Inspection on 14/06/07 for Meyrin House

This inspection was carried out on 14th June 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

Meyrin House 24/02/09

Meyrin House 23/04/08

Meyrin House 28/06/06

Meyrin House 05/01/06

Meyrin House 13/06/05

Meyrin House 10/01/05

Meyrin House 02/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Meyrin House 35 Hobleythick Lane Westcliff On Sea Essex SS0 0RP Lead Inspector Diane Roberts Key Unannounced Inspection 14th June 2007 09:00 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 Meyrin House DS0000015456.V343405.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. Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meyrin House Address 35 Hobleythick Lane Westcliff On Sea Essex SS0 0RP 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) 01702 437111 01702 437437 Strathmore Care Miss Elizabeth Ann Hay Care Home 18 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (18) of places Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th June 2006 Brief Description of the Service: Meyrin House is a large house situated in Westclliff on Sea close to Southend Hospital. It has been converted for its current use, and provides accommodation on two floors for eighteen residents of either sex. The home is registered for older people and older people with dementia. It has ten single and four double bedrooms, a large open plan lounge-diner with a small visitors/quiet area off the lounge area. There is a small patio and garden area and limited parking to the rear of the building. It has good access to local bus routes. The home has an updated Statement of Purpose and Service User Guide, which are available in the entrance hall. A copy of the last inspection report is also on display in the entrance hall. The current scale of charges as at June 2007 is from £356.72 - £518.00 per week. Rates relate to levels of dependency, single or shared rooms and respite care. Extras charged are for hairdressing, chiropody, toiletries and newspapers. Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as part of the annual inspection programme for this home. The deputy manager was available on the fieldwork day of the inspection with the registered manager being on leave. The inspection focused upon all of the key standards. A partial tour of the premises was undertaken. Evidence was also taken from the Annual Quality Assurance Assessment completed by the management of the home and submitted to the CSCI. 2 residents, 2 relatives and 3 staff were spoken to during the inspection and Residents and relatives completed feedback sheets; some with the help of the manager. All these comments were taken into account when writing the report. Some aspects of this service have failed to improve since the last CSCI inspection. These are highlighted in the agenda for action. Failure to comply with these regulatory requirements may result in the Commission taking legal action. What the service does well: What has improved since the last inspection? The standard of staff recruitment has improved which helps to protect vulnerable adults and some aspects of care planning, following the introduction of a new recording system, which helps with the provision of care by the staff team. Parts of the home have been decorated and new furniture has been purchased. Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Meyrin House DS0000015456.V343405.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 Meyrin House DS0000015456.V343405.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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the assessment process helps to ensure that only residents’, whose needs can be met by staff at the home, are admitted, further work on this process and making information available would improve outcomes for residents with staff being aware of all their assessed needs. EVIDENCE: The proprietors, who own several homes in the area, have a system in place whereby a ‘placement officer’, assesses prospective residents on behalf of the home. At the time of the assessment the registered manager or other staff in the home have no input. Completed assessments were reviewed of two recent admissions to the home. Overall the form used covers all the required areas of assessment, but could Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 9 be more person centred, identifying individual’s strengths and abilities and social side of care, giving a fuller picture of the prospective resident, especially those with a diagnosis of dementia. Forms were seen to be completed in detail giving some good information on the individual, but some information was seen to be at odds with Com 5 assessments from social services. Discrepancies should be explored further as part of the assessment process to ensure that all the residents needs can be met by the team at the home. From discussion with staff, it appears that they have no real involvement with the process. Residents can be admitted without consideration being given as to whether an individual would fit in and feel comfortable with the other residents in the home and without thought being given to where their room would be in the home in relation to their needs. It is also apparent that pertinent information recorded at the time of the assessment, is not always being carried through into the care planning system and the staff are not using this information as they do not ‘own’ the document and have not taken part in the process. It was also noted that staff had not picked up on a resident risk, regarding falls, from the assessment documentation. The manager identifies in her annual quality assurance assessment that pre-admission assessment could improve if the manager and the staff at the home were involved. Staff spoken to commented that the new care planning system needed to show more past medical history but this is actually recorded in the pre- admission assessment documentation. The company uses a standard letter to send to residents or their representatives regarding confirmation of an available place at the home. This letter does not confirm that the home will be able to meet their needs or how those needs will be met. This should be reviewed. A copy of the service users guide is available in the main hallway. A resident spoken to regarding their admission to the home could not remember getting a copy of the service users guide and copies were not seen in residents rooms. The guide was discussed with the deputy manager in relation to its format, which could be made more user friendly and innovative for the resident group at the home, making information more easily accessible to them. With regard to the admission process, one resident said that ‘I was made to feel welcome and was looked after, they did not just sit me down and leave me, they spent some time with me’. The last inspection report was seen to be available in the main reception area. Meyrin House DS0000015456.V343405.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 good. This judgement has been made using available evidence including a visit to this service. General standards of care at the home are good and relatives and residents are happy, however the care of individual and specialist needs could be developed further to improve outcomes for residents and the management of the home need to demonstrate a fuller understanding of this. EVIDENCE: The company have recently introduced a new care planning system into the home and the deputy manager reported that all residents’ records have been transferred and updated. Assessments are based on activities of daily living and care plans are raised from these and associated risk assessments. Overall care plans were seen to be completed well with a good level of detail in most areas but further work is needed to make them more individual to the resident and ensure that all their personal preferences and choices are listed making them more person centred. Identifying strengths and abilities needs to be Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 11 developed in order to promote self worth amongst residents and link in to objectives within the care planning process. Consideration should also be given to using assessments that relate to the primary resident group that have dementia, for example signs of well being and ill being and implementing care practices that build upon residents strengths. The care plans inspected were seen to be up to date and reviews were in place. Records showed evidence of alterations to the care plans. Some good observation detail by staff was noted in the care plans, which showed a good appreciation of residents’ behaviour and rights. Some care plans; mainly personal care and elimination had a good standard of detailed resident led information whilst others such as nutrition/dietary preferences and social care need more work. Overall the team need to further develop their approach to the care provision of people with dementia and demonstrate a good understanding of the needs of these residents. It was a shame to note that evidence of resident and relative input was still not fully in place especially where residents were able to have input or who had regular visits and input from close family. In some cases, where it was possible, family histories had not been completed and this information could have a bearing on the care provided to an individual. Relatives spoken to, who confirmed that they would have input, were not aware of the care planning records. One resident spoken to said that they had not been offered a bath for two weeks and the records confirmed this, with no evidence of resident refusal and a care plan that said ‘baths should be offered once a week’. The team should ensure that care plans are followed to ensure residents’ expectations are met. One resident said that ‘I am well looked after’ another said ‘although staff may be busy, they never leave you out and always let you know what is going on’. All residents who commented said that the staff listened to them and did act upon what they said. The team completes risk assessments for each resident, these are primarily for manual handling and nutrition with additional ones as the resident need indicated. These were seen to have been completed fully and were kept under review. Risk assessments, in relation to residents potentially wandering from the home, were found to be lacking in sufficient detail to identify the full risk and subsequent management. This needs review. Records showed that residents’ health needs were being met and input from doctors and district nurse was appropriate. Records also showed that residents had access to chiropodists, opticians etc. and were weighed regularly. Records showed that weighing on admission, however, was not always done as a baseline. This is linked to the home sharing sit on scales with another home and having to wait for the scales to be returned. This is not an efficient practice and does not help Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 12 the staff to obtain a full picture of the resident and may limit their assessment of them on admission. At the time of the fieldwork visit, there were no residents in the home with pressure sores. Where risks had been identified, district nurses had been contacted for assessment and pressure relieving devices. All residents who commented said that they felt they received the medical treatment that they needed. The team use a bottle to mouth medication system. This was reviewed and found to be maintained in good order. MAR sheets are neatly maintained and medications are checked into the home. Staff report that the visiting Gp’s do review medications on request and at other times. Reviews and changes were evident on the charts and in residents care plans. No control medications are in use at the current time. No excess stock was noted and a suitable returns system, with records, is in use. Interaction between staff and residents was seen and heard to be respectful and friendly. Residents spoken to commented positively on the staff team and although they said that ‘staff were busy, sometimes rushed’ they were ‘friendly and chatty’. Evidence in the care plans suggests that staff recognise the individuality/diversity of each resident but this could still be developed further. In the manager’s annual quality assurance assessment for health and personal care, the teams approach to caring for residents as individuals is not discussed at all and the focus is on services provided and facilities rather than residents. This is seen as a rather limited approach to these standards. Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst residents are happy with the food at the home, the availability of extra items, more choice of ingredients and resident involvement with the menus, would enhance mealtimes further. The activities programme at the home needs work to ensure that it relates to residents individual needs and optimises their abilities. EVIDENCE: The home has a basic activities programme in place, which is not linked to residents identified interests and needs within the care planning system. Ball games, cards and sing a longs are offered and staff are identified as having to facilitate this. On discussion with staff it would appear that they have a limited outlook on what could be provided and how to link this to the residents individual needs and their social history. Some residents had care plans in place that gave good detail on their social interests and how they liked to spend their time but the activities offered and taken up did not always reflect Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 14 this. There were no objectives in relation to social care and optimising of residents abilities and maintenance of their self worth. Relatives spoken to were able to give a range of hobbies that their relative use to enjoy in the past but inspection of the care planning records did not reflect this. Records in the care plans did not always reflect whether activities had taken place and what level of participation there was. The team at the home need to work on this aspect of care. Residents spoken to said that ‘it would be good if staff could take you out of the home’ and ‘a visit to a garden centre would be nice’. Residents spoken to confirmed that they had choice within their daily routine and staff responded to their requests and were generally flexible. Resident confirmed that their visitors were made welcome and relatives also felt that the atmosphere in the home was welcoming. Lunch was observed and was seen to be relaxed with staff helping residents appropriately. The tables were laid nicely and condiments were available. Residents at the home are happy with the food provided and from observation and tasting the chef does well with the ingredients available to her. Residents spoken to said that if you did not like something the chef would make you something else. Standard meals are generally good and varied. The ingredients list was noted to be limited, from an external supplier and consists of standard store cupboard items. Staff are unable to order items such as crisps, special biscuits, pickles, coleslaw or any extra items unless there is a specific function, such as a barbecue. Staff raise money independently of the company so they can provide extra items for residents on a more regular basis and at birthday teas etc. It was also noted that when the fruit and vegetables were delivered for the week, this was limited to 3 cabbages, 1 cucumber, 2 lettuces, a bag of onions, a bag of tomatoes and 13 bananas. The home does not place an order for what they would like and it is questionable as to whether this is sufficient. The delivery arrives and if possible they can exchange one item for another. The menus are primarily set by head office with little input from residents and the staff. Whilst the standard meals are acceptable, the approach by the company with regard to ordering extra items, the setting of the menu and fresh fruit and vegetable provision, is not resident led. It does not take into account the pleasure that mealtimes and extra items can bring to an individual and in some cases it does not cater for individual need. From discussion, the chef knows the residents preferences well and has a lot of interaction with both them and the relatives. She adjusts the menus as best as she can to take these preferences into account. The chef provides some special meals that on discussion and from records generally relate to the residents preferences and abilities. She has to provide one vegetarian meal but is unable to use lentils, as they are not on the ingredients order list. Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 15 The chef makes home made cakes for birthdays and for tea and a cooked breakfast is provided 3 times a week. Meyrin House DS0000015456.V343405.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): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst complaint management in the home is good, shortfalls were noted with regard to adult protection knowledge amongst staff that could potentially put residents at risk. EVIDENCE: The home has a satisfactory complaints procedure in place. No complaints have been received since the last inspection. Residents spoken to and who commented said that they would raise any concerns or complaints with the manager and relatives spoken to were aware of the procedure. The home does not have a formal logging system for complaints and this was discussed with the deputy manager so that the team can evidence that they have followed their procedure should a complaint arise. Consideration should be given to the format of the complaints procedure in relation to the resident group to help ensure that information is freely available. The management of adult protection issues was discussed with the deputy manager and a senior carer in the home. Both senior members of staff showed a limited knowledge of procedure and general management of such issues. Staff could not find the adult protection procedure but did ultimately find the local Essex Social Services Guidance. This is a concern with regard to the Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 17 protection of vulnerable adults. Training records show that the majority of staff at the home have been trained in 2003/4 and further training is planned in 2007. The manager states in her annual quality assurance assessment that ‘all staff are trained and follow guidelines as laid down by POVA’. This is questionable and needs review. It may be of value to update staff more often than every 3 – 4 years to ensure that they are up to date with current procedures/guidance. Since the fieldwork part of the inspection an incident occurred whereby a resident left the home. The incident was at night and at one point a staff member left the home leaving only one carer in the home. This issue is currently under investigation. Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment in the home is acceptable to residents and they feel that it provides a homely atmosphere. Improvements to some of the facilities and areas could enhance their quality of life further and maintain their safety. EVIDENCE: A full tour of the home was undertaken. In the last 12 months the corridors have been painted along with other parts of the home. New beds and armchairs have also been purchased for some rooms. Generally the home was seen to be clean but on entering the home an odour was noted. One resident who commented said ‘ sometimes the home smells’. Other residents who commented did not raise this as a concern. Odours were also noted in specific bedrooms and in the upstairs corridor. The team do have a carpet shampooer Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 19 but this is obviously only helping the problem a little and further work needs to be done to improve conditions. This needs to be addressed in order to provide a pleasant environment for residents to live in. The manager states in her annual quality assurance assessment that ‘we hope to purchase new carpeting for the entrance hall and throughout the home where required’ in the next 12 months. Bedrooms and the lounges are homely and comfortable. Corridors area plain and could be made more homely and stimulating. Signage and picture recognition may be of value to residents in the home with dementia and this should be considered in relation to the registration of the home. Overall, residents who commented were happy with the facilities in the home and both residents and relatives felt that there was a homely atmosphere and the small size of the home also helped this. Water temperatures were checked at random throughout the home and were found to be variable. Some were within acceptable guidelines whilst others were significantly high at 50oc and higher. This needs to be addressed. Records were checked for May 2007 and they showed that all temperatures were in acceptable limits. The maintenance man has worked at the home a long time and knows the hot water system. The management need to review the current risks and the appropriate action to reduce them. The home has a fire safety risk assessment system in place that is reviewed monthly and all other fire safety records were found to be in order. Random sampling of safety and maintenance certification showed that equipment and services in the home were kept in good order. The manager should make sure that she has further evidence on file, where shortfalls have been noted, to show that remedial work has taken place. This relates to the electrical wiring for the home. Training records show that nearly half the staff in the home have received training in infection control and records also state that further training is planned this year. On touring the home it was noted that lifting hoists and some wheelchairs needed deep cleaning. At the current time the home does not have a secure garden area for the residents to sit out in. Work is underway to address this, and railings are being made, but until this is done the quality of life for residents with access to the outside is poor. Security to the rear of the home is also of concern as the patio windows are open at times along with the main door at the back, leaving an opportunity for residents who are confused to wander. When the regulation officer arrived at the home the back door was open with no staff coming in or out. This risk and residents risk assessments must be kept under regular review to help ensure resident safety. Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It is positive for residents that the staff team at the home is stable and recruitment is sound. However, the current staffing levels and training provision at the home require review to ensure that residents needs can be met in full and that they are safe. EVIDENCE: From discussion and records, the staff team at the home is stable and turnover is low. This is positive for residents and those spoken to and who commented said that the staff are friendly and listened to them. There has been some agency use in the past three months to cover care shifts. Current staffing levels are 3, occasionally 4 in the morning – this includes the manager and 3 in the afternoon. Two staff are employed on night duty. From discussion with the deputy, staff deployment is by task allocation. Residents spoken to frequently commented that staff were busy but equally commented that call bells were answered promptly. Care staff undertake all the laundry duties and have to organise and provide the evening meal. Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 21 The staffing levels in relation to resident numbers and dependency need to be kept under regular assessment as the home has an identified risk of residents wandering out of the home and 2 residents are cared for in bed at the current time. The manager also confirms that the home has seven residents who need two care staff to provide care at night. Night staffing levels require review in order to assess whether there is currently adequate coverage to ensure resident safety. It was also noted on reviewing accident records, that a significant number of the accidents occur at between 06.00 and 08.00 a.m, when there are two staff on duty and residents are getting themselves up and about. Day staff commence on shift at 08.00hrs. Staff confirm that occasionally some do come in early because of local transport and state that this is a busy time and they help out. The timing of the day shift should be formally reviewed in order to ensure that residents’ needs are met and the incident of accidents is reduced, where possible. Records show that 50 of the care staff have achieved nvq level two or above and more staff are also undertaking this qualification. Recruitment procedures at the home were inspected and two files from recent employees reviewed. These were seen to contain all the correct checks and documentation and were maintained in good order. Interview records are held and inductions, using Skills for Care had commenced. Records show that the supervision of staff was inconsistent, for example, once in 6 months. Training records/plans were submitted to the CSCI and these were reviewed. Records showed that most staff were up to date with moving and handling and infection control but shortfalls were noted in relation to fire safety and food hygiene. The home has three appointed person first aiders. The rotas show that this number is not quite enough to cover the home at all times. Records also show that staff have attended courses on dementia care, bereavement management, the mental capacity act and continence management. The management should give consideration to the provision of training updates as many of the staff show that initial training was provided in 2004 and not since. For example, one member of staff has only had manual handling training since 2004. With the primary resident group being people with dementia, it would be of value to provide staff with more training on this specialist area. Currently 50 of the staff have had training in the past on this subject. Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management systems in the home are generally sound but they could be developed further in order to ensure that more residents’ views are regularly taken into account, affecting the development of services and facilities. EVIDENCE: The manager has worked in the home for 8 years and has a lengthy background in care provision. She has achieved the registered managers award qualification. Staff and relatives speak positively about her and relatives state that her communication with them is good. Staff meetings are held and records show that they do cover, for example, training, care provision and Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 23 activities. Staff spoken to said that they liked the working environment at the home and that the manager was helpful. The company employs an external company to visit the home once a year and complete an audit, which is linked to the national minimum standards. A questionnaire is sent out to residents’, relatives etc. and a 61 return rate but the breakdown of who completed the questionnaires is not recorded. The questionnaire is lengthy and detail and may not be entirely suitable for the resident group and alternative methods of obtaining feedback should be considered. Generally the audit results are positive and a summary should be made available to residents in the service user guide. The manager holds residents meetings and records are available. These show that the manager tries to obtain feedback from residents on aspects of life in the home, for example, activities, meals and care provision. These are limited due to residents’ participation, approximately 4 attend and again more ways should be considered to obtain feedback. The home holds monies on behalf of residents and records are maintained in the home. These were checked at random and found to be in order with receipts available. Records show that the manager carries out balance checks to audit the home’s system. The company holds money at head office on behalf of some residents and the staff have to request this, when required by the resident. It is unclear as to how these monies are held and what the balance of the account is. Access to this information should be available to the CSCI regulation officer. The home has a health and safety policy. Accident records are completed well and in sufficient detail. The home has a basic risk assessment system in place for the premises but at the current time does not have any safe working practice risk assessments in place. This was discussed with the deputy manager. Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The staff team at the home should be aware of and use the information provided in the preadmission assessment. Discrepancies in information provided at the time of assessment should be clarified. Care plans should be developed further with regard to individual needs/diversity and be more person centred. This primarily relates to social and nutritional care plans. Specialist needs – such as dementia must be taken into account more and the management approach be clear in the care plans. A programme of activities must be provided that meets the individual and group needs of residents, taking into account their preferences and feedback from consultation. This includes visits out of the home. This is a repeat requirement. Timescale for action 30/08/07 2. OP7 OP10 15 30/08/07 3. OP12 OP13 16(2)(n) 30/08/07 Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 26 4. OP8 12 Risk assessments must be completed for residents at risk of wandering/leaving the building and kept under review. Residents must also be weighed on admission so a full assessment of need can be made. The menu at the home should be reviewed with residents and staff input, along with the list of ingredients available to the staff to ensure that all residents’ needs are met and a quality service is provided that would enhance residents lives. Staff training in adult protection matters must be provided to all staff to ensure that they are aware of current practice. Improvements must be made to the premises with regard to the provision of a secure garden area, the needs of people with dementia, security of the rear door to the home and with regard to the maintenance of safe hot water temperatures. This is a partial repeat requirement. The home must be kept free from offensive odours. This is a repeat requirement. The home must be staffed in such numbers that are appropriate for the dependency, health and welfare of the residents. This is a repeat requirement. 01/08/07 5. OP15 16 30/08/07 6. OP18 13 14/09/07 7. OP19 23 30/08/07 8. OP26 16 30/08/07 9. OP27 18(1)(a) 01/08/07 Meyrin House DS0000015456.V343405.R01.S.doc Version 5.2 Page 27 10. OP30 18 Training in fire safety, first aid and dementia must be provided to all staff to ensure the safety of residents and that all their needs can be met by the staff team. The quality assurance system for reviewing and improving the quality of care provided by the team at the home must be developed further to ensure all residents views are obtained as far as possible in a format suitable for them. 30/08/07 11. OP33 24 30/09/07 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 OP1 Good Practice Recommendations The Service User Guide should be reviewed to ensue that the format is suitable for the resident group and the staff should ensure that they have a copy of this for information. The format of the complaints procedure should be reviewed with the resident group in mind to make it more accessible to them. Wheelchairs and lifting hoists should be kept clean. Consideration should be given to providing staff more regular training updates on key subjects such as adult protection. Full accounting records must be available for inspection, for monies held on behalf of residents. Safe working practice risk assessments should be developed for staff working in the home. DS0000015456.V343405.R01.S.doc Version 5.2 Page 28 2. OP16 3. 4. OP26 OP30 5 6 OP35 OP38 Meyrin House Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Meyrin House DS0000015456.V343405.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. 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