Inspection on 08/08/06 for Miramar

This inspection was carried out on 8th August 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Miramar 05/02/09

Miramar 06/02/08

Miramar 15/03/07

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 Key Unannounced Inspection 09:00 8th August 2006 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.V292092.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.V292092.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.V292092.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age range 50 years and over Date of last inspection 17th November 2005 Brief Description of the Service: The home is registered to provide personal care for up to 14 people over the age of 55 who may have a learning disability, mental illness or dementia. Miramar is an older adapted end of terrace house, close to the centre of Exmouth. Accommodation is arranged over the ground, first and second floors. There are two stair lifts, one to the first floor and another to the second floor. There are ten single and two double sized bedrooms. 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 also available on request. Information received from the home indicates that the current fees are £350 £500 weekly. Services not included in this fee include hairdressing, chiropody, hairdressing and dentist fees. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over a period of nine hours. The manager was present for most of the inspection. During the inspection plans of care for 4 residents were looked at in detail. This helps the Commission to understand the experiences of people using the service. A number of other residents were met and spoken with during the course of the day. The inspector also spent a considerable time observing the care and attention given to residents by staff. Several staff were spoken with during the day, including care staff, domestic, cook and the registered manager. Two relatives spoke about their recent experience of coping with the admission of their loved one to Miramar. Prior to the inspection 13 surveys were sent to residents to obtain their views of the service provided; 6 were returned. Comments were in the main positive. Ten staff were sent surveys in order to hear their confidential views; 9 were returned all with generally positive comments. Seven health and social care professionals, including GP’s were also contacted prior to the inspection. The Commission received one response. Positive comments were also returned by 4 relatives. On the day of the inspection the inspector toured the premises and a sample number of records were inspected including care plans, medication records, staff recruitment files, fire safety records and a record of accidents. What the service does well: Most residents appeared relaxed, happy and comfortable. Staff act in a caring manner towards residents. The home’s cook provides freshly made foods and caters for all nutritional needs. The environment is generally homely and comfortable. A relative commented in a questionnaire “Any problems are dealt with in a compassionate way by the manager and care staff, this enables residents and their families to be put at ease and share in a very happy environment with staff and surroundings within the home”. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: No person should be admitted to the home unless an assessment of their health, social and welfare needs has been undertaken and they are informed in writing that these needs can be met at the home. Comprehensive information relating to residents’ care needs should be included in care plans and these should be reviewed monthly, with the involvement of the resident or their representative Improvements are needed in the recording, of medication when received and administered at the home to ensure that residents are protected by the management. Attention is required to ensure that environmental standards, and all staff interactions, respect the privacy and dignity of all residents living at the home. For example rooms shared by two residents did not have adequate screening to fully ensure privacy and during the inspection a resident was spoken to in a kind, but childlike, manner. Residents must be consulted about the home’s programme of activities to ensure that those provided meet residents’ needs and wishes. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 7 Standards of hygiene at the home need to be improved in some areas. The home’s procedure for the recruitment of staff is not robust and does not currently protect residents at the home, this must be improved. Training must be provided for all newly employed staff to ensure that they are familiar with the homes’ policies and procedures, the layout of the home and the needs of the residents. Residents should be encouraged and supported to have an input in the running of the home. Arrangements should be made to review and improve the quality of care provided at the home by seeking the views of residents, wherever possible, and of stakeholders in the community, such as GPs, Chiropodists and District Nurses. The manager should have a job description to enable them to take responsibility for fulfilling their duties and to ensure that there are clear lines of accountability within the home. Attention is needed to several issues surrounding health and safety procedures at the home to ensure that all residents living at the home are protected. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 3 & 6. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. The assessment information for some residents is poor and inconsistent potentially putting residents at risk and could result in needs not being met. The home does not admit people who need intermediate care. EVIDENCE: The majority of residents have lived at the home for a number of years. The manager said that although she visits potential residents before they decide to live at the home to assess their needs to ensure that the home can meet them the information is not recorded. This was confirmed by a resident who said that they were not asked about their past medical history, likes or dislikes or any specific needs. This means that written information would not be available to staff to refer to potentially putting residents at risk of not being fully met. Two residents who have recently made Miramar their home discussed their move to the home. The manager had visited one on the day before their Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 10 admission to “put her mind at rest” and “ went through everything” with their family. Another resident had been visited by the manager before moving to Miramar and although given information about the home was not given a copy of the homes’ statement of purpose or service user’s guide. They were invited to visit the home which they did “ a couple of times.” Care plans of 4 residents were looked at. Only one included a pre admission assessment, compiled by a health care professional, that identified their care needs in sufficient detail on which a plan of care could be written. There is no information to identify, for example, does the staff rota need to be changed to meet care needs, is specialist equipment required, can specific individual dietary requirements be met, is the proposed room suitable and do staff need training updates in a specific field of expertise? Positive discussion took place with the manager as to the specific information needed and how this would be recorded. An assessment of potential residents’ health and social care needs should be carried out before a person makes a decision about living at the home to ensure that the home is able to meet these assessed needs. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7, 8, 9 & 10. Quality in this outcome is poor. This judgement has been made using available evidence including a visit to the service. Individual care plans have been developed for the majority of residents and most aspects of health; personal and social care needs are identified. Attention is needed to ensure that all residents’ needs are identified. Medication is generally well managed. Improvement is needed to ensure that residents are not put at risk. Residents’ privacy and dignity are generally met and promoted by the staff and management at the home. Improvement is needed in two areas. EVIDENCE: The majority of residents 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. Four care plans were looked at in detail. Reviews of care planned for individual residents had been undertaken 4 monthly, on average, but there was no evidence of residents or their Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 12 representatives being involved in the reviews to either agree with any changes or put forward their own wishes and choices. Most plans set out clear individual goals to help maintain residents’ independence and actions necessary to meet residents’ needs. Associated hazards are assessed and clear action is recorded to reduce any risk. Most of the staff team have worked at the home for many years and therefore know the residents well. However, details relating to the specific needs of an individual resident had not been included in the care plans putting the resident at potential risk. Plans did not include details of residents’ previous interests or activities or a record of those that residents have taken part in whilst living at the home. [refer to standard 12] Residents have access to healthcare services that meet their needs including chiropody, opticians, dentists and district nurses. The majority of residents responding to questionnaires felt that they “always receive the care and support they need”. The manager confirmed that none of the current residents manage their own medication and that no residents had expressed a wish to do this. The homes’ policy on residents looking after their own medicines was discussed. The manager said only staff that have received training administer medication to residents. Details of medication received at the home had not been recorded on the medication administration record. A record of medication that had been hand written did not include details of medication received at the home and had been signed by only one person; a second person should check the accuracy of the recording to ensure that the information is correct. Written instructions for the administration of medication, when an alteration had been made to times or dosages were not always clear. This was discussed with the manager who agreed that to make a new entry rather than change instructions would ensure that residents’ safety would be protected. The storage area for medication that needs to be stored at ambient temperature is in the dining room and has been fitted with a secure lock since a requirement was made at the last inspection. The home does not have a refrigerator exclusively for the storage of medicines requiring cold storage, however, currently no medication needed to be stored in this way. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 13 Open containers of creams/ ointments with no indication of the date of opening/expiry were seen in residents’ rooms. Creams and ointments deteriorate once opened. Current practice puts residents at risk of infection and decreases the effectiveness of the cream. The ordering of residents’ medication is undertaken by staff at the home. Residents’ prescriptions are sent directly from GP surgeries to the dispensing pharmacy and are not checked at the home against the items that were ordered before they are submitted. It is considered essential to have sight of this, as it is the only document signed by the prescriber confirming their instructions. Codes indicating why a medication had not been given had been used on medication administration records. However, the code used for a resident who had “refused” a medication had been recorded as “not indicated”. This was discussed with the manager who agreed that this incorrect information could potentially put the resident at risk. The home does not have a Controlled Drugs Register. No residents at the home are currently prescribed medication, which requires to be recorded in such a Register. However, there was evidence that a medication, which should have been recorded, had been used at the home recently. The manager confirmed that this had been recorded on the MAR chart only. The manager works closely with a local pharmacy and a review of residents’ medication is undertaken 6 monthly. Residents’ privacy and dignity are generally met and promoted by the staff and management at the home. However, there is a risk that confidentiality is not always maintained. The manager discussed a recent incident when residents overheard staff discussing the needs of a resident. The manner in which a resident was being assisted with personal needs during the inspection did not promote their dignity or privacy. A toilet used by residents on the ground floor does not have a lock fitted. Screens provided in a shared room were not adequate to maintain privacy and no screens had been provided in another shared room. This compromises residents’ privacy when personal care is being given or at any other time. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12, 13, 14 & 15. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. Attention is needed in relation to activities and stimulation for residents. Meals are wholesome and nutritious, taking account of the likes and dislikes of individuals. Residents are encouraged to maintain contact with their families or friends as they wish. EVIDENCE: Some residents said they were very happy at the home and that they enjoyed the “music man” who came to the home periodically. Many of the residents said they were happy having music and TV available in the lounge or their bedrooms. Some residents use the local facilities for shopping, church, cafes, pubs and so on. Residents said they enjoyed watching musical videos and carrying out some in-house activities with staff. According to information received before this visit activities provided include visits by music men, singers, watching video, afternoon DVD’s, playing board games, holding “beauty mornings” when hair and nails are attended to and day trips out on a regular basis. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 15 Throughout this visit residents were seen in the lounge and dining room and in their rooms. Some residents moved around the home freely and two went out. The home does not have a programme of activities or entertainment. None of the residents were undertaking any activities, interests or hobbies during this visit. Staff assisted residents with personal care needs and gave out drinks but were not seen to spend time with them either individually or as a group. Televisions were on in the lounge and in some residents’ rooms but not all residents were taking an interest. One residents said, “ don’t go out very much, get bored, would like to go out for a walk, and staff talk in passing”. Staff said that the resident is frequently asked whether they would like to go out but they refuse. There was no record of this in their plan of care. Records of activities undertaken and details of their past interests or hobbies should be included in individual care plans [refer to standard 7] Questionnaires returned by two residents stated there were normally activities for them to take part in and one felt there were never any activities at the home. Some residents said that staff were kind, caring and helpful. Staff were seen to be respectful and patient to residents. The atmosphere at the time of this inspection was warm and homely. All residents spoken to during this visit said that they enjoyed the meals prepared at the home. A menu is displayed in the dining room however a resident said this “was only for show”. Residents are not told what they will be served for lunch but all confirmed that if they were given anything they did not like they would be given an alternative. Questionnaires returned by six residents confirmed that they always enjoy the meals at the home. Visitors are welcome at the home at any time. During this visit several visitors came to the home and were made welcome by the staff and residents. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16 & 18. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. The home has a satisfactory complaints process. Staff have a good knowledge and understanding of the forms of abuse thereby ensuring that residents are protected at the home. EVIDENCE: All but one resident confirmed that they feel comfortable discussing any concerns with staff at the home. One resident said that they wouldn’t feel comfortable complaining because they thought the staff would “tell them off”. Six residents’ questionnaires confirmed that they always know who to speak to if unhappy and know how to make a complaint. There was nothing to suggest that residents are anything other than well cared for at the home. Residents said that staff were very helpful and kind. All staff have undertaken Adult Protection training and were able to discuss different forms of abuse. They all said that they would not hesitate to report any suspicion of poor practice. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19 & 26. Quality in this outcome is poor. This judgement has been made using available evidence including a visit to the service. Residents are satisfied with the surroundings that the home offers. Attention is required to some areas of the home that are not maintained and need attention. Some infection control practices require attention. EVIDENCE: The home provides a lounge and a dining room. Residents’ rooms had been personalised with their own belongings and some small items of furniture. Throughout the home there was evidence of poor maintenance. For example, in one residents’ room a built-in headboard had not been completed, another room had spotlights fitted, however these were loose and not fitted on to the ceiling safely. Other examples include wardrobe doors not being fitted, drawers without handles, and a partition to an ensuite being incomplete. The manager Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 18 said that a resident had recently ripped their clothing because of two screws protruding from a wall. Residents are potentially put at risk because of inadequate routine maintenance. The issues were discussed with the manager and a maintenance person attended to several of the problems immediately. The home is generally clean and residents were satisfied with their surroundings. The lounge and dining rooms are bright and comfortable, and the bedrooms appear homely. Six residents confirmed that the home is always clean and fresh. The current procedure for taking soiled linen to the laundry is through the dining room. The manager agreed to consult with the environmental health authority to ensure that a safe procedure is carried out. Currently, French doors are being fitted in the dining room to enable staff to go to the laundry room without having to take laundry through the kitchen. The owner told the inspector that a ramped area will be provided to enable residents or others with limited mobility entrance to the home. Commodes in two rooms were not clean. The manager described the method used by staff when dealing with commodes, which was not satisfactory. The laundry does not have floor or walls coverings which are easy to clean, and it was not clean at the time of this visit. These concerns were discussed with the manager who agreed that current infection control procedures at the home potentially put residents at risk of cross infection. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27, 28, 29 & 30. Quality in this outcome is poor. This judgement has been made using available evidence including a visit to the service. Current residents’ needs are generally met by a competent staff team. The procedure for staff recruitment does not protect residents and needs to be improved. EVIDENCE: The manager aims to have 2 care staff on duty throughout the day and 1 waking and 1 sleeping at night. Since the last inspection staff numbers have been increased to 3 care staff on duty between 9am-2pm on 4 days a week. It is often necessary for the manager to undertake care duties, which prevents her completing other responsibilities necessary to maintain the standards of the care in the home. The manager confirmed that the current staffing levels are “ adequate unless something untoward happens.” This has been discussed with the provider who has agreed that additional staff can be allocated as necessary to meet residents’ needs. A relative’s response to a questionnaire included “ My opinion is there are insufficient staff on when I visit, usually afternoons, because if someone needs help upstairs that leaves one member of staff downstairs and one in the office. If an emergency arises, what happens then.” When asked if there was anything that staff could suggest to improve the way the care home works one care staff said “to redistribute jobs from night staff, Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 20 such as getting people up, to day staff as it is too much and there is too little time to do it all in”. Staff said that they “get loads of training, anything that’s going”. Some staff files included certificates of training, which they had undertaken. Staff have undertaken manual handling and protection of vulnerable adults training in 2005. Newly employed staff are not given induction training to enable them to be familiar with procedures at the home, the environment or the current residents. The home has a checklist to record what training has been given but two of these records looked at had not been completed. The manager said that new staff are “ shadowed” by experienced staff before they undertake unsupervised care. According to information provided by the home 14 care staff are currently employed at Miramar. Three members of staff hold an NVQ at level 2., two are completing NVQ training and the manager is due to complete NVQ level 4 in care by June 2007. A requirement was made following the last three inspections that the home obtain documentation on all staff to prove their identity. An immediate requirement was also issued relating to recruitment practices at the last inspection. Four staff files were looked at during this visit. There was no documentation at all for one member of staff and a police check had been received for only one recently recruited member of staff. The manager confirmed that no documentation has been obtained for another member of staff and the recruitment procedure has not been followed. This poor procedure for the recruitment of staff puts residents at risk. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Op.31,33 & 38. Quality in this outcome is poor. This judgement has been made using available evidence including a visit to the service. Residents benefit from the continuity and stability of the staff team led by the manager. Not all practices at the home promote and safeguard the health safety and welfare of people using the service. EVIDENCE: Residents’ finances were not looked at during this visit. Information received indicates that money is not held in the home on behalf of residents, it is managed by residents themselves or by relatives. Residents and staff benefit from the experience of the current manager who has worked at Miramar for several years, has been involved in the care of the elderly for 20 years and in a managerial position for the last 6 years. The Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 22 manager is currently undertaking a Registered Manager’s award, which is due to be completed in June 2007. The manager does not have a job description to enable her to know the responsibilities for carrying out her duties. Information received indicates that “key management responsibilities are divided between the proprietor and registered manager.” The manager said there are not always clear lines of accountability within the home. Staff said that they “Get a lot of support from manager” and “If there is ever a problem the manager will sort it out”. The manager has day-to-day contact with all residents and families at the home. An “open door” policy operates where residents, relatives or health care professionals may speak to her about any problems, observations or updates at any time. No quality assurance survey has been undertaken to ensure that all residents are happy at the home. The manager has tried to hold residents meetings but these have not proved to be successful, as the majority of residents have limited verbal communication skills. Since the last inspection the manager has undertaken assessments of risk from potential environmental hazards around the home. The actions to be taken to reduce some assessed risks were not being complied with. For example the office, which contains electrical equipment and files, unless occupied should be kept locked at all times according to the risk assessment; at the time of this visit the door, which is a fire door, was wedged open. To minimize the risk of residents falling from the first floor it has been assessed that windows should be fitted with restrictors to limit their opening. During a tour of the building it was noted that restrictors had not been fitted to two first floor windows and although another window had been fitted with one it had been disconnected allowing the window to open fully. The risk assessment states that all cleaning materials that are assessed as a risk to residents should be kept in a locked cupboard in the washroom; this was not being complied with at the time of this visit. Residents are not protected from the risk of fire at the home. All fire doors were wedged open at the time of this visit despite some of them being fitted with automatic closing devices. A fire exit on the first floor is located in a shower room. The door to this room has been fitted with a bolt on the inside which staff are not able to open from outside the room. This compromises resident’s evacuation from the building in the event of fire. The home’s fire log was looked at. Fire alarms at the home, which should be tested weekly, had not been tested for 6 weeks and emergency lighting, which should be tested monthly, had not been tested since May 2006. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 23 Poor maintenance of fire equipment puts residents at risk. During a tour of the building it was noted that radiators had not been fitted with covers and that two radiators were very hot. No risk assessments had been undertaken to ensure that measures to protect residents from the risk of burns had been undertaken. Electrical equipment, seen in some residents’ rooms, had not been tested to determine whether the equipment is in a satisfactory condition. Also, no assessment of the risk presented by trailing electrical leads in a resident’s bedroom had been undertaken. Health and safety procedures are not being carried out consistently at Miramar potentially putting people, who have chosen to make it their home, at risk. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 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 1 X X X X X X 1 STAFFING Standard No Score 27 3 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X X X X 1 Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14[1][c] [d] Requirement Timescale for action The registered person shall not provide accommodation to a 08/09/06 service user at the care home unless, so far as it shall be practicable to do so, there has been appropriate consultation regarding the assessment with the service user or a representative of the service user and the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 26 2. OP9 13[2] The registered person shall make 08/09/06 arrangements for the recording and safe administration of medicines in the care home. [This refers to ensuring that a record is kept of all medicines received at the home. Controlled drugs not being recorded in Controlled Drug register. Ointments/ creams with no indication of their expiry date. Ointment being used past its date of expiry Codes should be used correctly on medication administration records to ensure an accurate record is kept of medication received by residents.] The registered person shall make 08/09/06 suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users. The registered person shall 08/09/06 consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including activities in relation to recreation, fitness and training. The registered person shall after 08/10/06 consultation with the environmental health authority, make suitable arrangements in maintaining satisfactory standards of hygiene in the care home. [This relates to laundry procedure and effective cleaning of commodes] 3. OP10 12[4][a] 4. OP12 16 [2][n] 5. OP26 16 [2][n] Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 27 6. OP26 23[2][d] 7. OP29 19 8. OP30 18[c][1] 9. OP33 24 [1][a][b] The registered person shall ensure that all parts of the care home are kept clean and reasonably decorated. [This relates specifically to the laundry room] 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 2 members of staff working at the home with no records, 2 with no references and only one with a CRB/POVA] The registered person shall ensure that persons employed at the care home receive training appropriate to the work they are to perform. [This relates to newly employed staff not receiving induction training] The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. 08/11/06 08/09/06 08/10/06 08/11/06 Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 28 10. OP38 13 (4) (a,b,c) The registered person must ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. Unnecessary risks to the health or safety of service users must be identified and so far as possible eliminated. 08/11/06 11. OP38 23[4] (This relates to environmental risk assessments being complied with to minimise any identified hazards with particular attention to window restrictors, guarding radiators, ensuring that electrical equipment is tested to make sure it is safe.) The registered person shall after 08/09/06 consultation with the fire authority make adequate arrangements for containing fires [This relates to fire doors being wedged open. An immediate requirement was made at the time of this visit.] For the evacuation in the event of fire of all persons in the care home [This relates to a fire exit located in a room where the door may be bolted ] For reviewing fire precautions and testing fire equipment at suitable intervals. This relates to fire alarms and emergency lighting not being tested regularly] Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 29 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 Comprehensive information relating to residents’ care needs should be included in care plans. Care plans should be reviewed monthly, with the involvement of the resident or their representative. Two members of staff should sign to confirm hand written information on medication records are correct. The manager/ designated person should see the prescription form before sending it to the pharmacist for dispensing. [See narrative standard 9] It is recommended that when an entry is hand written onto the Medicines Administration Record chart that this is signed and dated by the person making the entry and it is then checked and countersigned by a second person and that all details relating to the medication are recorded. Instructions on medication administration records should be clear. The home should have a Controlled Drugs Register for the safe recording of controlled drugs and such drugs should be stored in a metal cupboard, which complies with the Misuse of Drugs [safe Custody] Regulations 1973. A separate, secure and dedicated refrigerator should be available in the home to be used exclusively for the storage of medicines requiring cold storage. 3. 4. OP10 OP28 Screening should be provided in residents’ rooms to ensure their privacy is not compromised. The home should continue to work towards achieving at least 50 of staff being trained to at least NVQ level 2. 2. OP9 Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 30 4. OP30 The manager should develop individual training and assessments profiles for each member of staff. The manager should ensure that induction training is formalised to the National Training Organisation specifications. The job description of the registered manager should enable them to take responsibility for fulfilling their duties. There should be clear lines of accountability within the home. 5. OP31 6. OP33 The provider should ensure the quality assurance plan describes how the provider and manager will assess the care delivered and include time frames. The home should continue to find methods to seek the views of residents, wherever possible, and of stakeholders in the community, for example GPs, Chiropodists, District Nurses and so on. Testing of electrical equipment should be carried out as a routine to determine whether the equipment is in a satisfactory condition. 7. OP38 Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Miramar DS0000021983.V292092.R01.S.doc Version 5.2 Page 32 - 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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