Inspection on 03/05/05 for Miramar

This inspection was carried out on 3rd May 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 17/11/05

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 Bel Heginworth Announced 3 May 2005 rd 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 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 D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Miramar Address 145 Exeter Road Exmouth EX8 3DX Telephone number Fax number Email 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 CRH PC Care Home providing Personal Care 14 Category(ies) of LD Learning Disability [14] registration, with number LD[E] Learning Disability - over 65 [14] of places MD Mental Disorder [14] MD[E] Mental Disorder - over 65 [14] Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Age range 50 years and over Date of last inspection 18th October 2004 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 ensuite 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 D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over 6 hours with the manager, Nikki Inglis and the provider, Mr Sloman being present throughout the day. The majority of residents living at Miramar have limited verbal communication skills and were therefore were unable to contribute fully to the inspection process. Frequent short periods of time were spent with residents and observations were made throughout the day. One resident was spoken with and one relative and three staff members were consulted and their views on the service discussed. 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: The home must complete checks on staff to ensure that residents are well protected. Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 6 Any hazards in the home must be assessed to reduce any risks to residents or staff. Daily records kept on residents should include details about the care given, including the foods that have been eaten. This is to ensure staff can check that care needs are being met. Records of staff training need to be easily read. Staff should attend training that protects residents. 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. Medicines that are bought “over the counter” and not prescribed by a GP should be included in the home’s relevant policy. Advice has been given to the home by the CSCI pharmacy inspector about some issues relating to medicines in the home. 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 D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 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 standard(s) 0 Not inspected on this occasion. EVIDENCE: Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, 10 & 11 Residents are treated kindly and their rights are treated with respect. Care plans provide staff with the information they require to meet residents’ needs safely. Additional work is needed in the daily recording methods. Medicines and administration are managed well. Improvements are needed in the policy relating to over the counter medicines. 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 the goals. Associated risks are assessed and provide action to reduce the risk. The manager intends to provide training sessions to explain the new format to staff. Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 10 The home has daily recording sheets that are divided into sections of the shifts worked each day. The sheet includes sections for medical appointments, achievement of goals, weight, foods eaten and balances of monies. The goals achieved have not been completed; this is mainly because the manager has to implement the training for staff. Monthly care plan evaluations will be introduced after the training has been completed. The section for foods eaten does not provide accurate information to ensure nutritional needs are being met. This is a repeated recommendation. The manager intends to include this in the training. Residents’ needs are carefully identified and met in close liaison with community professionals, for example district nurses and physiotherapists. A resident talked about how the “nice” the staff were and how they always treated him with respect and supported him in choices he made. Staff were observed acting in a caring and respectful manner. It was highlighted during the last inspection that the home must have a homely remedy policy for medicines that are not prescribed. The manager has been waiting for advice from the pharmacy to implement this. The home has a number of insulin dependant residents. Insulin is stored in the domestic fridge. This must be stored in a secure container that cannot be easily removed. All staff have received training on the “Safe Administration of Medicines”. The manager should carry out regular assessments of staffs’ competencies in relation to medication. The assessment should take into account the home’s medication policies and procedures. The wishes of service users in relation to death and dying have been added to individual records. This was a recommendation during the last inspection. Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 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 standard(s) 15 The meals in the home are good and offer both choice and variety. Specialist dietary needs are catered for. EVIDENCE: Residents expressed complete satisfaction in the standard of meals provided. Menus are displayed and staff will also tell residents what meals are on the menu in order to check if they like what is on offer. Individual preferences are always catered for. Menus are varied and the cook takes care to ensure meals are well presented and is aware of any special diets such as low fat and low sugar. Home baked cakes are made regularly. A recommendation has been made under section 7 –11 that relates to the recording in care plans of foods eaten. Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 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 standard(s) 18 The home has systems in place that protect residents from abuse. Improvements are needed for staff training on Adult Protection EVIDENCE: The provider has the responsibility for the finances of two residents. Financial records have improved with two signatures and receipts obtained for each transaction. Residents’ interests are thereby well protected. The home has policies and procedures that provide some guidance on Adult Protection issues. However, staff have not received any form of adult protection training. The provider agreed to arrange this as soon as possible. Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 22 & 24 Miramar is homely, comfortable and meets the needs of the residents. EVIDENCE: The home is decorated brightly, which creates a warm and homely atmosphere. It has a large comfortable lounge with suitable seating for older residents. One resident said he was happy with the environment and had everything he needed in his bedroom. There are stair lifts going up two levels of the home, these can cause an obstruction on the staircase if the seat is left down. Risk assessments have been completed for the use of the stairs in residents’ individual records. It was recommended during the last inspection they should be expanded to include detailed actions of how to minimise risks from the stair lifts. This work has not been completed. (A recommendation has been made relating to this under section 31 – 38) A physiotherapist will be carrying out an assessment on the environment in the Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 14 new few months. The provider said he will action any recommendations made. The bedrooms have call bells but they are currently not working. The provider has arranged for these to be mended. Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 The numbers and skill mix of staff ensures that residents’ needs are met. Improvements are needed in staff training records including induction training. Recruitment practices do not fully protect residents. EVIDENCE: The majority of staff have been working at the home for a number of years and therefore know the residents well. Residents spoke fondly of the staff and said they were always caring and respectful. During the last two inspections requirements were made to improve the home’s recruitment practices. For example CRB checks, two written references and the necessary documentation to prove identification was not in place for all staff. Some of the staff have been working at the home for over 15 years, it would therefore be inappropriate to obtain references for them now. However, it is still necessary to obtain the other documentation, listed in Schedule 2 of the Care Home Regulations; and keep copies of them. The manager has re-organised the staff files and has been working hard to obtain the necessary documentation. However staff that have recently started working at the home did not have two written references in place. But did have CRB checks. CRB checks have still not been completed for all of the staff that have worked at the home for some time. The home has applied for some, but not all, and is Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 16 still waiting for the outcome. An Immediate Requirement was issued relating to recruitment practices, stating that CRB checks must be completed for all staff. Two written references, proof of identity and CRB / POVA checks must be satisfactorily completed for new staff prior to employment. The home has an induction and training programme. It was recommended during the last inspection that the home should ensure that this meets the National Training Organisation (NTO) specifications. This has not been completed yet. All care staff receive a minimum of three paid training days per year. It was highlighted during the last inspection that the home should develop individual training and development assessments and profiles for each staff member. Some of these have been completed. Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36 & 38 The health, safety and welfare of residents and staff are, on the whole protected. Some improvements are needed to reduce risks. The home has started to consider how it will review its performance. Improvements are needed in this area. EVIDENCE: Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 18 The manager, Nikki Inglis carries out the majority of the day-to-day running of the home. The provider, Mr Sloman has given the manager a day in management time to complete the work she is responsible for. During this inspection he agreed to provide an additional half-day to allow the manager enough time to complete all of her management work. The provider has produced a quality assurance policy. The policy has been copied from the National Minimum Standards under standard 33. It does not describe how the home will measure the quality of care within the home and it does not include a time frame. The provider has sent quality assurance surveys to relatives in the past, but did not receive any response. Relatives told the provider that they would discuss issues as and when they came up rather than fill out a questionnaire. The provider should seek the views of other interested parties, such as district nurses, GPs and other visitors to the home. A relative spoke highly of the quality of care within the home. She described staff as “very caring” and contacted her on a regular basis. Due to the extremely limited communication and written skills of the majority of the residents at the home, the surveys are not appropriate. The provider and staff ensure residents are happy in the home by spending time with them and by making observations. Care plan evaluations, once up and running, will help to review the care delivered to residents. Three members of staff felt supported by the manager and spoke fondly of the provider. The manager and provider supervise and guide the carers on a daily basis. The manager has introduced formal supervision for some staff and intends to continue this process for all, on a regular basis. The home has a health and safety at work document but does not have any risk assessments in relation to safe working practices or the environment. This is a repeated requirement. It was agreed that these must be completed by 30th June 2005. An additional unannounced inspection will take place to ensure this work has been completed. The fire logbook was up to-date with records of relevant staff training to ensure that the health and welfare of residents are protected. Other policies and procedures were not inspected. The majority of this information is taken from a pre-inspection questionnaire, which is sent to the CSCI prior to the inspection. This was not received in time so will be used as evidence on the next inspection. Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 x 3 x 3 x x STAFFING Standard No Score 27 3 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x 2 x x 3 x 1 Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 20 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 OP29 Regulation 19 & Schedule 2 Requirement 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 Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 21 Timescale for action 03/06/05 2. OP38 13 (4) (a,b,c) 30/06/05 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. 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 particulalry important for those residents with additional nutritional needs. 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. All staff should attend Adult Protection training. 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 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 GP’s, Chiropodists, District Nurses and so on. Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 22 2. OP9 3. 4. OP18 OP30 5. OP33 Commission for Social Care Inspection Suite 1, 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. Extracts may not be used or reproduced without the express permission of CSCI Miramar D54 D06 S21983 Miramar V211548 030505 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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