefore be monitored at the next inspection. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 33 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 2 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X 2 2 Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? no 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 5a Requirement The contract must show the full fees together with any contributions paid by the health authority towards the cost of care. Care plans must reflect the personal, health, social, emotional and spiritual needs of the individuals to ensure people receive the care and support they require. Where risk assessments show risks to individuals these must detail interventions and actions by staff to minimise the risks. The lunchtime routine must be reviewed to ensure people receive hot and nutritious meals. Adult protection inter-agency guidelines must be obtained from any authorities making arrangements for the placement of people in the home to ensure allegations are responded to appropriately. Complaints must be fully recorded so that records are full and transparent detailing the investigation, outcome and any DS0000071550.V366307.R01.S.doc Timescale for action 01/10/08 2 OP7 14 01/08/08 3 OP8 13 01/08/08 4 5 OP15 OP18 16 13 01/08/08 01/09/08 6 OP17 22 01/08/08 Meyer House Version 5.2 Page 35 7 OP19 23 8 OP38 23 9 OP19 23 10 OP23 23 action taken to resolve the issues. All areas of the home used by residents must be free from hazards and accessible to ensure people living there are safe. There must be checks made and recorded on the temperature of the hot water to ensure people are protected from any potential harm. Dorguards must be fitted to individual doors so that they close in the event of the fire alarm sounding, keeping people safe. Please provide us with an action plan detailing the proposed fitting of these. Fire drills must take place regularly to ensure staff are aware of what to do in the event of a fire so that individuals living and working there are safe. 01/08/08 01/08/08 01/08/08 01/09/08 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 3 Refer to Standard OP1 OP12 OP15 Good Practice Recommendations Information and guidance provided to residents should be made available in other formats. Activities and entertainment should be reviewed so that people are stimulated and spend time involved in activities of their choice. Records should be maintained of all food provided. Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Meyer House DS0000071550.V366307.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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