Inspection on 05/02/09 for Miramar

This inspection was carried out on 5th February 2009.

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

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

Other inspections for this house

Miramar 06/02/08

Miramar 15/03/07

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Miramar 145 Exeter Road Exmouth Devon EX8 3DX Lead Inspector Michelle Oliver Key Unannounced Inspection 5th February 2009 9:30 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.V374130.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.V374130.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.V374130.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age range 50 years and over Date of last inspection 6th February 2008 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 £376 £550 weekly. Services not included in this fee include hairdressing, chiropody, hairdressing and dentist fees. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home and the people living and working there. With the information provided, CSCI surveys were sent to people living at the home, their relatives, staff and outside professionals, in order to hear their confidential views of the service, prior to our unannounced site visit. Completed surveys were received from 6 people living at the home; 5 staff and 2 health and social care professionals expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. We spent 7.5 hours at the home, speaking with people living there and staff. We also spent time observing the care and attention given to people by staff. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and three people were spoken with in depth to hear about their experience of living at the home. We also spoke with 8 staff, including the owners, the registered manager, nursing, care and ancillary staff, individually or in a small group. A tour of the premises was made and we inspected a number of records including pre admission assessments, care plans and records relating to medication, recruitment and health and safety. Finally the outcome of the inspection was discussed with the owner and the registered manager. What the service does well: People living at the home were generally very happy with life at the home; one person told us, “ Staff are always very good” and another “ I like living here for it is a lovely place to live. I would call it a very good home with all the amenities in which to relax and enjoy oneself”. A health care professional, who responded to a questionnaire, commented that the service is “warm, supportive, practical and able to work flexibly” and another “ they give people choices”. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 6 A relative told us “My wife has been cared for very well due to staff assisting her with medication”. During our visit staff were attentive and friendly in their approach to people living at the home and skilfully meet the needs of individuals. Good information is available to people to help make a decision about whether this home would suite their needs. People’s health care needs are well met and the home works with other professionals, such as GPs and nurse specialists to ensure people have access to the care they need. People can be assured that caring staff will respect their privacy and dignity and enable them to make choices within their daily lives. People were generally happy with activities provided and most felt their social needs were met. People spoke highly of the food served at the home, which is of good quality and nutritious. The home can cater for various diets. One person commented “The food is good for we have things like toasted cheese, baked beans and pasties” and also confirmed they like the roasts they have Sundays and are “ Able to have a choice”. Relatives are always welcome at the home. One person commented, “I am very happy about the care of my relative. The staff are pleasant to me when I visit”. Several people described the atmosphere at the home as warm, friendly and welcoming. People feel confident that their complaints or concerns will be addressed. There are systems in place to ensure that people living at the home are protected from harm or abuse. People living at the home were happy with their accommodation. The home has sufficient aids and equipment to support the need of the people living there. Many people praised the staff team for their caring approach and attitude. The staff morale at the home is high and staff feel valued in their role and have a good sense of job satisfaction. Staff are well trained and relatives and professionals were confident that they had the skills to meet the needs of the people living there. The home is well managed, with systems in place to ensure that people ‘have their say’ about the development of the service. What has improved since the last inspection? Four requirements were made at the last inspection in January 2008. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 7 The manager and staff have worked hard to meet these but some elements have yet to be fully met. [See “What they could do better”] The general management of medication has improved. Staff have received training and all records that we looked at during this inspection were accurate and up to date. A record is now kept of the administration of creams and ointments. The manager has introduced a system whereby staff have responsibility for the certain rooms at Miramar. This is to ensure that they are clean and tidy and things such as toiletries and towels are replaced. Improvement however, is still needed. [See “What they could do better”] The recruitment procedure has improved. We saw records for a recently recruited member of staff, which included references and a police check but details relating to past employment or proof of identity had not been obtained. [See “What they could do better”] The home employs a person to undertake routine maintenance of the home. However, several areas are in need of maintenance. [See “What they could do better”] The laundry floor has been fitted with floor covering which makes it easily cleanable, to prevent cross infection and maintain cleanliness. What they could do better: Three requirements and 14 recommendations for good practice have been made as a result of the findings of this inspection. Two of the requirements were made at the previous inspection in 2008 and have been partially met Not all areas of the home are kept clean at all times to make sure that people live in a clean, fresh and hygienic environment and any risk of infection is minimised. Proof of identity and information relating to past employment history of a person employed at the home have not been obtained or recorded. Not all parts of the home that people living there have access to are as far as reasonably practicable, free from hazards to their safety. People living at the home are not given Contracts or Statements of Terms of Conditions. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 8 Assessments do not provide enough information to ensure the home can establish whether they can meet peoples’ needs and do not form the basis of individual care plans. The service does not confirm in writing that the service can meet individuals assessed needs before they move to the Home. Care plans do not include details of how individual people prefer their care to be given and information is not regularly reviewed with the involvement of people or representatives. Details about peoples’ past hobbies and interests have not been recorded to ensure that they might continue to lead their lives as they wish. A record is not kept of all complaints made, including details of investigation and any actions taken. People do not live in a safe well-maintained environment. The laundry floor is not kept clean, to prevent cross infection and maintain cleanliness. Facilities are not available for the disposal of protective clothing such as aprons, gloves and paper towels in one of the toilets used by people living at the home. Not all areas of the Home are kept clean, fresh and free from odour. Recorded staff rotas showing which staff are on duty at any time during the day or night and in what capacity are not kept. Induction training is not comprehensive and does not meet current Skills for Care standards. The results of quality assurance surveys carried out at the home are not made available to people living there and other interested parties including the CSCI. A record of routine maintenance has not been undertaken. Arrangements had not been made to ensure that fire prevention equipment is maintained. This relates to two fire doors being propped open because automatic closures needed to have batteries replaced. 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.V374130.R01.S.doc Version 5.2 Page 9 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.V374130.R01.S.doc Version 5.2 Page 10 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): 2,3 &6 Quality in this outcome area is adequate. The assessment information is inconsistent potentially putting residents at risk and could result in needs not being met. People living at Miramar are not provided with a Contract/ Statement of Terms and Conditions before admission to the Home. The home does not admit people who need intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of the people living at Miramar have done so for a number of years and could not recall their admission. Information included in questionnaires returned from 6 people living at Miramar confirmed that they all received sufficient information about the Home before they made it their home. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 11 The manager told us that people who are considering making Miramar their home will be told about the home in detail, and where possible visit, have a meal and meet people living there and staff. One person who has moved into Miramar since the last inspection told us “ I visited it and I had a word in the back yard with [owner and manager]. I decided it was the right place for me”. During this inspection we looked closely at the records of three people living at the Home, including the records for a person who had moved in to Miramar since the last inspection. Although the home had been provided with a summary of a Care Management assessment for this person, there was no evidence to suggest that the person had been involved in this assessment and the Home had not been provided with a copy of the persons care plan. This means that the person is potentially at risk of their individual needs not being fully met at the Home, as sufficient information has not been provided before their admission. A comprehensive assessment of individuals needs is required to ensure that staff numbers, knowledge and experience, environment and equipment are sufficient to meet the peoples’ needs. Three people who responded to questionnaires confirmed that they had received a contract when they moved into Miramar. One person told us they had a contract with “Social Services” and three people confirmed they had not received a contract. We looked at the file of a person who has recently moved into the home. There was no evidence of a Contract or a Statement of Terms and Conditions being given to the person. All people must have a contract setting out the home’s, and their rights and responsibilities. People who have a contract with Social Services must have a Statement of Terms and Conditions to provide them with arrangements, rights and conditions of occupancy with the home. We discussed this with the manager and were told that she had compiled a contract and plans to issue one to each person living at the home. The home does not admit people who require intermediate care. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 12 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 good. Individual care plans have been developed for the majority of people living at the Home. Improvements to the information recorded in individual plans of care would ensure that care is delivered in a person centred way. Medication is generally well managed. Peoples’ privacy and dignity are generally met and promoted by the staff and management at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of those who responded to questionnaires and those spoken to during this inspection are very satisfied with the level of care they receive at Miramar. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 13 During this inspection we looked, in detail, at care plans for three people, including those for a person who has moved into Miramar since the last inspection. Care plans included details of individual needs and goals to be achieved however, they did not include any strengths or abilities individuals have. For example how much help do they want or need in relation to personal care, what can they do for themselves or what degree of privacy would they like. Individual plans of care did not include information to enable staff to carry out care in a person centred way. For example information did not provide staff with details of how individuals choose to have their personal care provided, no details relating to what, why, when or by whom assistance should be provided was recorded. The lack of recorded detailed information potentially puts people at risk of receiving inconsistent care and puts a great responsibility on staff remembering how people choose to have care provided. It also means that some staff might not be aware of peoples’ needs or risks. This could be unsafe and peoples’ needs might not be met. No plan of care had been completed for a person who had been admitted to the Home since the last inspection. Information, which had been provided to the home by Care Management, included details of medical conditions and increased risk of the person’s vulnerability. No details of how these were to be met at the Home had been assessed or recorded. This potentially puts the person at risk of their health, social and welfare needs not being met. Most of the staff team have worked at the home for many years and therefore know people living there well. Staff spoke to us about people’s individual likes and dislikes and how they choose to be cared for. We were told that there were no “routines” at the home and people could choose what they did and when. All 5 staff that responded to questionnaires confirmed they are given up to date information about people’s needs and that they always or usually have the right support to meet the different needs of people who use the service. Assessments of risks associated with falls and nutritional needs had not been undertaken for people living at the home. This means that people may be at increased risk as no information has been recorded to enable staff to prevent these risks. A risk of a person choking had been highlighted in a care plan. However, no information was available to enable staff to minimise the risk or action to be taken in the event of it happening. We noted that bed rails were being used to prevent two people from the risk of falling out of their beds. Although relatives had been consulted, and had agreed to the use of bed rails, no assessments of the risks of injury associated with the use of the rails had been undertaken. For example would the Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 14 individuals try to climb over them or could they sustain an injury by trapping head or limbs between the rails. Care plans had been reviewed 3-4 monthly, on average, but there was no evidence of individuals or their representatives being involved in the reviews to either agree with any changes or put forward their own wishes and choices. We spoke to several people living at the home during this inspection. None of them were aware that they had an individual plan of how their care was to be carried out. None could remember being included in any reviews or being told of any changes to their care. Some people living at the Home have limited communication skills and a limited understanding of care plans and are therefore not all able to take part in the writing or reviewing of their individual plans. Care plan files include daily recording sheets that are divided into sections relating to shifts worked by staff each day. The sheet includes sections for medical appointments, achievement of goals, weight and foods eaten. 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 individuals’ progress. During this inspection a Community Nurse visited the Home to attend to a person who has a pressure sore. The nurse told us that she was happy with the care staff at the home provide and said that people who live at Miramar are well cared for and staff consult health care professionals for advice. Although the nurse had confirmed that good care was provided when we looked at the care plans for this person no information relating to how staff at the home should care for this person had been recorded. Details included in the plan of care had not been reviewed or updated since the person developed a pressure sore. Details on the person’s daily reports were brief. For example, “Appetite good, fluid intake poor”. No plan to ensure that the person improve their fluid intake had been recorded. Another entry stated, “creams applied” with no indication of what cream or where it had been applied. This lack of detail potentially puts the person at risk of receiving inconsistent care. The home had ensured that a pressure-relieving mattress had been provided for this person but there was no indication of how pressure would be relieved when the person was sitting in a chair. An entry on a daily report for this person stated, “ Sat in [their] room watching TV and sliding.” An assessment of the person’s mobility had not been undertaken, which once again potentially puts the person at risk of receiving inconsistent care. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 15 Medication management and procedures have improved since the last inspection. Staff have received training and medication administration records were accurate and well maintained. The manager confirmed that none of those people living at the Home look after their own medication and that no one had expressed a wish to do this. Peoples’ privacy and dignity are generally met and promoted by the staff and management at the home. All the people we spoke to during this inspection told us that staff respect their privacy and dignity. They said that staff are “very kind” and that they are all “well treated”. However, there is a risk that privacy is not always maintained. A toilet used by people living at the home on the ground floor does not have a lock fitted. In response to a questionnaire one person told us “ staff are very helpful and always let me use a telephone in private when I ask”. People living at Miramar have access to healthcare services that meet their needs including chiropody, opticians, dentists and district nurses. During this inspection an optician visited one of the people living at the home. The person underwent an eye examination whilst sitting in the lounge. We asked the optician if the person had been offered a choice of being examined in the privacy of their room. The optician said that the person had but was “perfectly happy” being seen in the lounge. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 16 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 good. People who live here benefit from having easy contact with their friends and family. Activities are provided at the home, which many people can join in, but this may not provide adequate stimulation and interest for all people currently living at the Home. People enjoy a balanced diet which takes into account the likes and dislikes of individuals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the people living at the home that we spoke to during this inspection told us they were very happy. In response to a questionnaire one person confirmed, “I like living here for it is a lovely place to live. I would call it a very good home with all the amenities in which to relax and enjoy oneself”. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 17 People benefit from being encouraged and supported to maintain contact with family and friends. The home has an open door policy and relatives, visitors and friends are welcome at any time, made to feel welcome and have a meal if they wish. Throughout the day of this inspection relatives and friends visited the home and were welcomed and made to feel at home by all those living there and staff. We were told that Miramar is “like a home from home”. People living at the home told us they are woken each morning and “reminded” they have to get up. When we asked them whether they could choose to stay in bed a little longer if they wished they told us that they were should they would be able to but that they had never asked. We were also told that people were reminded when it was time for them to go to bed but, once again, if they chose not to go they were sure that would be “ alright” but they had never asked. Some people living at the home are independent and come and go as they please. However, they do let staff know when they are going out and generally where they are going. One person told us that they attend Mass each Sunday, enjoy going to libraries and has several friends in the area they visit. Several of the people told us how much they had enjoyed their “ summer holiday” when they went to West Cornwall. They were looking forward to planning their holiday for 2009. In response to questionnaires 4 people living at Miramar confirmed there were “always”, 1 “usually” and 1 “sometimes”, activities arranged at the home that they could take part in. One person said they “wish we could go out more often, shopping or for a cup of coffee” but agreed that the weather didn’t allow this during the winter. One person commented “I attend a meeting in the lounge when a singer comes and sings songs. A woman sometimes comes and gives a quiz on music and films”. During the afternoons a member of staff is employed to spend time engaging people in activities. During this inspection activities took place in the lounge. The home has a good selection of games for people to play, including bingo, skittles, jigsaws and cards to name only a few. A wide range of books, some in large print are also available as well as magazines and daily papers. During this inspection 3 people stayed in their rooms. One person told us this was their choice. They enjoyed watching TV, listening to the radio or reading. They also told us they have a motorised scooter, which the manager had encouraged and supported them to buy, and enjoyed the independence this has afforded them. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 18 Another person who stayed in their room is partially sighted and unable to watch TV or read. Throughout the day the person sat in their room listening to a radio. We asked the manager and staff what activities this person enjoyed and took part in. We were concerned that this person spent time alone as when we checked regularly the person was alone. The manager and provider told us that staff checked on the person frequently and that at the time of this inspection the provider was working in a bathroom close to the person’s room so they were not alone. The care plans and daily reports recorded for this person did not reflect time spent with this person or any activities they had been involved in. Care plans did not include information relating to peoples’ interests or past hobbies. This means that people may not be encouraged to continue with a pastime they enjoy, as information is not available and may be at risk of not continuing to lead their lives as they wish. All 6 of the people living at Miramar who responded to questionnaires confirmed that they enjoy the meals served at the Home. One person commented “The food is good for we have things like toasted cheese, baked beans and pasties” They also confirmed they “like the roasts we have on Sundays” and they were.“ Able to have a choice”. The home employs 2 cooks, one of which works Monday – Friday and another who cooks during the weekends. The cook preparing the meals during this inspection has been employed at Miramar for several years and knows the people living there well. She told us that she knows individual likes and dislikes although a record is not kept. The cook visits people daily to chat with them, tell them what is on the menu for that day and check that they are agreeable to this or would like an alternative. The home follows a two weekly rotating menu, which is displayed in the dining room. The menu is varied and interesting. We were told that menus are reviewed following “ resident meetings” when people usually have suggestions for changes or additions to the menu. People living at Miramar are given the choice of being served their meals either in their rooms or in the comfortable dining room. Lunch served during this inspection was well presented and staff supported people, needing assistance with eating, sensitively and discreetly. All of those spoken to during this inspection praised the quality and variety of the meals served at the home. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 19 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. People living at the home 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 people living at the home are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People spoken to during this visit said they had never had cause to complain, but were sure that if they did have a complaint that staff would listen and take it seriously. One person confirmed they would know who to speak to if they had any concerns and commented “The manager and the owner and any member of staff”. Another person told us “I have nothing to complain about for I get on well with the staff and the people here”. The manager operates an “open door policy” and during this inspection several people went to the office and chatted to her and the owner. The manager told us that this enables her to sort any problems before they escalate and become greater issues. The manager told us staff have good relationships with all people living at the home, and spend a lot of time talking to them, making sure that if they have Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 20 any complaints or concerns they can be dealt with. Many of the people living at Miramar have difficulties in communicating and during this inspection we saw staff listening carefully to people with poor verbal and communication problems to make sure they understood what they were saying. Six people living at the home who responded to questionnaires confirmed that they always know who to speak to if unhappy and know how to make a complaint. Two complaints have been made to the Commission, one to Social Services and one directly to the home since the last inspection. The Home investigated the complaint made to them, following their complaint procedure and the complaint was not upheld. However, we were told that the home does not keep a complaints record and no record was maintained of the investigation. This was discussed with the manager who said that a record of all complaints will now be kept and will include details of any actions taken. 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.V374130.R01.S.doc Version 5.2 Page 21 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 adequate. People benefit from living in a home that has a friendly family atmosphere. However, improvements to the level of cleanliness and maintenance, in some areas of the home, to provide a cleaner safer environment, are needed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides comfortable accommodation for people living there. This includes 10 single rooms, 2 shared rooms, a lounge and a dining room. Most bedrooms have toilet and hand washing facilities. A stair lift enables people living at the home to reach the first and second floors. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 22 All 6 people who responded to questionnaires confirmed that the home was “always” fresh and clean. Comments made in response to questionnaires included “Staff come in and do the cleaning in the morning and they do my room and the staff always provide me with fresh clothes to wear in the morning” and“ Everything in the room is clean. Washing is done and clean clothes are kept in drawers and wardrobes”. During this inspection we visited all areas of the home, with peoples’ consent. Individual rooms were homely and reasonably decorated. People are encouraged to personalise their rooms bringing furniture and possessions that are precious to them from their own homes. The home was generally fresh apart from two rooms where we noted unpleasant odours. This was discussed with the manager. During this inspection we saw several areas that continued to need improvement since the last inspection. For example, some cupboard doors were missing handles and screws were left sticking out. We noted nails sticking out of walls, at a level where people could injure themselves. In one room boarding around a toilet and hand basin had been removed to allow the use of a hoist. The boarding had been replaced with a shower rail and curtain. The area between the carpet of the room and the vinyl of the toilet area had not been made good and created a trip hazard. Although most areas of the home were reasonably clean and fresh some areas needed improvement. A toilet and a raised toilet seat were not clean, an ensuite did not have adequate hand washing facilities [no soap] and a commode had not been cleaned. We noted that a downstairs toilet being used throughout the day did not have a bin for the disposal of gloves; also no paper towels were available although a cloth towel was. This puts people at risk of cross infection. Some rooms were dusty and looked as though they had not been dusted for some time. In one room an area behind a chest of drawers was littered with dead leaves and other debris. We discussed the level, and maintenance, of cleanliness at the home with the manager who discussed the number of hours currently allocated to cleaning the home. The lounge and dining room were clean and comfortable. The cook told us they are responsible for cleaning the kitchen and during this inspection it was spotless. Staff spoken to were able to describe procedures followed at the home to prevent cross infection and to maintain adequate hygiene. They spoke about wearing protective gloves and aprons and how these are disposed of. They also Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 23 spoke about the procedure followed when undertaking laundry tasks. All of the procedures met with current good practice guidelines. However, we did see staff assisting people to a toilet and not disposing of their gloves when they had completed the task. We noted that there was no bin available in this toilet for the disposal of gloves or aprons. The laundry facilities have been improved since the last inspection, making it easier to keep clean. However, the floor is now easily cleanable but at the time of this inspection needed cleaning. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 24 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 good. A competent staff team generally meets current residents’ needs. The procedure for staff recruitment has improved but does not fully protect people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home currently provides adequate staffing to meet the needs of the people living at Miramar. The manager aims to be available throughout the day as well as 2 members of care staff, a cleaner and a cook during the mornings and an activities co coordinator during the afternoons. During the night one waking and one sleeping care staff are on duty at the home and the manager is available “on call”. We looked at the staff rota and only care staff working hours are recorded. There is no indication of the hours that cooks, cleaner or the manager work at the home. In response to questionnaires 2 staff confirmed there were “always” and 2 “usually” enough staff on duty to meet people’s care needs. [1 didn’t respond Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 25 to the question] Five members of staff confirmed that they are given training relevant to their role, which helps them understand and meet the individual needs of people living at the Home and keeps them up to date with new ways of working. Four staff members confirmed their induction training covered everything they needed to know to do the job when they started and one thought that it “mostly” covered everything. One member of staff commented “If I need anymore information I just have to ask as the management are very approachable”. We looked at an induction-training format. It covered topics such as familiarisation with the layout of the home, actions to be taken in the event of fire and some employment issues. It does not meet the recommended Skills for Care induction training programme. This was discussed with the manager who agreed that the induction training needed to be improved and that she was researching this on the Internet. Included in information received from the manager prior to this inspection we were told, “over half the staff have completed NVQ2 and the remainder are at present undertaking their Level 2”. The manager told us that staff are automatically enrolled to undertake a Nationally recognised qualification [NVQ] when they are employed at the Home. At the time of this inspection some staff met with an NVQ assessor at the Home to discuss their progress and to be given a plan of continued training. All staff agreed that ways of communicating information amongst staff was well achieved. Miramar is a small home and the management is very family orientated. People living there told us that they were “made to feel comfortable, like members of one big, happy family”. As a result of this ethos and the fact that a relatively small group of staff are employed, carers are aware of the needs, likes and dislikes of people living at Miramar. This information, however, is not consistently recorded. [Refer to OP 7] During this inspection staff were very well informed in relation to people’s needs. We were told that before appointing staff at the home two written references and police checks are obtained for all new employees prior to commencing in post. We looked at the recruitment files for 1 recently employed staff member. Documentation included completed police check and 2 references as required. However, proof of identity was not included and the application form did not include a history of employment. This potentially puts those living at the home at risk of being cared for by staff that has not been recruited through a robust recruitment procedure. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 26 Regular staff meetings are also held to ensure that staff are kept up to date with any relevant issues relating to people’s needs, work practices, training information and CSCI inspections. All staff that responded to surveys, and those spoken with during our visit, felt well supported by the manager, the owner and other staff. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 27 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 home is run in the best interest of the people living there. Systems are in place to promote the safety and health of people living and working at the home although recruitment procedures and poor maintenance place people at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People living at the home 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 21 years and in a managerial position for the last 7 years. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 28 The owner is involved in the day-to-day running of the home and staff and people living there spoke highly of them. The manager told us that due to the size of the home people are consulted on all aspects of their life at Miramar on a daily basis when staff chat with them. The manager and owner told us they ask for opinions and make sure that people know that staff and management are open for any comments. The manager told us she operates “an open door approach” to people living at the home, staff and visitors, which encourage good communication and standards. A quality assurance survey was undertaken in September 2008. Questionnaires were sent to relatives and people living at the home seeking their opinions on the quality and variety of activities provided at Miramar. The outcome of the survey indicated that some improvements could be made. A basic summary of the last satisfaction surveys has not yet been collated for people to see. The home does not manage anyone’s finances at the Home. People either manage their own, or where necessary relatives assist them to manage their finances. The home will invoice people retrospectively for services such as hairdressing, chiropody and other personal items that may be needed. Records looked at during this inspection included, individual plans of care, including risk assessments, daily reports and monitoring records, administration of medicine records, staff files and rotas, menus and records of accidents at the home. The home’s recruitment procedures had not been followed consistently. This potentially puts those living at the home at risk of being cared for by staff that has not been recruited through a robust recruitment procedure. Most records were well maintained and were securely stored in locked cupboards. We were told that people’s individual records would be made available to them, or their representative, if they wished. Health and safety at the home has improved since the last inspection but the need for improvement continues. During our tour of the building we saw several examples of poorly maintained furniture and fittings. This puts people living at the home at risk of injury. [Referred to in standard 19] Windows checked on the first floor had been restricted to prevent accidents, and radiators were covered to prevent burns. Any accident involving people living or working at the home are recorded. This information is currently held in one file rather than in individual files. This procedure does not meet current Data Protection guidelines. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 29 Information received before this inspection did not include up to date records of maintenance or servicing of gas and electrical systems or regular servicing of other equipment. We looked at these records during this inspection and all were up to date. Since the last inspection arrangements have been made with an independent fire prevention trainer. We looked at a record of fire equipment tests and staff training and all was up to date. However, we did note that doors to 2 rooms, which were fitted with automatic door closures, were propped open. We were told that batteries needed to be replaced in the door closure units. The owner immediately replaced these to ensure that the doors no longer required being propped open. Since the last inspection a warning sign has been put onto the door of a cupboard housing electrical meters. This cupboard should be kept locked but during this inspection the door was easily opened although a form of locking devise had been fitted. The cupboard contained cleaning fluids and off cuts of floor covering. We looked at an assessment undertaken by a fire prevention assessor in March 2008 and noted “ action required: secure electrical cupboard and remove all stored matter” This has not been complied with. Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 30 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 31 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 OP26 Regulation 23[2][d] Requirement Arrangements must be made to ensure that all areas of the home are kept clean at all times. This is to make sure that people live in a clean, fresh and hygienic environment and any risk of infection is minimised. 2. OP29 19 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. [This relates to proof of identity and information relating to past employment history being recorded] [This requirement has been partially met since the last inspection] 3 OP38 23[2][b] All part of the home that people living there have access to must be as far as reasonably practicable, free from hazards to their safety. DS0000021983.V374130.R01.S.doc Timescale for action 05/04/09 05/04/09 05/04/09 Miramar Version 5.2 Page 32 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. 2. Refer to Standard OP2 OP3 Good Practice Recommendations Each person living at the home should be provided with a contract or statement of terms and conditions, to ensure they are aware of their rights. Assessments should be up to date and provide enough information to ensure the home can establish whether they can meet residents’ needs and should form the basis of individual care plans. The service should confirm in writing that the service could meet individuals assessed needs before they move to the Home. 3. OP7 It is recommended that information in care plans be more detailed to include details of how individual people prefer their care to be given and all information should be regularly reviewed with the involvement of people or representatives. Details about peoples’ past hobbies and interests should be recorded to ensure that they might continue to lead their lives as they wish. A record should be kept of all complaints made and includes details of investigation and any actions taken. People should live in a safe well maintained environment. The laundry floor should be kept clean, to prevent cross infection and maintain cleanliness. Facilities should be available for the disposal of protective clothing such as aprons, gloves and paper towels. The home should be kept fresh and free from odour. A recorded staff rota showing which staff are on duty at any time during the day or night and in what capacity should be kept. Induction training should be comprehensive and meet current Skills for Care standards. DS0000021983.V374130.R01.S.doc Version 5.2 Page 33 5. OP12 6. 7. 8. 9. 10, 11. 12. OP16 OP19 OP26 OP26 OP26 OP27 OP30 Miramar 13. OP33 The results of quality assurance surveys carried out at the home should be made available to people living there and other interested parties including the CSCI. Arrangements should be made to ensure that fire prevention equipment is maintained. This relates to two fire doors being propped open because automatic closures needed to have batteries replaced. There should be a record maintained for routine maintenance. 14. OP38 Miramar DS0000021983.V374130.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V374130.R01.S.doc Version 5.2 Page 35 - 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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