Inspection on 17/11/05 for Miramar

This inspection was carried out on 17th November 2005.

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

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

Other inspections for this house

Miramar 05/02/09

Miramar 06/02/08

Miramar 15/03/07

Miramar 08/08/06

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 17th November 2005 09:05 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.V264466.R01.S.doc Version 5.0 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.V264466.R01.S.doc Version 5.0 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 Mr Andrew Sloman 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.V264466.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age range 50 years and over Date of last inspection 3rd May 2005 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. Many of the bedrooms are small but have en-suite facilities of toilets and washbasins. A lounge, a separate dining room and conservatory / entrance hall are situated on the ground floor. There are steps up to the front entrance. To the rear is a courtyard/patio with level access. There is no on-site parking. Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4 hours with the manager being present throughout. The pharmacy inspector completed an inspection of the medicines and procedures. Many of the residents living at Miramar have limited verbal communication skills and were therefore were unable to contribute fully to the inspection process. The inspector consulted five residents and two staff and their views on the home were discussed. Frequent short periods of time were spent with all residents and observations were made throughout the inspection. The inspector looked round parts of the building and a number of records were inspected. What the service does well: What has improved since the last inspection? What they could do better: Requirements must be met within the time scales set and good practice recommendations should be implemented. Staff should read and use the care plans to ensure they are aware of residents’ needs and any risks. Daily records should provide detailed information on residents’ needs. Medication storage and recording must improve to fully protect residents. Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 6 Staffing levels should be in such numbers that residents’ needs are being met and an assessment of staff training needs should be completed and actioned. The home must complete checks on staff to ensure that residents are well protected. Any hazards in the home must be assessed to reduce any risks to residents or staff. The provider needs to obtain the views of people who use the home or know it, on how well the home is run and how good the care is. 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. Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Residents benefit from good admission and assessment practices, which ensure that the home is able to meet their needs. EVIDENCE: The majority of residents have lived at the home for a number of years. Two residents who were admitted fairly recently had good assessments of need completed. Care managers provided good information to ensure the home was able to meet residents’ needs. The home does not provide any intermediate care. Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&9 Care plans provide staff with information they require to meet residents’ needs safely. Additional work is needed to ensure staff read and use the care plans effectively and daily records monitor care. Some of the storage areas for medicines and the recording methods used have the potential to place service users at risk. EVIDENCE: The majority of residents have limited communication skills and have a limited understanding of care plans and are therefore unable to contribute to their formulation or reviews. Care plans have significantly improved. The manager has worked hard to compile a new format that sets out clear goals with actions necessary to meet residents’ needs. Associated hazards are assessed and clear action is recorded to reduce the risk. Most of the staff team have worked at the home for many years and therefore know the residents well. However, care plans and risk assessments are not being read regularly. This means that some staff might not be aware of residents’ needs or risks. This could be unsafe and residents’ needs might not be met. Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 10 The home has daily recording sheets that are divided into sections of the shifts worked by staff each day. The sheet includes sections for medical appointments, achievement of goals, weight, foods eaten and balances of monies. However, staff record very little on these sheets and information about care plan goals are left blank. This means when care plan reviews take place there is no record of residents’ progress. Hand written entries on Medication Administration Record (MAR) charts were found not to be signed and dated and on some the actual dose to be administered was not present. For medicines prescribed with a variable dose it was not clear from the records the dose that had actually been administered. There were no records of training or assessment of competence in the home for those members of staff trained in the administration of insulin to a service user although a community nurse had carried this out. The storage areas for medicines were found not to be secure. Those stored at ambient temperature were in a cupboard that did not have a secure lock and the cupboard was not of a secure construction. Those stored in the refrigerator were not secure and no record was being made to demonstrate that they were being stored at the appropriate temperature. For those medicines prescribed with a “when required” dose clear guidelines of when to be administered were not available. The medication policy is currently under review. Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 14 Residents benefit from good social, cultural and recreational pursuits, including contact with relatives. EVIDENCE: Some residents said they were very happy at the home, they said 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. The manager intends to look into other activities to provide a better variety. Some residents said that staff were kind, caring and helpful. Staff were seen to be respectful and patient and offering choices to residents. The atmosphere throughout the home is warm, friendly and fun. Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 & 18 Residents are protected from abuse. EVIDENCE: The provider helps manage one resident’s money, which is paid directly into a bank account in the name of the resident. All other residents keep their own money. All staff have attended training on Adult Protection issues. Staff demonstrated a good knowledge of this and knew what to do if they suspected abuse. Residents are therefore well protected from potential abuse. Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 Residents benefit from a clean and homely environment. EVIDENCE: Residents said they felt comfortable in the home and had everything they needed. On the day of the inspection the home was clean and tidy with a warm and cosy atmosphere. A cleaner is employed each day. Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 On the whole residents’ needs are met by a competent staff team. Immediate improvements are needed in recruitment practices. EVIDENCE: The provider employs 2 care staff per shift and 2 staff at night. To meet the needs of the residents in the mornings, the manager is relied on to step in to carry out care duties when necessary. Due to the current complex needs of the residents living at the home a review of staffing levels must be completed. To fully meet residents’ needs a minimum of 3 care staff are necessary in the mornings. Staff said they felt they had enough time to complete the morning routine but had to be very organised. The manager should not be relied on to step in as a matter of course. This prevents her completing other responsibilities necessary to maintain the standards of the care in the home. The inspector was told that all staff have now received training in Abuse Awareness, which better protects residents. The manager needs to complete an assessment of staff training needs to ensure residents’ needs can be met. A requirement was made during the last two inspections to obtain documentation on all staff to prove their identity. An immediate requirement was also issued relating to recruitment practices. The home had employed staff before obtaining CRB / POVA checks and two written references. The provider has only applied for the CRBs. A new staff working today had no new CRB / Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 15 POVA check or references obtained. An Immediate Requirement was issued. These poor practices do not fully protect residents. Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Residents’ financial interests are safe guarded. Generally the home is run in the best interests of the residents. EVIDENCE: Residents’ finances are managed by relatives or the residents themselves. No money is held in the home on behalf of residents. The majority of residents have limited verbal communication skills. Staff work hard to ensure residents’ needs are met. They demonstrated an excellent knowledge of how residents communicate and would therefore recognise if residents were unhappy. The manager has tried to seek the views of relatives and visiting professionals on how the home is run in the form of a survey. District nurses, GPs and relatives have said they feel able to discuss any concerns they might have directly to the manager rather than complete a survey. Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 17 It was highlighted during the last inspection that the manager should complete and assessments of potential hazards around the home. New staff would then be aware of hazards to residents and of the actions which they need to take to reduce risk. Examples would include risks associated with the stair lift and conservatory. Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 3 2 Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation Reg 13(2) Timescale for action The registered person shall make 17/12/05 arrangements for the safekeeping of medicines received into the care home. (This refers to the need to store medicines requiring refrigeration securely and at the appropriate temperature). (This also refers to the need to store all medicines in a secure place within the home). The registered person shall make arrangements for the recording and safe administration of medicines in the care home. (This refers to the need to be able to determine the dose administered for those medicines prescribed with a variable dose). The registered person shall. 30/12/05 Having regard to the size of the care home, the statement of purpose and the number and needs of service users – (a) Ensure that at all times suitably qualified, competent and experienced persons are working DS0000021983.V264466.R01.S.doc Version 5.0 Page 20 Requirement 2 OP27 18 (1) (a) Miramar 3. OP29 19 at the care home in such numbers as are appropriate for the health and welfare of service users. The provider must ensure that the necessary checks are completed to establish staff fitness and authenticity to work at the home. The information required for staff, within the Care Home Regulations must be kept in the home. This is a repeated requirement, although work has started to complete this it still falls short of meeting the Regulations. An Immediate Requirement was issued. 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 completed and providing detailed, clear information on actions necessary to minimise any identified hazards, with particular attention being paid to the chair lifts and the means of escape) This is a repeated requirement, although work has begun it is not completed. 15/12/05 4. OP38 13 (4) (a,b,c) 15/12/05 Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 21 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 OP7 Good Practice Recommendations Daily records should include information about the goals set in the care plans. Monthly care plan evaluations should take place. The daily records should include information about foods eaten, this is particularly important for those residents with additional nutritional needs. This is a repeated recommendation. The home should obtain a Homely Remedy Policy for the use of over the counter medicines and follow the guidelines provided by the CSCI pharmacy inspector relating to liquid medication and the storage of medicines in the fridge. It is recommended that when an entry is hand written onto the Medicines Administration Record chart that this is signed and dated by the person making the entry and it is then checked and countersigned by a second person. It is recommended that clear guidance is available for all staff to refer to regarding the administration of those medicines prescribed with a “when required” dosage regimen. The manager should develop individual training and assessments profiles for each member of staff. The manager should ensure that induction training is formalised to the National Training Organisation specifications. The provider should consider having a registered manager in the home to help the provider better manage the home. 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. 2. OP9 3. OP30 4. 5. OP31 OP33 Miramar DS0000021983.V264466.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 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. 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