Inspection on 23/04/08 for Meyrin House

This inspection was carried out on 23rd April 2008.

CSCI found this care home to be providing an Adequate service.

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 14/06/07

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Meyrin House 35 Hobleythick Lane Westcliff On Sea Essex SS0 0RP Lead Inspector Ms Vicky Dutton Unannounced Inspection 23rd April 2008 08:00 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.V363098.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.V363098.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 Meyrin35@tiscali.co.uk www.southendcare.com 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.V363098.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th June 2007 Brief Description of the Service: Meyrin House is a large house situated in Westcliff 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 April 2008 is from £388.01 - £535.65 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.V363098.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced ‘key’ site visit. At this visit we (CSCI) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. The level of compliance with requirements made at the previous inspection was assessed. The site visit took place over a period of eight hours. A partial tour of the premises was undertaken, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. Prior to the site visit the home had completed and sent in to CSCI their Annual Quality Assurance Assessment (AQAA). This outlined how the home feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives involved professionals and staff. The views expressed at the site visit and in survey responses have been incorporated into this report. We were was assisted at the site visit by the manager, and other members of the staff team. Feedback on findings was provided to the manager throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the service does well: Meyrin House has an experienced and competent manager who has worked there for some time. This provides stability for people living at the home. People living at Meyrin House are happy there. They feel that the staff team care for them well. Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 6 Relatives are happy with the service and care provided. They particularly like the warm and friendly atmosphere of the home and being able to visit at any time. One relative said, “I am very Happy with the care my relative has here. The atmosphere is nice and friendly and the staff do a wonderful job.” Another relative said “I cant praise Meyrin enough. My [relative] is well cared for as are the other residents. It doesnt matter what time we visit, we are always welcomed, we are very happy with all the care provided.” What has improved since the last inspection? What they could do better: People do not have access to enough written or pictorial information to help them to decide if the home will be suitable for them, and meet their needs. A service users guide that is up to date and available in suitable formats to meet peoples’ needs should be in place to achieve this. People can expect to be cared for well, and care planning is becoming more focused on peoples’ individual needs. This process needs to continue. People or their families should have a greater involvement in care planning. So that staff is up to date in their knowledge, and to assist them in reacting appropriately to any situation, they should have access to up to date policies and procedures. The organisation needs to show that all policies and procedures that guide staff practise are regularly reviewed. People living in the home should receive care from staff that are developing good skills from the start of their employment. To achieve this the staff induction programme should be based on Skills for Care standards. Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 7 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.V363098.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People wanting to move into the home can be assured that their needs will be assessed to make sure that the home will be suitable for them. They cannot be sure to have access to sufficient written information about the home to help them to make an informed choice. EVIDENCE: A Statement of Purpose and Service Users Guide were available. The Service Users Guide dated from 2006 and was noted to require some updating so that it includes details of fees. The manager said that people were not normally given copies of the service users guide before they moved into the home to help them make a decision. A copy of the organisations’ brochure might be given, and on moving in a ‘Residents Handbook’ is available in each room. People are encouraged to visit before they move in so that they can see the home and get information. The two people who most recently moved into the home did so at very short notice, but the manager reported that their families Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 10 had visited before this happened. Another person said that ‘Me and my friend…….visited and I had lunch.’ On four surveys received all felt that they had received enough information about the home to help them decide if it was the right place for them. The Company employs an admissions co-ordinator to carry out pre-admission assessments for a group of homes owned by the Company. The manager with responsibility for the home, and an overview of the current occupancy, is not often involved with this process. The AQAA completed by the home said. ‘We could ensure that a member of the home is at pre-assessment, although staffing levels and emergency situations do not always allow this.’ The manager was however very clear that given the information available, they would not let someone move in if they felt that their needs could not be met by the facilities or staffing levels. However management sometimes may not have sufficient information beforehand to make this decision. The two most recent admissions to the home were at short notice, and both agreed before full pre-admission assessment information could be seen by staff at the home. For one person there was a note on file timed at 17.30 confirming a telephone conversation about an admission who would be arriving that afternoon/evening. It said that the assessment had been completed and that the paperwork would be brought over. For the second admission again the assessment was completed and admission agreed before full information was available to the home. The manager said that information about these people had been obtained from their families when they had visited the home before the assessment. This situation is not ideal and does not allow staff to properly prepare for peoples’ arrival, and commence the care planning process so that peoples’ needs are understood and met from the start of their stay. Intermediate care is not provided at Meyrin House. Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. People can expect to receive the personal and health care support they need. EVIDENCE: People able to comment during the site visit were happy with the care provided. One said, “Everything is fine here.” Four surveys were returned to us (CSCI) by people living at Meyrin House. These said that people ‘always’ received the care and support they needed, and that staff listened and acted on what they said. On surveys returned by five relatives all felt that the home ‘always’ met the needs of their friend or relative. Relatives said, “My relative is well cared for as are the other residents,” and “my relative is always kept clean. Their clothes put together well so they feel nice about themselves as with all the residents. They treat the residents with care.” Another relative said, “staff have an empathy with the residents and they are all well cared for.” Care plans viewed generally provided a good basis to ensure that people receive the care they need in line with assessments carried out. It was not however always clear that staff had involved the person or their relatives in the Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 12 care planning process. Care plans were fairly person centred but some attention to detail would benefit this process, and potentially enhance peoples’ care. Sometimes a reasonable level of detail was provided such as ‘likes a serviette at mealtimes, has an average size meal on a normal sized plate.’ At other times detail was lacking such as for oral care. An assessment identified that the person had both top and bottom sets of false teeth, but the care plan did not identify this and just said that the person (who was diagnosed with dementia) ‘can care for [their] own oral hygiene with prompting and supervision.’ One person spoken with expressed particular thoughts about life and living at Meyrin House. The manager identified that this was usual behaviour and described the steps previously taken to try and address their needs. However care plans did not adequately describe behaviours, and thoughts likely to be expressed but instead made reference to the person ‘……..gets very rude.’ Sometimes relevant information from assessments was not identified in the relevant care plans. For example the potential to bruise easily due to medication not included in the care plan relating to personal care and skin care. Good risk assessments were in place for appropriate aspects of care such as moving and handling, behavioural and communication issues. Senior staff have a good knowledge of individual peoples’ needs, and try different ways to help meet them such as using cards to help a person with poor communication. Observations during the site visit showed that care staff were kind and caring. Relatives felt that staff ‘always’ had the right skills and experience to look after people properly. A visiting professional said, “My limited experience of the home shows caring professional staff who look after their residents well.” Care files incorporated good records of peoples’ ongoing care. Care plans had been regularly reviewed. Peoples’ healthcare is monitored by staff and, for example, their weight monitored so that any change in need would be responded to. Since the previous inspection a number of staff have undertaken training in areas such as nutrition, continence care and pressure area care. This will increase their understanding and help them to deliver better care to people. On surveys people felt that they ‘always’ received the health care that they needed. Relatives said that they were ‘always’ kept up to date with important issues affecting their friend or relative. Professional visits were well recorded in care files, and showed that appropriate referrals were made to different practitioners, for example the falls prevention team and a community psychiatric nurse. Records showed that regular visits are also received from an optician and chiropodist. The manager said that dental care is accessed according to need. Care plans had assessments in place relating to people’s nutritional and tissue viability needs. The risk of falls had also been assessed. Medication at the home is generally well managed and good records were being maintained. The manager said that the medication system is audited on a weekly basis to ensure good practice and compliance. Advice was given on one aspect of recording practice. Concern was expressed over the potential risk of harm to one person. Their medication had a specific instruction about Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 13 the need to avoid a particular food whilst undergoing treatment. This information was not included in the person’s care plan, and their nutrition records indicated that they had been having the identified food on a daily basis. The manager undertook to look into this urgently but thought that the nutrition records had been incorrectly completed, and that staff had filled them in ‘automatically.’ This suggests that nutritional recording may not be entirely reliable. It was positive to note that the recently revised Royal Pharmaceutical Society guidelines about the management of medicines in care homes were available. However the home’s own policies and procedures relating to medication date from 2002. There was no evidence to show that they been reviewed, so they may not provide up to date information to staff to inform and guide their practice. Although all staff administering medication have been trained, for four out of the six people identified as ‘trained in the safe handling of medication and have a good understanding of the policies and procedures associated with the handling and administration of drugs,’ the training undertaken dated from 2004 or 2005. The manager confirmed that there is currently no formal system for monitoring people’s knowledge and competence on an ongoing basis. The manager said that they would develop this. Temperatures in the medication storage area are monitored. Records showed that over the winter period temperatures of 23 and 24 degrees Celsius have regularly been recorded. Remedial actions may therefore be needed to ensure that medicines are always stored in optimum conditions and below 25 degrees Celsius as the weather gets warmer over the summer period. During the day staff treated people with kindness and sensitivity. A relative said, “They care about the people as individuals and help them to keep their dignity.” People’s privacy was respected. Privacy curtains were provided in shared bedrooms. However it was noticed that the communal toilets in the living area were not fitted with locks. This means that people using them could not be assured of privacy. Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are able to enjoy a lifestyle that meets some of their expectations such as having visitors and enjoying good food. Other aspects of daily life such as activity and occupation may be less suited to meeting their individual needs. EVIDENCE: Since the previous inspection staff have been working to try and improve the level of activity and occupation available to people. A weekly planner identified activities to take place each morning and afternoon, and which staff would be responsible for delivering these. Activities on offer included ball games, chair based exercises, jigsaws, dominoes, colouring, arts and crafts and sing-alongs. Records showed that activity sessions are taking place twice a day including weekends. Laminated pictures are available to advise people of what activity is on offer. Worksheets guide staff about undertaking the activity. The manager reported that entertainers visit the home on an occasional basis. People have the opportunity to fulfil their spiritual needs and a regular church service is held. One person said of the church services, “they are nice and I love the hymns.” A computer with Internet access is available for people to use. Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 15 In the care plans viewed, those relating to likes, dislikes social, activities and hobbies were not very detailed, and did not cross reference to other information known about the person such as previous interests or likes and dislikes. This might assist staff in providing a more person centred approach in this area. People with dementia need a greater level of assessment to see what types of stimulation are most appropriate for them. Relatives felt that the provision of activities was still an area for improvement. Some comments made were: “I would like to see some kind of activity taking place, even a sing song or reminiscence sessions. I know that all the residents have varying degrees of dementia and activities are difficult to organise, so many of them dont want to know,” and “some form of entertainment or activities could be provided.” During the inspection staff did not always fully consider individual needs. For example one person, who the manager identified as liking to keep to themselves, was trying to watch a television programme. The volume was turned down low and loud music with one song being played several times was coming from the dining area. The same person was later encouraged to complete a child’s jigsaw puzzle. The person was not very amused and said “well I will do this in two minutes.” This shows that care staff may not always have a detailed knowledge and understanding of people’s individual needs and preferences. During the day staff interacted with people and undertook activities such as dominos on a one to one basis. People’s care plans identified preferences such as rising and retiring times. Visiting at the home is open, and people can receive visitors at any time. During the site visit people were always made welcome and offered refreshment. One visitor said, “we never get very far before seats and drinks are organised for us. We feel like part of the family and chat to the other residents.” On surveys people said, “It doesnt matter what time we visit, we are always welcomed,” “the home creates a friendly atmosphere for residents and visitors. We always feel welcome,” and “I can come into the home what ever time I like and its always the same.” People’s rooms were homely and showed that personal possessions had been brought into the home. Information on advocacy services was on display for people. People made positive comments about the food provided such as “yes the food is usually good” and “lovely grub” were made. On surveys people said that they ‘usually’ enjoyed the meals at the home. A relative said, “The food is fresh and varied and always looks delicious.” The cook spoken with was very in touch with individual people’s likes and preferences. On the morning of the site visit cooked breakfasts were being individually prepared and served. Lunch looked appetising and was enjoyed by people. Since the previous inspection the ordering and food delivery system used has changed. This has enabled more flexibility in the choices offered to people. A set four weekly rotating menu has been in use for a long time. The cook reported that Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 16 management are now looking at developing a summer and winter menu to provide more variety. Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 17 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 can raise concerns about the service. They can expect that staffs training and knowledge will safeguard them from abuse. EVIDENCE: A complaints procedure was on display in the entrance area. It was discussed with the manager that the location of the procedure might not be ideal for people to view easily as it was situated quite high on the wall. It was also noted that the complaints procedure should be updated to include details of the Local Authority who have the statutory authority to investigate any complaints about the service. The organisation’s policy/procedure on concerns and complaints dates from January 2002, with no indication that it has been reviewed. This may not provide staff with up to date guidance on the management of complaints. People spoken with, or on surveys, said that they knew who to speak to if they were not happy, and knew how to make a complaint. People said that if they had raised concerns staff had ‘always’ responded appropriately. Since the previous inspection a proper system for recording complaints has been developed. One complaint had been recorded and managed effectively. Each care file viewed was noted to include a ‘POVA risk care plan.’ This indicated any potential areas of concern, and strategies to minimise the risk of any incidents occurring. Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 18 A training matrix showed that all staff had undertaken training in safeguarding adults. The Company’s policy is for this training to be undertaken every two years, and some staff are therefore due for update training. A member of staff spoken with understood what safeguarding and whistle blowing meant. Some relevant contact information for the Local Authority and police was available along with ‘alert’ forms. A copy of the Southend on Sea Protection of Vulnerable Adults Procedure that was distributed in 2002 was in place. This information could be bettered by the specific current contact details for local safeguarding teams being available. Staff do not have access to up to date policies and procedures to enhance and guide their understanding and practice. The AQAA completed by the home indicated that their Safeguarding Adults and the Prevention of Abuse policy, Whistle blowing and Missing Service Users, policies date from 2002 with no indication that they have been reviewed. This was confirmed at the site visit. From care planning information it was evident that some people living at the home have the potential to exhibit challenging behaviour. This had been risk assessed and care planning strategies put in place. Although not verified through training information the manager said that some staff had undertaken some in house training in managing challenging behaviour ‘a couple of years ago.’ Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 19 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, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to live in a pleasant home that is suitable to meet their needs. EVIDENCE: Meyrin House provides a comfortable and homely environment for people to live in. The site visit included a partial tour of the premises. Minor issues noted were fed back to the manager. Maintenance personnel are shared with other homes in the area. The manager reports that sometimes this means that jobs take a while to be addressed. Since the previous inspection a number of improvements have taken place. Some redecoration has been done and some carpets replaced. All rooms have new beds and bed spreads. New net curtains have been provided. The manager reported that the bedroom furnishings, some of which are quite shabby, are slowly being replaced. Although only a very small garden is available at the back of the home, this Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 20 has been made a more secure and pleasant area, with further works planned. Some additional outside space is available at the front of the building but it was reported that people do not like using this area because of the very busy road that the home is situated on. For people who have dementia and may wander the home has been made safer by the fitting of keypad type locks to external doors. A start has been made to thinking about how signage might help the orientation of people who have dementia. Most rooms now have a bright picture and name on them. Toilets and other communal facilities and corridor areas have yet to be thought about. One person who has dementia was noted in their care plan to need orientation to use toilet facilities. Toilets in the communal areas have the word ‘toilet’ on but no additional signage that might help where people may have lost their ability to read clearly. On the day of the site visit the premises appeared to be cleaned to a satisfactory level. Basic cleaning schedules are in place, but there are no planned and rotational deep cleaning regimes set up to ensure that all areas benefit from an in depth clean on a regular basis. Apart from isolated areas odour control was satisfactory. On surveys people felt that the home was ‘always’ or ‘usually’ kept fresh and clean. A relative said, “The home is well organised and clean.” One member of staff however felt that they would benefit from ”enough equipment and proper cleaning materials to make the home clean and smell good.” A laundry area is provided that is suitable to meet the needs of people living at Meyrin House. All but one member of staff are recorded as having undertaken training in infection control. The organisation’s policy is for staff to be updated in this area every two years. Records show that some staff are overdue for update training. A housekeeper spoken with confirmed that they had a good understanding of infection control and outlined some of the training recently undertaken. This included them currently working on a National Vocational Qualification (NVQ) in support services. Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 21 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. People can feel confident that they will be looked after by safely recruited and well trained staff. EVIDENCE: People spoken with were positive about staff and made comments such as “the girls are very helpful,” “I have no complaints, the staff are kind to me” and “I think the staff work very hard, I love them” were made. The manager on the AQAA felt that a strength of the home was that they ‘have some very experienced staff members who have remained loyal to the home and the company, which in turn provides stability for the residents.’ Staff felt that there was good teamwork at the home. Basic staffing levels are three care staff one of who is in charge throughout the day. On three days each week the manager’s hours are supernumerary. Two staff are employed on night duty. Care staff undertake all the laundry duties and have to organise and provide the evening meal, which will take them away from caring tasks. Rotas viewed showed that the stated staffing levels are being maintained. Five or six hours of domestic cover, and catering staff until 15.00 are provided each day. Generally people seemed to be happy with the current level of staffing, and one person commented “there is always someone around.” However one relative said that more staff needed to be around when people needed to go to the toilet. Someone living in the home said, Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 22 “sometimes they are busy, but they always come back to me.” On the day of the site visit 15 people were being accommodated and staffing levels appeared adequate to meet their needs. No agency staff are currently used, but to achieve this a number of staff are working long hours (see also below). Many staff are working an average of 56 hours a week, with one member of night staff working 70 plus hours one week. This is not good practice, and could put people at risk if they are being looked after by tired staff. The issue about the amount of hours being worked by staff has been raised at previous inspections. Of eleven care staff currently employed one has completed NVQ at level three. Three further staff are currently undertaking this qualification. The home has not yet reached the advised standard of having 50 of care staff trained to NVQ level two or above. Staff are recruited centrally by the organisation. Management, staff or people living at Meyrin House have no input into the recruitment process. This means that potentially the staff recruited may not meet the needs of the home or fit in with the existing team. On the AQAA the manager felt that this was an area where the home could improve. The files of two recently recruited staff were viewed. Both had been recruited from overseas with their start date and the date that checks such as POVA 1st and Criminal Records Bureau were applied for being the same. The manager said that these staff did not immediately start work in the home, but were being orientated into the area, and receiving training from the organisations training officer for the first week, by which time a POVA 1st check was in place. One file had a criminal record check from the person’s country of origin, together with translations of references and a medical declaration. An application form and a record of an interview were also available. The other person had been recruited as a ‘student carer,’ and appropriate information was available. Under this scheme the person is supposed to work 36 hours a week composed of 16 hours of college and 20 hours work in the home. The rotas showed that on one week they had worked in the home for 56 hours. Although staff recruitment is not undertaken in a standard manner, it was possible to conclude that people are protected by appropriate checks on potential staff being undertaken. A comment about one new member of staff was that they had ‘basic English’ with the potential to learn. Another member of staff spoken with during the inspection had some difficulty understanding and responding. As many people living at Meyrin House have dementia and communication difficulties, the organisation need to ensure that the staff it employs always have good communication skills. The file of one of the two new members of staff showed evidence of induction that would give them knowledge and enable them to start caring for people. The manager said that the induction process was undertaken by the organisation’s training manager. There was a basic first week induction checklist. An ‘Introductory Orientation of Newly Appointed Care Assistants’ Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 23 was also on file. It was stated that ‘this programme may last up to six weeks.’ The programme was a basic yes/no checklist confirming that different topics had been discussed with the employee. The second file did not contain induction information. The manager said that staff had not yet commenced a Skills for Care based induction programme. This included a member of staff who had worked at the home for seven months. Generally staff undertake a good level of basic training that will enable them to meet the needs of people living in the home. All but the newest members of staff have undertaken some training in dementia care. This is important as the majority of the people living at Meyrin House have dementia. Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 24 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, 37, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe and well managed home. EVIDENCE: Meyrin House benefits from having a longstanding, qualified and experienced manager in post. A relative spoken with felt that the home “was very well organised.” The provider has strategies in place to monitor the service. An annual quality audit is undertaken by an external company. This last took pace at Meyrin House in May 2007. The audit includes seeking people’s views via questionnaires. Quality monitoring audits take place on a monthly basis. Visits as required by regulation are also carried out on a monthly basis. These visits Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 25 include talking to people about the service provided. These elements show that people’s views on the service are sought. Internal quality audits also take place such as weekly medication audits and walk around health and safety checks. Risk assessments are in place to guide staff practice. The AQAA completed by the manager was fully completed, and recognised areas where improvements could be made. The AQAA identified that many of the home’s policies and procedures have not been reviewed since 2002. This includes in some areas where legislation changes may mean that a review is required such as ‘Confidentiality and Disclosure of Information,’ or areas important to the service such as ‘Individual Planning and Review,’ and ‘Health and Safety (Health and Safety at Work Act 1974).’ Other shortfalls have been identified elsewhere in this report. Records viewed showed that when people’s personal monies are held for safekeeping, this is done in a safe way that protects their interests. No major health and safety issues were noted at this site visit. The manager said that an environmental health officer visited the home six months ago and had no major concerns. The AQAA completed showed that systems and services are regularly maintained. A fire risk assessment was in place, and records showed that regular fire drills take place so that staff are aware of the correct procedures to follow. The AQAA stated that 100 of staff are trained in food safety. This is correct but training records showed that five existing staff are now overdue for update training to keep their skills and knowledge current and people safe. Since the previous inspection training in core areas has been ongoing. From training information available staff are up, to date in moving and handling and more staff have attended first aid training. Staff have also received recent fire and health and safety training. Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 26 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 27 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. 2. Standard OP7 Regulation 15 Requirement Care plans should be developed further with regard to individual needs/diversity and be more person centred. This primarily relates to social care plans. Specialist needs - such as dementia must be taken into account more and the management approach be clear in the care plans. This is a repeat requirement with the previous compliance date of 30/08/07 not yet fully met. 2. OP18 13(6) So that people are protected and 01/06/08 staff take appropriate actions, up to date policies, procedures and information must be available and understood by staff in relation to safeguarding. Timescale for action 01/06/08 Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 28 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 People should have access to good written information about the home that will help them to decide if the home is right for them. The manager should be involved in the assessment process when people are considering moving into the home. Actions should be taken to control the temperature in the medication storage area, so that peoples’ medicines are stored in optimum conditions. People should be assured that the staff looking after them are always fully able and competent. Management therefore need to monitor the hours worked by staff to make sure that they are not too tired to carry out their duties effectively and safely. So that staff practice is based on up to date information, policies and procedures used to ensure the correct running of the home should be kept under regular review. 2. OP3 3. OP9 4. OP27 5. OP37 Meyrin House DS0000015456.V363098.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V363098.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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