Inspection on 15/03/07 for Miramar

This inspection was carried out on 15th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Miramar 05/02/09

Miramar 06/02/08

Miramar 08/08/06

Miramar 17/11/05

Miramar 03/05/05

Miramar 18/10/04

Miramar 07/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOMES FOR OLDER PEOPLE Miramar 145 Exeter Road Exmouth Devon EX8 3DX Lead Inspector Belinda Heginworth Unannounced Inspection 15th March 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 Miramar DS0000021983.V324428.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. Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Miramar Address 145 Exeter Road Exmouth Devon EX8 3DX 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) 01395 264131 nikki.inglis1605@btconnect.com Mr Andrew Sloman Mrs Nicola Jayne Inglis Care Home 14 Category(ies) of Learning disability (14), Learning disability over registration, with number 65 years of age (14), Mental disorder, excluding of places learning disability or dementia (14), Mental Disorder, excluding learning disability or dementia - over 65 years of age (14) Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age range 50 years and over Date of last inspection 8th August 2006 Brief Description of the Service: The home is registered to provide personal care for up to 14 people over the age of 55 who may have a learning disability, mental illness or dementia. Miramar is an older adapted end of terrace house, close to the centre of Exmouth. Accommodation is arranged over the ground, first and second floors. There are two stair lifts, one to the first floor and another to the second floor. There are ten single and two double sized bedrooms. Residents who have a room on the second floor need to be able to manage stairs as two steps lead to the rooms making these unsuitable for people with limited mobility or who have cognitive or sensory impairment. Many of the bedrooms are small but have toilets and washbasins provided in them, one room also has a shower. A lounge, a separate dining room and conservatory / entrance hall are situated on the ground floor. There are steps leading up to the front entrance. To the rear is a small courtyard/patio. There is no on-site parking. The home’s statement of purpose and service user guide is available at the home, which includes details about the philosophy of the home and details about living at the home. This is available to all potential residents before they make a decision about living at the home. A copy of the most recent inspection report is pinned up on the office wall and is also available on request. Information received from the home indicates that the current fees are £350 £500 weekly. Services not included in this fee include hairdressing, chiropody, hairdressing and dentist fees. Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This second key inspection was unannounced and took place during a week day, over a period of 5 hours. The manager and provider were not available during this inspection. The manager sent some information by e-mail the next day, to provide some information in areas that could not be inspected on the visit. During the inspection plans of care for 4 residents were looked at in detail. This helps the Commission to understand the experiences of people using the service. A number of other residents were met and spoken with during the course of the day. The inspector also spent time observing the care and attention given to residents by staff. Four staff were spoken with during the day, including care staff and the cook. One relative was spoken with who provided some very positive information about the care and services within the home, which have been included in the main body of the report. Prior to the inspection surveys were sent to residents, relatives, staff and health professionals to obtain their views of the service provided. Two responses were received from relatives, two from health professionals, seven from staff and eight from residents. Comments were in the main positive. Prior to the inspection the manager completed a pre inspection questionnaire. This provided information about residents, staffing and fees. It also explained how the home is maintained and what checks, policies and procedures are in place to ensure that the health and safety of residents and staff is not compromised. This information helps the inspector to prepare for the inspection and form a judgement on how well the home is running. The inspector looked around parts of the building and read other records. These included, fire safety, accident and medication records. What the service does well: On the day of the inspection residents were relaxed, appeared comfortable and happy. Staff understand residents’ individual needs and work hard to be effective when delivering care. Staff were observed being kind, caring and respectful. A relative commented that “staff are always so helpful and kind, my relative is so settled and happy here”. The cook provides good homemade food that is varied and healthy. Residents said they enjoyed it and could have an alternative if they did not like what was on offer. Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 6 The environment is generally clean, homely and comfortable. Some improvements have been made to make it safer in some areas but further improvement is still needed. What has improved since the last inspection? What they could do better: Although there is information about residents prior to moving into the home, assessments require more detail to ensure the home can be satisfied it can meet someone’s needs. This information must then be used to formulate a plan of care that will help staff be able to meet residents’ needs safely and consistently. On the day of the inspection 3 residents who had been living in the home from August 06 had no care plans completed by the home. These plans should include all details of residents’ needs, including social needs and needs relating to disabilities. Residents’ daily reports need improvement to provide more detailed information and should be consistently written in a manner that is respectful. One report referred to a resident who spent all day “moaning” but no information was given about what the staff did to find out what was wrong or what they did to try to resolve the issues. Although medication practices have improved some areas need further attention to ensure residents’ health, safety and welfare is fully protected. For example, one resident was prescribed inhalers twice a day, the inhaler was not present in the medication cupboard and had not been signed to say it had been given. Residents must be consulted about the home’s programme of activities to ensure that those provided meet residents’ needs and wishes. Any interests or hobbies should be included in their care plan to ensure all staff are aware of their interests. Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 7 The home’s procedure for the recruitment of staff is not robust and does not currently protect residents at the home. A domestic worker has been employed since the last inspection. The inspector was unable to establish what training this worker had received. At the last inspection it was highlighted that training must be provided for all newly employed staff. This will ensure that they are familiar with the homes’ policies and procedures, the layout of the home and the needs of the residents. Although there are enough staff on duty to meet the basic needs of residents, a review of the home’s staffing numbers is recommended. This will ensure all residents’ needs can be met, including social needs within the current staffing structure. Residents should be encouraged and supported to have an input in the running of the home. Arrangements should be made to review and improve the quality of care provided at the home by seeking the views of residents, wherever possible, and of stakeholders in the community, such as GPs, Chiropodists and District Nurses. The manager should have a job description to enable them to take responsibility for fulfilling their duties and to ensure that there are clear lines of accountability within the home. Further attention is need to safety standards within the home, for example, the use of window restrictors, the testing of electrical equipment and radiator covers to ensure residents are protected from harm. 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. Miramar DS0000021983.V324428.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 Miramar DS0000021983.V324428.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): 3&6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessment information for some residents is limited and inconsistent potentially putting residents at risk and could result in needs not being met. The home does not admit people who need intermediate care. EVIDENCE: Four residents’ files were read in detail, three of which had been admitted between, August, November and December 2006. The majority of information came from previous placements or social services. Although this information was detailed, some of it was completed a long time before the admission and was therefore not always up to date. The home also completes an assessment, however it had limited information. The assessment sheet covers topics such as medical history, diagnosis, medication, allergies, mobility, personal care, mental alertness, anxieties, diet and continence. Next to each heading there was only room to write one line of information. What was written provided very Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 10 limited detail of the residents’ needs. In addition the assessment did not cover areas relevant to living at Miramar, for example, ability to use stairs or stair lifts. However, all of the information put together from other placements, social services and the homes own assessment, provided enough to formulate a care plan. In the case of three residents who had been admitted last year no care plans were in place, other than social services care plans. This means that all needs that were highlighted through the information gathering process were not reflected in a plan of care. In addition, no individual assessments of risk had been completed. This compromises residents’ welfare and safety and puts residents at risk of receiving inconsistent care. Two staff described residents’ needs well but said in some cases they were still getting to know them. They said they said they were going by the information provided before admission rather than a care plan. Staff also said, in many cases they were finding the information was no longer accurate since the residents had moved in to Miramar. Out of the eight responses to the surveys sent out prior to the inspection, all said they had received enough information about the home before deciding to move in. Two residents spoken with during the inspection confirmed they visited the home before deciding to live there. A relative also confirmed they had been involved in the admission process. Miramar DS0000021983.V324428.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. Most residents’ needs can be understood through information provided in care plans but some plans continue to put residents at risk through having limited information. Medication is generally well managed but some practices could place residents at risk. Residents’ privacy and dignity are well met and promoted by the staff and management at the home. EVIDENCE: Many of the residents have limited communication skills and limited understanding of care plans. They are therefore not all able to take part in the writing or reviewing of their individual plans. However, one response from a relative said it “would be helpful and reassuring to see a care plan”. Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 12 Four care plans were looked at in detail. As previously mentioned, three residents’ files that were read had no care plans compiled by the home. Instead, social services care plans were being used. Although these provided some information, staff admitted they found much of the information was inaccurate. An example was that one resident was said to require two staff awake at night. The home only provides one staff awake and one staff sleeping in. Staff said the resident did not require two staff awake. Another example said that a resident was at risk from pressure sores and would need to be encouraged to change position and move throughout the day. This information was not set out in a plan of care and no information was recorded each day to say it had happened. However, staff spoken with were aware of this information and during the inspection they were observed encouraging the resident to change positions. In addition, no hazards to these residents had been assessed with clear action recorded on how to reduce risks to residents and staff. The manager said through her communication with the commission after the inspection that she intends to complete these in the following weeks. This will ensure staff have accurate information and guidance on how to meet these residents’ needs safely and consistently. Those residents with care plans had good information and risk assessments. However, daily records did not reflect that any of the goals within the care plans were being met. This would make it very difficult to accurately review care plans. One resident said she sometimes got bored and there was little to do in the home. No information was recorded in her care plan describing her hobbies or interests. Staff said the manager intends to arrange a key worker system which will give staff responsibilities towards who they are key working for. This will include ensuring care plans are accurate and up to date. A relative’s response to comment cards sent by the commission said “it would be helpful if there was one named carer who had particular responsibility, who could check if he needed anything e.g clothes etc”. Residents have access to healthcare services that meet their needs including chiropody, opticians, dentists and district nurses. The majority of residents responding to questionnaires, with the support of the staff, felt that they “always receive the care and support they need”. Throughout the inspection it was clear that the staff team have a good knowledge of residents’ needs and work hard to ensure those needs were met. Most admitted their knowledge came from good verbal communication rather than using written information in care plans. Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 13 The medication practices have significantly improved since the last inspection, with better administration procedures in place. During this inspection most records were found to be accurate and up to date. However, one resident who was prescribed an inhaler had not received any in the last week. On inspection of the medication cupboard no inhaler could be found. Staff said the resident did not need it and she refused to take it. The decision “does not need it” was not made by a doctor and the appropriate code was not recorded on medication administration records. The home does not have a refrigerator exclusively for the storage of medicines requiring cold storage, however, currently no medication needed to be stored in this way. Staff said there were plans to store medication requiring cold storage in a safe, in a fridge, in a shed outside. The shed has no lock, the safe would be able to be removed from the fridge. This is therefore an unsuitable and unsafe solution to storing medicines requiring refrigeration. Staff said that up dates in medication training have been arranged for all staff. This was confirmed by the manager through her communication by e-mail. Throughout the inspection staff treated residents with respect and ensured their privacy and dignity was maintained. A relative spoken with said staff “are always so kind”. Screening is provided in a shared bedroom through a curtain rail between the two beds. Miramar DS0000021983.V324428.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. Residents would benefit from more stimulating activities and occupation. Meals are wholesome and nutritious, taking account of the likes and dislikes of individuals. Residents are encouraged to maintain contact with their families or friends as they wish. EVIDENCE: Some residents said they were very happy at the home and that they enjoyed the “music man” who came to the home periodically. Many of the residents said they were happy having music and TV available in the lounge or their bedrooms. Some residents use the local facilities for shopping, church, cafes, pubs and so on. Residents said they enjoyed watching musical videos and carrying out some in-house activities with staff. According to information received before this visit activities provided include visits by music men, singers, watching video, afternoon DVD’s, playing board games, holding Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 15 “beauty mornings” when hair and nails are attended to and day trips out on a regular basis. Throughout this visit residents were seen in the lounge and dining room and in their rooms. Some residents moved around the home freely and two went out. The home does not have a programme of activities or entertainment. During the inspection some of the residents were undertaking jigsaw puzzles with the help of the staff. One resident said she enjoyed doing puzzles. Another resident was provided with baby bricks and a baby toy, which they showed little interest in. This was discussed with staff who said it was not easy finding activities that all residents enjoyed. After the inspection, the manager said that the “baby toys” had been brought in by relatives. Care plans had little reference to residents’ interests or hobbies. One resident who responded to a survey said they would like to play bingo. Staff were seen to spend time with residents when they had the opportunity. However, much of their time was spent providing personal care, ensuring residents were comfortable and providing drinks and food. One resident said in response to a survey “I like the staff a great deal and I get on with them. I think Miramar is a home of love and concern. I like the food here and the companionship”. A relative who was visiting said their relative had made friends and was so much happier at Miramar saying “ I couldn’t wish for better care, the staff are wonderful”. All residents spoken to during this visit said that they enjoyed the meals prepared at the home. Residents ask what food is on offer and all confirmed that if they were given anything they did not like they would be given an alternative. Questionnaires returned by eight residents confirmed that they always enjoy the meals at the home. During lunchtime, some residents used bowls and spoons instead of dinner plates and knifes and forks. Although it was clear this was to aid them to eat, there was no reference to this in their care plans. Some staff would therefore not be are aware of how to meet residents’ needs effectively. Some residents confirmed that they are supported to maintain contact with their families. A relative who was spoken with said that staff always make them feel welcome. One comment from a relative’s survey said “the staff are kind and I am able to work with them”. Miramar DS0000021983.V324428.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives are assured their concerns or complaints will be dealt with appropriately through a satisfactory complaints procedure. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that residents are protected at the home. EVIDENCE: Residents spoken with said they rarely had cause to complain but some said if they have raised any concerns staff have always listened and dealt with the problem. Staff were observed listening carefully to residents with poor verbal communication skills to ensure they understood what they were saying. Eight residents’ responses to surveys confirmed that they always know who to speak to if unhappy and know how to make a complaint. One relative said “the staff are so easy to talk to, if I was unhappy I know they would deal with it immediately. All staff have undertaken Adult Protection training and demonstrated an excellent understanding of different forms of abuse. They all said that they would not hesitate to report any suspicion of poor practice. Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are satisfied with the surroundings that the home offers. The continuing improvements to many areas of the home have ensured residents live in more comfortable surroundings. Some infection control practices have improved which ensures residents health and welfare is better protected. EVIDENCE: The home provides a lounge and a dining room. Residents’ rooms had been personalised with their own belongings and some small items of furniture. During the last inspection it was highlighted that throughout the home there was evidence of poor maintenance. The majority of this work has now been completed making the home safer and more comfortable for residents. Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 18 The home is generally clean and residents were satisfied with their surroundings. The lounge and dining rooms are bright and comfortable, and the bedrooms appear homely. Seven residents who were spoken with and eight who responded to surveys confirmed that the home is always clean and fresh. Since the last inspection a window has been replaced in the dining room with French doors, which leads out into the garden and to the laundry room. This has made the dining room brighter and stopped staff having to carry soiled laundry through the kitchen. After taking advice from the Environmental Health Department, laundry is now put in plastic laundry bags to take through the dining room to reduce the risk of cross infection. The French doors also lead out to a new ramped area which enables residents with mobility problems to have easier access to the home. During the last inspection it was highlighted that the laundry did not have floor or walls coverings which were easy to clean, and it was not clean at the time of this visit. During this inspection the walls the painted brick walls were clean and anon slip floor covering had been fitted. It was also highlighted ruing the last inspection that commodes were not clean; during this inspection all commodes were found to be clean and hygienic. These improved standards of hygiene protect residents and staff from the risk of cross infections. Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Current residents’ needs are generally met by a competent staff team. A comprehensive induction training for new staff will ensure residents’ health and welfare can be met at all times. Robust recruitment practices are not fully understood and do not protect residents. EVIDENCE: The manager aims to have 2 care staff on duty throughout the day and 1 waking and 1 sleeping at night. At the last inspection the manager said staff numbers had been increased to 3 care staff on duty between 9am-2pm on 4 days a week. However, during this inspection staff said this only happened once a week, to enable some residents to go out. It was highlighted during the last inspection that it was often necessary for the manager to undertake care duties, which prevents her completing other responsibilities necessary to maintain the standards of the care in the home. The manager confirmed during the last inspection that staffing levels were “ adequate unless something untoward happens.” This was discussed with the provider at the time of the last inspection who had agreed that additional staff could be allocated as necessary to meet residents’ needs. Staff said during this inspection that it is rare for additional staff to be on duty. Whilst the staff felt that on a “normal” Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 20 day two staff were adequate to meet the basic care needs of residents, it was not enough to meet residents’ social needs or to cope if anything went wrong. One staff survey said “more staff on the morning shift so that residents are not got up by night staff”. Residents spoken with during the inspection said they could get up when they wanted and one resident said they often wanted to get up early as “they did not sleep well”. All surveys from residents prior to the inspection and from relatives, spoke very highly of the staff team. One survey said “ the staff are very kind and caring”, another said “ I couldn’t wish for a better home, the staff are so good”. A relative spoken with on the day of the inspection said “ the staff are so helpful and kind, my relative has settled in so well here”. During the last inspection it was highlighted that requirements were made following the last three inspections that the home obtain documentation on all staff to prove their identity. An immediate requirement was also issued relating to recruitment practices. During this inspection recruitment files were not available for inspection. Only one staff had been recruited since the last inspection. This was the cleaner, she was aware that a police check (CRB) had been applied for but was unsure if a Protection of Vulnerable Adults (POVA) check had been obtained. It is a requirement that staff who are employed before a CRB check is obtained that a POVA check is completed to ensure the person is not on the list that bans someone from working with vulnerable people. Contact with the manager since the inspection confirmed that a POVA check had not been obtained. The manager thought it was acceptable to employ her as long as the staff was working under supervision. This can only happen after a clear POVA is returned. The manager agreed to take the cleaner off the rota until this happened. The manager must ensure that she fully understands her responsibilities to protect residents through robust recruitment practices. The majority of the staff working at the home have worked there for a number of years or come from backgrounds in care. They therefore are experienced and knowledgeable. Residents spoken with felt the staff team understood their needs. One relative said “the staff team are very professional”. Staff said they have received a lot of mandatory training and further training has been booked for fist aid, manual handling, infection control and challenging behaviour. A list with the dates was on the notice board. Staff said they found the training helpful and were able to talk about what they had learnt and how they put it into practice. One staff said the challenging behaviour course would be useful in helping them to understand how to manage residents who were more challenging. According to information provided by the home 14 care staff are currently employed at Miramar. Three members of staff hold an NVQ at level 2., two are completing NVQ training and the manager is due to complete NVQ level 4 in care by June 2007. Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from the continuity and stability of the staff team led by the manager. Improvements to practices in the home are helping to promote and safeguard the health, safety and welfare of people using the service. Some areas continue to put residents at risk. EVIDENCE: Residents and staff benefit from the experience of the current manager who has worked at Miramar for several years, has been involved in the care of the elderly for 20 years and in a managerial position for the last 6 years. The Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 22 manager is currently undertaking a Registered Manager’s award, which is due to be completed in June 2007. Residents’ finances were not looked at during this visit. Information received indicates that money is not held in the home on behalf of residents, it is managed by residents themselves or by relatives. During the last inspection it was highlighted that the manager did not have a job description to enable her to know the responsibilities for carrying out her duties. Information received indicated “key management responsibilities are divided between the proprietor and registered manager.” The manager had said there are not always clear lines of accountability within the home. The manager was not available during this inspection therefore this issue was not discussed. The manager has day-to-day contact with all residents and families at the home. An “open door” policy operates where residents, relatives or health care professionals may speak to her about any problems, observations or updates at any time. Staff said that they “Get a lot of support from manager” and “If there is ever a problem the manager will sort it out”. Two relatives who responded to surveys spoke positively about the manager, one said “she is lovely and keeps me informed on what’s going on”. Residents spoke fondly of the manager, many saying she was kind and “sorted things out for them”. Healthcare professionals who responded to surveys spoke highly of the care home and said how well the home meets their clients’ needs. The manager and staff ensure that residents are happy with the care they receive through day-to-day contact, talking with outside professionals and relatives and care plan reviews. However, during the last three inspections it was required that a formal quality assurance system be set up to ensure that the views of residents, relatives and outside stakeholders are sought and recorded to ensure the home is being run in the best interests of residents. By auditing the outcome of satisfaction questionnaires the home can set up an improvement plan to ensure residents benefit from a home that is run involving them and in their best interests. After the inspection, the manager confirmed that she had written a quality assurance plan, this was not seen on the day of the inspection. The manager also said she has started to work on producing suitable satisfaction questionnaire for residents, staff and relatives. She has also arranged monthly residents meetings. The manager has undertaken assessments of risk from potential environmental hazards around the home. This ensures that staff are aware of the action they need to take to prevent residents and themselves from coming to any harm. To minimize the risk of residents falling from the first floor it has been assessed that windows should be fitted with restrictors to limit their opening. During a tour of the building it was noted that restrictors had been fitted to Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 23 two first floor windows and although another window had been fitted with one it had been disconnected allowing the window to open fully. This places people at potential risk. At the last inspection requirements were made relating to fire safety procedures. This resulted in the fire authority visiting and making further requirements. Subsequent visits from the fire authority confirmed they were satisfied with the action the home had taken. During this inspection all fire safety procedures were found to be in order, fire safety checks had been regularly completed and staff were up to date with fire safety training. Almost all of the radiators in the home have been covered. The manager confirmed after the inspection, that priority has been given to completing all of the work necessary to ensure residents’ are protected from the risk of scalds. During the last inspection it was highlighted that electrical equipment, seen in some residents’ rooms, had not been tested to determine whether the equipment is in a satisfactory condition. Also, no assessment of the risk presented by trailing electrical leads in a resident’s bedroom had been undertaken. Information relating to this was not available during this inspection. Miramar DS0000021983.V324428.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 3 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 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 25 Yes Are there any outstanding requirements from the last inspection? 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 OP38 Regulation 13 (4) (a,b,c) Requirement The registered person must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Unnecessary risks to the health or safety of service users must be identified and so far as possible eliminated. (This relates to environmental risk assessments being complied with to minimise any identified hazards with particular attention to window restrictors, guarding radiators, ensuring that electrical equipment is tested to make sure it is safe.) This is repeated from the last inspection and has been met in part. 2. OP9 13 2 The registered person shall make 30/05/07 arrangements for the recording and safe administration of medicines in the care home. (This refers to ensuring that a Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 26 Timescale for action 30/06/07 medication prescribed is available and if not used the correct codes are used in the medication administration records) 4. OP12 16 2n The registered person shall 30/06/07 consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including activities in relation to recreation, fitness and training. The registered person shall not employ a person to work at the care home unless he has obtained the information and documents specified in paragraphs 1-7 of schedule 2, he is satisfied as to the authenticity of the references referred to in paragraph 5 of schedule 2. [This relates to 1 member of staff working at the home without a CRB/POVA] The registered person shall ensure that persons employed at the care home receive training appropriate to the work they are to perform. [This relates to newly employed staff not receiving induction training] The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. 30/04/07 5. OP29 19 6. OP30 18c1 30/04/07 7. OP33 24 1ab 30/05/07 Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2. 2. Refer to Standard OP3 OP7 Good Practice Recommendations Assessments should be up to date and provide enough information to ensure the home can establish whether they can meet residents’ needs. Comprehensive information relating to residents’ care needs should be included in care plans. Care plans should be reviewed monthly, with the involvement of the resident or their representative. 3. 4. 5. OP27 OP28 OP31 Staffing numbers on duty each day should be reviewed to ensure there are enough staff on duty to meet residents needs, including social needs. The home should continue to work towards achieving at least 50 of staff being trained to at least NVQ level 2. The job description of the registered manager should enable them to take responsibility for fulfilling their duties. There should be clear lines of accountability within the home. 6. OP33 The provider should ensure the quality assurance plan describes how the provider and manager will assess the care delivered and include time frames. The home should continue to find methods to seek the views of residents, wherever possible, and of stakeholders in the community, for example GPs, Chiropodists, District Nurses and so on. Testing of electrical equipment should be carried out as a routine to determine whether the equipment is in a satisfactory condition. 7. OP38 Miramar DS0000021983.V324428.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Miramar DS0000021983.V324428.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. 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