Inspection on 06/02/08 for Miramar

This inspection was carried out on 6th February 2008.

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

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

Other inspections for this house

Miramar 05/02/09

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Miramar 145 Exeter Road Exmouth Devon EX8 3DX Lead Inspector Michelle Oliver Unannounced Inspection 6th February 2008 09:30 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.V349330.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.V349330.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.V349330.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age range 50 years and over Date of last inspection 15th March 2007 Brief Description of the Service: The home is registered to provide personal care for up to 14 people over the age of 50 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. People 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 £372 £500 weekly. Services not included in this fee include hairdressing, chiropody, hairdressing and dentist fees. Miramar DS0000021983.V349330.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 8 people living at the home; 6 relatives, 3 staff and 3 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 9 hours at the home, speaking with people living there, their relatives 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. During our visit we met and spoke with two relatives. 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 assessments and 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, “I feel [my relative] is well supported to lead the life they choose”, and “ manager has made a real effort to reach my relative and work Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 6 with them in a sensitive way to meet their needs” and. “I feel the staff are warm and caring”. Relatives told us about the “high standards of care” provided at the home, one said, “I am very happy about the care of my relative. The staff are pleasant to me when I visit”. People spoke highly of the staff; we were told that staff were “respectful, friendly, kind, marvellous and caring”. 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. A good admissions process ensures that the home can meet people’s 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. Relatives told us they were always welcome at the home and that they were informed of important issues concerning their relative. 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. Overall, health and safety is well managed and people are safeguarded from harm. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Three requirements were made as a result of this inspection. Two requirements made at the last inspection, relating to recruitment and medication, have been partially met since the last inspection. However, some aspects of the management of medication at the home does not safeguard people living at the home. Some areas of the home were clean and fresh, but there are areas that need improvement. Some areas of the home have been redecorated and some furniture and fittings have been renewed but further improvements are needed During the day people frequently use a toilet on the ground floor. The door of this toilet cannot be locked, which puts people at risk of their privacy not being respected. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 8 Details about peoples’ past hobbies and interests are not recorded. This means that staff are not provided with information to enable them to support and encourage people to continue to lead their lives as they wish. The results of quality assurance surveys carried out at the home are not currently available to people living there or other interested parties. This means that people living at the home, and others, are not aware of the outcomes and what steps the home is taking to improving services. The home’s recruitment procedure has improved but it is not sufficiently robust to fully protect people living at 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. The summary of this inspection report can be made available in other formats on request. Miramar DS0000021983.V349330.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.V349330.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): 3&6 Quality in this outcome area is adequate. The home has developed a system, which will ensure that peoples’ needs are assessed before they make a decision to make it their home. The home does not admit people for intermediate care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were not able to assess whether the homes pre admission assessment has improved since the last inspection as no people have moved into the home. 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 Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 11 meal and meet people living there and staff. Two people told us about visiting the home before they made a decision to make it their home. The manager told us she would visit the person concerned at their home or in hospital to carry out an assessment of their health, social and welfare needs. This is to make sure that peoples’ individual needs can be fully met at the home. This includes making sure that staff knowledge and experience, environment and equipment are sufficient to meet the peoples’ needs. Meetings are held with the care managers, other health care professionals and family to make sure that all relevant information is gathered. The manager also said that people already living at the home are considered before a person moves in. In response to surveys sent before this inspection a care manger replied, “In respect of our clients who are placed at Miramar the manager has made good efforts at gathering the correct information.” The home has drawn up a pre admission assessment form since the last inspection, which we looked at during this inspection. The manager told us that she was going to improve the form to include more detail, make it more user friendly with more space to record details. Miramar DS0000021983.V349330.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 adequate. Continued improvements to the information recorded in individual plans of care would ensure that care is delivered in a person centred way. People’s health needs are well met with good disciplinary working, helping to protect people’s welfare. Medication practice has improved but some practices could place people at risk. People feel they are treated with respect and that caring staff uphold their privacy. This judgement has been made using available evidence including a visit to this service. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 13 EVIDENCE: All people currently living at Miramar have individual plans of care that have been based on the homes’ previous admission process. The manager and staff have worked hard to improve the plans since the last inspection but the need for improvement continues. Many of the people living at the home have limited communication skills and limited understanding of care plans. Therefore, not all people are able to take part in the initial writing or ongoing reviewing of their individual plans. A relative, in response to a survey, said, “I would like to see a proper care plan for my relative and that his needs are met”. A relative, spoken to at the time of this inspection, said they had not seen their relatives care plan but were totally satisfied that staff knew “ all about them” and met all their needs. 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. We also spoke to 2 relatives who were also unaware of care plans and could not remember being involved in any reviews. However, all people spoken to were happy with the care provided at the home. During this inspection we looked at 3 peoples’ care plans in detail. Care plans included an assessment of peoples’ needs in relation to their mobility. This assessment includes details of a persons weight, equipment needed, how mobile a person is, whether they are able to understand and cooperate with staff when moving, the condition of their skin and whether there are any additional factors, such as pain, to be considered. This ensures that when being assisted to move staff are aware of individual needs and abilities. Care plans included information about peoples’ individual health, social and welfare needs. This included needs such as mental health needs, mobility, personal hygiene and eating and drinking. Plans also included some associated risk assessments and goals, in relation to peoples’ needs. Information available in care plans to enable staff to meet peoples’ needs were not sufficiently detailed to ensure that this is carried out as individuals would wish. For instance, information recorded in one care plan relating to mobility stated, “can be very mobile if the mood takes [them]. If [they] are having a down day [they will refuse to move”. No details of what a “down day” was, how this could be recognised, what led up to it or how staff could encourage them to maintain their ability were recorded for staff information. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 14 Another plan stated, “can be a fussy eater”, with no details of the persons individual needs recorded. We asked a cook whether a list of the persons likes and dislikes was available for staff to refer to. We were told there was not but the cook could provide us with the information. This puts the person at risk of being given foods they do not like. We spoke to the person concerned who confirmed they are usually given what they like. 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. Assessments to ensure that staff have accurate information and guidance on how to meet all needs safely and consistently, with clear action recorded on how to reduce risks, had not been undertaken. No details relating to risk of falls or nutrition had been recorded in the 3 plans we looked at. This means that people may be at risk, as strategies to minimise risks had not been considered. People living at Miramar have access to healthcare services that meet their needs including chiropody, opticians, dentists and district nurses. During this inspection a district nurse visited the home to provide treatment for one person. During this inspection two people attended out patient appointments accompanied by the manager and the owner. We saw that changes to their treatment were recorded on their daily record to ensure that staff were kept informed and up to date. We saw evidence in a care plan that a person received ongoing medical attention for an ongoing, long standing condition. A risk associated with the condition could result in the person choking and no action had been undertaken to assess the risk of this happening. No information was available to enable staff to minimise the risk or action to be taken in the event of it happening. This means that peoples’ health and safety is potentially at risk, as some hazards have not been identified or actions planned to reduce them. A daily record is kept of how people at the home live their lives. We saw some good information about people recorded by staff. This included identifying when a person was unwell at a very early stage and involving their doctor. The majority of people who responded to questionnaires, some with support from staff, felt that they “always receive the care and support they need” and it was clear that the staff team have a good knowledge of peoples’ needs and worked hard to ensure those needs were met. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 15 We spoke to all staff on duty at the time of this inspection. All were able to tell us how they care for people in an individual way and could tell us how they encouraged and supported people to make choice about how they live their life at Miramar. The majority of people living at the home, who responded to surveys, some with the help of staff, felt they “ always receive the care and support they need”. A relative who responded to surveys commented that the home had a “ Very caring ethos, but care and support can seem to lack structure and co ordination”. Another told us the “Manager has made a real effort to reach my [relative] work with them in a sensitive way to meet [their] need” and “ I am very happy about the care of my relative”. Management of medication has improved since the last inspection, with improved administration procedures being introduced. However, not all staff are following procedures. We looked at medication administration records [MAR] for all people living at the home and found the recording was inconsistent. For instance the date and amount of medication had not been recorded when received at the home. We saw several gaps on the MAR where no signature or code had been made. For instance we saw a record that indicated that on several occasions an inhaler had not been given to a person. There was no explanation as to why this had not been given. We noted that medications administered at lunch time were not signed to record this until after they had been given. Medication should be signed for when given to, taken or refused by a person. This practice put people at risk of not receiving medication and up to date information not being recorded. We checked all current medication packs during this inspection. Tablets were missing from several of the packs. This means that people are at risk of not receiving their medication. We noted that tablets for 2 people, that should have been given several days before this inspection, were still in packs. We checked the MAR. A member of staff had signed to confirm they had been given. The record was not accurate. This puts people at risk of not receiving medication as prescribed. We also noted some good practice. For instance a person had requested a pain reliever, was given appropriate medication and a record had been made of the reason it was requested and the effect it had. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 16 The manager told us that a record is kept of all medications that are returned to a pharmacy when no longer needed. We were unable to check this as we were told that medication had recently been returned and the record was currently at the pharmacy. We saw medication that had been dispensed by a hospital more than a month previously that was no longer being used but had not been returned to the pharmacy for disposal. Several people at the home had been prescribed creams/ointment that need to be applied by staff daily. There were no records of these being applied. People who were able to understand and communicate told us that staff respect their privacy and dignity. However, during this visit two people were not given a choice and had their hair cut whilst sitting in the middle of the lounge. During our visit, staff were polite and friendly when delivering care. All health and social care professionals responding with surveys felt that staff respected people’s privacy and dignity. One person told us, “Staff are always polite and respectful”. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 17 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 and from a varied and wholesome diet. 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 This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home has recruited a person who is responsible for arranging and carrying out activities at the home. This person was a carer at the home and so knows the people living there well. People are encouraged and supported to choose whether they want to join in activities. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 18 During this inspection a game of bingo was taking place in the lounge. Several people were sat in the lounge but only 3 people were taking part. Many people said they enjoy sitting outside when the weather allows, some spoke about enjoying watching TV, musical videos, taking part in in-house activities, and listening to music in the lounge or in their bedrooms. Some said all they do is sit and watch the TV all day. 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. The majority of people spoken to during this inspection said they were very happy living at Miramar and that they enjoyed the “music man” who came to the home periodically. People told us how they enjoy the convenience of local facilities for shopping, attending church, and going to cafes, pubs and so on. Throughout this visit people were seen in the lounge, dining room, in their rooms, some moved around the home freely, two attended appointments and one went out to visit their family. A notice board in the dining room provides people with information including what day of the week it is, forthcoming events, such as whose birthday and days out, trips to the theatre and activities for each afternoon during the week. The manager told us they would like to take more people out, but due to staffing levels and funding at times this is not possible. Several people told us how much they enjoy the holiday they had last year with the staff and how much they are looking forward to going this year. Comments made in response to surveys received before the inspection included that one person had “really enjoyed their holiday with staff members. A relative suggested the home could improve by “Do more daytime activities, maybe opportunities for people to go out more” and another.” More outings every so often”. A care manager told us “The activities, including a short holiday, have proved very beneficial to my client”. We also received comments from people living at the home about the meals they are provided with. One commented “Wonderful meals, variety”. The manager and owner told us that Miramar is run as a family home, and staff try where they can to involve people living there in its day to day running. This could be any thing from helping in the garden or the kitchen. People are encouraged to leave their rooms and socialise with others, throughout the day, Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 19 especially at meal times. Staff feel meal times are an ideal time for everyone to socialise. A menu, which has been revised and is discussed with people living at the home, is also put up on the notice board in the dining room every day. This gives people information on choices available for breakfast, lunch and tea, with alternatives if they do not like what’s on the menu. We were told before this inspection that the home holds two lunch sessions as some people need help with their meals and staff feel it is good for them to eat together. This also allows staff to spend quality time with them. During this inspection we saw 4 people who needed assistance come to the dining room with 2 carers. Their meals were well presented in a way that suited each individually. Carers assisted them discreetly, telling one person who was partially sighted what they were about to eat and encouraging others. The meal was unhurried and all ate a hearty meal. Other people who came to the later lunch were socialising with each other, staff and the owner. The owner was invited to have lunch with them and a lot of conversation and laughter followed. People living at the home told us they are supported to maintain contact with their families. A relative told us they are always “made to feel welcome and part of the family”. During this visit many visitors came to the home and were made to feel welcome by the staff. Relatives told us they visit, often have lunch and usually stay most of the afternoon. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 20 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. 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.V349330.R01.S.doc Version 5.2 Page 21 any complaints or concerns they can be dealt with. Many of the people living at Miramar have difficulties in communicating and during this inspection staff we saw staff listening carefully to people with poor verbal and communication problems to make sure they understood what they were saying. Eight people living at the home and four relatives’ responses to surveys confirmed that they always know who to speak to if unhappy and know how to make a complaint. A relative, in response to a survey stated they were not aware of how to make a complaint and would inform the Commission for Social Care Inspection. However, they also commented, “I had two separate episodes of concern, which I have tried to raise with the manager and provider. One was about administering [my relatives] pocket money”. As a result of discussing the concerns with the manager a system was immediately implemented. This means that the home listens to suggestions and complaints, takes them seriously and acts upon them. 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.V349330.R01.S.doc Version 5.2 Page 22 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 family atmosphere. However, improvements could be made to improve the level of cleanliness and maintenance, in some areas of the home, to provide a cleaner safer environment. 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, lounge and dining room. Most bedrooms have toilet and hand washing facilities ensuite. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 23 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. Since the last inspection the home has employed a maintenance person and a programme of refurbishment has taken place. We were told this is ongoing. The kitchen has been refurbished, hallways, corridors and the dining room have been redecorated. Several carpets that were rucked and worn, and created a hazard of people tripping, have been replaced since the last inspection making the home safer for people to walk around. Washhand basins are now provided in the toilets that previously did not have this facility. As part of the general refurbishment the home has upgraded a bathroom to include fitted a hydrotherapy bath and shower, new flooring and wall covering. This programme of refurbishment at the home needs to be continued. During this inspection several areas were seen that needed improvement. For example, some cupboard doors were missing handles and screws were left sticking out. We saw a glass door of a vanity unit in another room was broken and sharp; tiles around several vanity units were broken or missing. Two divan bed bases were ripped, the wooden struts of the bed were visible and in one room part of the floor boards around a washbasin were missing. This puts people living at the home at risk of injury. A relative when asked to comment on ways the home could improve commented, “general refurbishment is required but I believe this is planned and in some instances has commenced”. Although most areas of the home were reasonably clean and fresh some areas needed improvement. Two toilets and a raised toilet seat were not clean. One ensuite did not have adequate hand washing facilities [no soap] and a commode had not been cleaned. This puts people at risk of cross infection. Some rooms were dusty and looked as though they had not been dusted for some time. We discussed the level, and maintenance, of cleanliness at the home with the manager who said she plans to improve the quality of the cleaning carried out at the home. 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.V349330.R01.S.doc Version 5.2 Page 24 spoke about the procedure followed when undertaking laundry tasks. All of the procedures met with current good practice guidelines. The laundry facilities have been improved since the last inspection, making it easier to keep clean. However, the floor is not easily cleanable and a a large amount of dust and fluff had accumulated. In response to surveys one relative commented, “I think the fabric of the building is, in places, in a poor state of repair”. A care manager commented Miramar “Offers a warm friendly, homely environment with a caring staff team. There is a good feel to the home when visiting although the fabric of the home could do with refreshing”. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 25 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 & 20. Quality in this outcome area is good. Staff numbers and the skill mix are satisfactory and ensure peoples’ needs are met in a timely and proper way and people benefit from having experienced and friendly staff who have a good understanding of their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager aims to have 2 care staff on duty throughout the day and 1 waking and 1 sleeping at night. Cooks, domestics and a maintenance person support carers at the home. People told us staff were “always” or “usually” available and felt they received the care and attention they needed. When asked people told us that staff come quickly to answer bells, one person said, “I have all the help I need”, another said, “They (staff) are there when I need them, and another person told us, “I am very happy with care and help I get”. All relatives responding to surveys felt that the home gave the support required and could meet the different needs of people living there. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 26 The manager and staff felt that generally staffing levels were good. One staff member said, “We are never left short” and another said, “We have enough time not be rushed when giving care”. During our visit staff were seen to attend to people in a timely way. Bells were answered promptly and although busy during the morning, there was a calm and orderly atmosphere. 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. Staff morale at the home is high and staff felt valued; several people described satisfaction they get from working at the home. Comments from staff included, “Miramar is a happy place to work” and “I am very happy in my work place”. All surveys received from people living at the home, and from relatives, prior to the inspection praised all staff currently working at the home. One person in response to a survey said, “ staff are very attentive and if you need something revealed to one of your relatives they tell them”. Training is discussed with staff at the beginning of each year and a plan developed that will ensure training is provided to staff throughout the year. This training includes ‘safeguarding adults’ as well as the mandatory training to meet peoples’ basic needs, such as manual handling and health and safety. Staff told us they had recently attended training relating to understanding peoples’ behaviour staff may find challenging. Information about training courses is posted on a notice board in the dining room. When asked if there was any training staff feel would further help them care for people at the home several said that training in caring for people with dementia and those with diabetes. Staff were clear about their role, knew what was expected from them and showed a good understanding of the actions they needed to take to meet and promote equality and diversity. Past records and staff files show the home does not have a high staff turnover have not employed agency staff for over two years. All staff have achieved NVQ level 2 or are working towards it. Recruitment practices are reported on in the management section of this report. Miramar DS0000021983.V349330.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 well managed, and 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 of some furnishings place people at risk. This judgement has been made using available evidence including a visit to this service. Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 28 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 20 years and in a managerial position for the last 6 years. The manager completed a Registered Manager’s award in June 2007. The manager said that people are consulted on all aspects of their life at Miramar on a daily basis when she visits and chats with all of them individually. People spoken to confirmed this and said “ nothing is ever too much trouble for her”. The manager operates an “open door” policy at the home.The office door is literally left open so that people know they are encouraged to speak, in private if they wish, to the manager at any time. One person said “all staff are approachable ” and “we are free to say anything we like”. The owner is involved in the day-to-day running of the home and staff and people living there spoke highly of them. A quality audit has been undertaken since the last inspection to gather people’s views relating to the running of, and the quality of life experienced at the home, including standards of care, activities, individual needs and the general atmosphere at the home. We were told the results of the survey show that both people living at the home and relatives are happy with care received in Miramar. A basic summary of the last satisfaction surveys has not yet been collated for people to see. The home manages one person’s finances in as much as providing them with a weekly allowance. We saw the money was kept securely and receipts to confirm money had been received by the home and handed over to the person concerned. Other 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. During this inspection we looked at recruitment files for three people who had been employed at the home since the last inspection. All included some of the required documentation including satisfactory police checks. However, only two files included a completed application form, none included a record of past employment, one only included a reference from a persons GP and only two included statements of terms and conditions. This potentially puts people living at the home at risk of being cared for by people who have not undergone a robust recruitment procedure. Other staff members have been employed at the Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 29 home for some time and recruitment files have been looked at during previous inspections. 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] Records show that staff have regular training in the prevention of fire, fire safety, moving handling, infection control and food hygiene. Staff and records confirmed this. The fire logbook showed that fire alarms are regularly checked. A fire risk assessment for the home is currently being up-dated to conform to new legislation. Information received before this inspection [AQAA] showed maintenance or servicing of gas and electrical systems was up-to-date. Also that other equipment, such as the lift and hoists were serviced regularly. 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.V349330.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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 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.V349330.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 OP9 Regulation 13[2] Requirement The registered person must make arrangements for the recording, safe administration and disposal of medicines received into the care home. The registered person must make arrangements for the recording, safe administration and disposal of medicines received into the care home. This relates to • Not all medication being signed for when received at the home, • Some records being inaccurate with regard to numbers of tablets • Not all medication records were accurate. Some indicated that medication had been given when it had not. • Medicines had not been returned to a pharmacy when no longer required. Arrangements must be made to make sure that the management Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 32 Timescale for action 20/03/08 of medication at the home is safe and protects people living there. 2. OP26 23[2][d] Arrangements must be made to 20/03/08 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. 3. 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, he is satisfied as to the authenticity of the references referred to in paragraph 5 of schedule 2. This relates to only one reference being obtained for one member of staff, An application form not being completed for one member of staff, No previous record of employment being obtained for 3 staff, And Only 2 members of staff being provided with terms and conditions of employment. 4. 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. 20/04/08 20/03/08 Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 33 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 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. A record should be kept of the administration of creams and ointments All toilets used by people living at the home should be fitted with locks that are accessible to staff from the outside in case of an emergency. This is to ensure that peoples’ privacy and dignity are respected at all times. Details about peoples’ past hobbies and interests should be recorded to ensure that they might continue to lead their lives as they wish. The laundry floor should be easily cleanable, to prevent cross infection and maintain cleanliness. The results of quality assurance surveys carried out at the home should be made available to people living there and other interested parties. 2. 3. OP9 OP10 4. OP12 5. 6. OP26 OP33 Miramar DS0000021983.V349330.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Miramar DS0000021983.V349330.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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