Inspection on 25/04/06 for Miramar Nursing Home

This inspection was carried out on 25th April 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Miramar Nursing Home 26/04/07

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Miramar Nursing Home Miramar Nursing Home 20 Trusthorpe Road Sutton On Sea Lincs LN12 2LX Lead Inspector Jean Cope Unannounced Inspection 25th April 2006 09:00 Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 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 Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 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 Adults 18-65. 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 Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Miramar Nursing Home Address Miramar Nursing Home 20 Trusthorpe Road Sutton On Sea Lincs LN12 2LX 01507 442484 01507 443313 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) Super Care Limited Care Home 28 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (28) of places Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories:Mental Disorder requiring Nursing Care, not falling within any other category (MD) 24. Mental Disorder requiring Personal Care, not falling within any other category (MD) 4. The maximum number of service users to be accommodated is 28. Date of last inspection This is the first inspection under this provider. Brief Description of the Service: Miramar is a detached property located near to the sea front and the town centre of Sutton on Sea, which has a range of local shops and facilities. Accommodation is provided on 2 floors, communal areas being situated on the ground floor. A car park is available at the front of the building. The home is able to accommodate 24 people in 10 single and 9 double rooms and is registered to provide nursing and residential care to people with mental health needs. There is a purpose-built day centre next to the home but this is currently not in use by service users, though it is used occasionally for accommodation for staff in flats on the second floor. The fees in the home range from £380 to £513 Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was undertaken using a review of all the information available to the inspector regarding the service history of Miramar and through undertaking a visit to the home. The fieldwork visit took place over a six hour period. The main method of inspection used was called ‘case tracking’ which involved selecting three residents and tracking the care they receive through the checking of their records, discussion with them, the care staff and observation of care practices. A tour of the premises was conducted and other documents connected with the running of the care home were also inspected. What the service does well: What has improved since the last inspection? What they could do better: Some of the outstanding requirements have not been met and have been given new timescales. An immediate notice requirement was left requiring that the fire bells are tested on a regular basis to ensure they are working. The home’s fire risk assessment needs to be reviewed and updated. Some of the call bells in the home were not working and the recommendations made following servicing of the lift remain outstanding. Staff need to be trained on how to safeguard adults living in the home. Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 6 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 Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service The acting manager will not admit new residents unless she is sure that the home can meet their needs. EVIDENCE: The home has just been taken over by a new provider in the last month who is preparing a new statement of purpose and service user guide. The acting manager has not had any new referrals since the last inspection, but stated that a senior member of staff would always visit the new resident to ensure that the home is able to meet their needs. The last two residents moved into the home for a trial period to ensure that they would be happy in the home and were assessed by staff during this period. Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from having a plan of care which is regularly reviewed and updated to reflect their changing needs. EVIDENCE: All service users have a comprehensive plan of care which is kept updated and is regularly reviewed. Risk assessments are undertaken when necessary and could be seen in the care plans sampled. Some residents have their own keys, therefore a risk assessment must be undertaken which states if there are risks and how the risks can be reduced. Staff were also able to give a good account of the needs of individual service users. Service users are supported to have independent lifestyles wherever possible. Individual service users were returning from an unescorted shopping trip, others were leaving the building to go shopping. Some restrictions have been placed on one service user but these have been recorded and the reasons discussed with the service user. Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 10 Service users must have the opportunity to participate and offer their views regarding the running of the care home. Previously, the management team had organised residents’ meetings but it has become apparent that service users are not expressing their views in this setting. The acting manager is looking at developing a different system to ensure that they feel able to express their views. Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported to follow their chosen lifestyle and any restrictions placed on them are recorded and explained to them. EVIDENCE: Some service users have chosen not to take part or join in community activities, whereas others have. One service user said that they went to the local social club which they enjoyed, others visit the library and village hall when special events are taking place. Other service user uses their bus pass to visit friends and relatives in Lincoln and Mablethorpe. Two service users have planned to take holidays with their families in forthcoming weeks. A service user said that he always managed to get to the Air Show at RAF Waddington each with the support of staff. One service user also attends the local church. Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 12 Most meals are taken in the dining room. Breakfast consists of a choice of cereals, porridge, toast and preserves. A hot dish such as scrambled or poached egg is also available. Since the last inspection the acting manager has placed a board in the dining room informing service users of the menu for the midday meal. A choice is available if a service user doesn’t like what is on offer. Fruit and yoghurt is also always available. The kitchen staff have a list of the dietary likes and dislikes of service users and one staff member had a good awareness of the needs of an appropriate diet for service users who need a diabetic diet. It was recommended that the menu be reviewed with service users with a view to developing a more varied diet. Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ physical and emotional needs are taken seriously by the staff team. EVIDENCE: There was evidence that service users had attended hospital appointments and had received GP consultations. One service user is having their blood pressure monitored by the nursing staff in the home to assist their GP to gather further information. Service users and staff receive the support from the local mental health team when required. Visits to the optician and the dentist have also been arranged. Systems are in place for the recording and disposal of medications. The administrator has purchased a new British National Formulary which lists medications, their usage and side effects. The acting manager described the process of administrating medication which was appropriate. Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all staff are trained in how to safeguard service users from being abused which could put services at risk. EVIDENCE: The acting manager said that there had been no complaints since the last inspection and none were received on the day of the visit. One service user said they would have no difficulty in telling the administrator if they had a complaint to make. Service users do not know how to make a formal complaint. Some staff have received training on how to safeguard vulnerable adults from abuse, but further training is planned. Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a clean home and can make their rooms more homely by bringing in their own possessions. EVIDENCE: Since the last inspection, new seating has been provided in the games room. Service users are able to personalise their own rooms if they wish. Some attention must be given on how to make the home more comfortable and homely and less institutionalised. The home was clean and tidy and odour free throughout. The staff toilet must be supplied with paper towels to reduce the risk of cross infection. A catheter bag stand was seen in one room which was rusty and could not be adequately cleaned and needed to be replaced. Staff use soluble disposable bags for soiled linen. Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are looked after by kindly staff who are respectful to them. EVIDENCE: The home has a largely stable staff group. There is always a qualified nurse on duty who is assisted by three care assistants during the day time, and during the night there is one qualified nurse on duty assisted by two care assistants. The acting manager allocates work daily to staff on the shift so they are clear about their roles and responsibilities. Staff were observed to be speaking with residents in a patient, kindly and supportive way. One service user said that the staff were kind. Some staff have received training in moving and handling fire training and how to safeguard adults from abuse, but the administrator said that some courses are now needing to be repeated. A training plan will be developed. The new proprietors are currently advertising for registered mental nurses. Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users and staff have been put at risk by the lack of action in relation to health and safety issues which have not been attended to. EVIDENCE: The acting manager has handover sessions with all the staff so that they are made aware of any changes in residents’ needs when they start their duties. The home is managed by an acting manager and the new proprietors are pursuing all avenues to recruit a manager with a mental health nursing background. There is a full time administrator in post who takes responsibility for the administrative record keeping, booking training and bringing in contractors to service and complete any repairs necessary in the home. Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 18 The administrator also takes responsibility to assist service users with their financial affairs. Staff received fire training in February this year. Examination of the fire records showed that fire bells had not been tested on regular basis. An immediate requirement notice was left, requiring these to be tested on a weekly basis. The lift contractors had serviced the lift, but the recommendations had not been dealt with. Service users said that some of the call bells were not work. There were no data sheets in the home for the hazardous chemicals advising staff what action they need to take if there was a spillage or accident. The home’s fire risk assessment needs to be reviewed and kept udated. Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 1 x Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5 (2) Requirement All service users including potential service users are to be given an up to date copy of the service users’ guide. A new statement of purpose should be developed and made available in the home. The registered person must ensure that service users know how to make a formal complaint. Staff must receive formal training in the protection of vulnerable adults and in the interim period the manager must ensure that staff awareness is addressed in this subject. Some staff have received training but there are still staff who have not received training. Fire alarms must be checked and recorded on a weekly basis. An immediate requirement notice was left. Fire alarms must be checked and recorded on a weekly basis. An immediate requirement notice was left. Timescale for action 30/07/06 2 3 YA1 YA22 4 22 30/07/06 30/07/06 4 YA23 13 (6) 30/08/06 5 YA42 23 (2)(c) 25/04/06 Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 21 6 YA42 23(4)(c) 7 YA42 13(4)(a) 8 YA42 13(4)(c) The fire risk assessment needs to be reviewed as the responsible individual sometimes occupies the flat attached to the office. The lift has been service and requires further attention. The work defined in the report must be complied with. Some call bells are not working. The registered person must ensure that the systems allows all residents to call for staff in an emergency situation. 30/06/06 30/07/06 30/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA39 Good Practice Recommendations All service users including potential service users are to be given an up to date copy of the service users’ guide. It is recommended that systems must be put in place to offer service users the opportunity to participate and offer their views regarding the running of the home. It is recommended that service users be offered opportunities to maintain or gain independent living skills and these opportunities recorded in their care plans. It is recommended that the acting manager and staff consult with service users about their choice of foods and varying the menu. It is recommended that paper towels be provided in the staff toilet and equipment used in the home which cannot be properly cleaned and poses a risk of cross infection be removed. 3 4 5 YA11 YA17 YA30 Miramar Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Nursing Home DS0000066650.V290881.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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