Inspection on 29/07/08 for Rose Lodge

This inspection was carried out on 29th July 2008.

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

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

Other inspections for this house

Rose Lodge 16/01/10

Rose Lodge 29/07/09

Rose Lodge 07/03/08

Rose Lodge 20/06/07

Rose Lodge 12/07/06

Rose Lodge 09/12/05

Rose Lodge 08/09/05

Rose Lodge 09/06/05

Rose Lodge 31/01/05

Rose Lodge 24/08/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Mulberry Residential Home 2 Isca Road Exmouth Devon EX8 2EZ Lead Inspector Louise Delacroix Unannounced Inspection 29th July 2008 10:25 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 The Mulberry Residential Home DS0000059793.V366245.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. The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Mulberry Residential Home Address 2 Isca Road Exmouth Devon EX8 2EZ 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 227071 themulberry@btconnect.com Eminence Care Ltd Manager post vacant Care Home 25 Category(ies) of Dementia (25), Dementia - over 65 years of age registration, with number (25), Mental disorder, excluding learning of places disability or dementia (25), Mental Disorder, excluding learning disability or dementia - over 65 years of age (25) The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Dementia- Code DE- maximum 25 places Dementia, over 65 years of age- Code DE(E)- maximum 25 places Mental disorder, excluding learning disability or dementia- Code MDmaximum 25 places Mental Disorder, excluding learning disability or dementia - over 65 years of age -Code MD(E)- maximum 25 places The maximum number of service users who can be accommodated is 25. 7th March 2008 2. Date of last inspection Brief Description of the Service: The Mulberry is registered to provide accommodation and personal care for up to 25 older people with a dementia type illness. They may also care for older persons with mental health problems. The property is a large detached and extended house in a secluded residential area of Exmouth. The home is approached by a private driveway, has pleasant secure gardens and parking on site. The accommodation is arranged over the first and ground floors, with a passenger lift to the first floor. The home has 21 rooms for single use, and 1 for double occupancy. The lounge and dining areas are designed in an open plan arrangement and are situated on the ground floor. The current weekly charges range from £380- £480. Items not included in the fee include chiropody, hairdressing and clothing. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk/ CSCI Inspection reports are available on request from the manager. The Mulberry Residential Home DS0000059793.V366245.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 using this service experience adequate quality outcomes. This quality rating reflects some improvements, which have been made since our last key inspection. However, the Registered Provider will be required to provide us with an improvement plan to ensure that improvements are maintained and further progress is made towards good outcomes for people living in the home. The inspection was unannounced and took place over nine hours and twenty minutes. There were eighteen people living at the home. During the inspection we spent time talking to people living, visiting and working at the home. We looked round the home, including the communal areas and individuals’ rooms. We also looked at records relating to people’s physical and mental health, as well as staff training and recruitment files, and maintenance files. Some people have difficulty expressing themselves verbally so we spent time in the communal areas to observe what life is like for people living at the home. Before the inspection we sent out an annual quality assurance assessment (AQAA), which the home completed to tell us how they worked and improvements they plan to make. We also sent out surveys to a range of people, including people living at the home and visiting the home. People living at the home were supported to fill in their surveys by their relatives. We received six surveys from people living at the home, and three from health professionals. We also spoke to a relative on the telephone to gather their views of the service. Their views and comments have been included in the report. Since the last key inspection, there has been a random inspection on 29th May 2008, which we carried out to check on the progress of improvement and to monitor the well-being of the people living there. The home currently has no registered manager but an acting manager has been in post since May 2008. There has been a safeguarding concern at the home relating to one person’s care, and a multi-disciplinary approach has been taken by health and social care professionals to monitor the well-being of people through reviews of people’s care and visits to the home. This safeguarding review has now ended with no further action needed. What the service does well: The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 6 The home ensures that they assess people’s care needs before they move to the home to ensure that it is the right place for them. Care records are up to date and people have access to medical treatment. Medication is generally well managed and staff pay attention to people’s appearance to help maintain their dignity. Relatives feel able to visit when they choose and feel welcomed. Positive changes have been made to the home’s menu and better records are being kept about people’s levels of nutrition. Visitors feel able to make complaints on their relative’s behalf and feel listened to. The home keeps a record of complaints and action taken. Staff have received training in safeguarding vulnerable adults. The laundry is managed well and some staff have training in infection control. There are appropriate levels of staff, who have access to mandatory training, including first aid. Recruitment is robust, which helps keep people at the home safe. Maintenance of equipment is up to date and the home continues to keep us informed of adverse events at the home to help us monitor people’s well-being and helps us ensure that appropriate action is taken i.e. if someone falls. What has improved since the last inspection? What they could do better: Requirements are made with a timescale for the home to make improvements by. During this inspection, we made five requirements about work the home must complete. These are ensuring that care plans are effective tools to help provide good quality care to people, and monitoring staff interactions with people living at the home to ensure they respect people’s dignity. Activities/meaningful occupation must be improved to help promote people’s well-being. Staff must also receive suitable training in caring for people with The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 7 dementia and mental health needs. There is an outstanding requirement relating to care staff induction, which was not looked at on this occasion. We also made recommendations to improve practice i.e. improving risk assessments and developing a homely remedy policy. Ensuring that people have choice when they get up and how they have personal care given. Writing a policy to give guidance about understanding aggression and physical intervention. Work should continue to ensure all areas of the home are odour free. Staff training should be reviewed to ensure it has been given to an appropriate standard. There should be a registered manager working at the home, and quality assurance needs to be improved so that there is better communication about changes. 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. The Mulberry Residential Home DS0000059793.V366245.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 The Mulberry Residential Home DS0000059793.V366245.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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that the home will assess their needs before they move in to ensure the home is suitable. EVIDENCE: Nobody has moved to the home since our last inspection. However, the acting manager has recently been to assess the needs of someone considering moving to the home. We looked at the draft paperwork for this person, which showed that an assessment had been completed. The acting manager told us how they had liaised with the person, their family and with health care professionals. We spoke about ensuring that this good practice is clearly recorded on the paperwork, that social interests are included and that people are encouraged to visit. During our visit a visitor looked round the home on behalf of their relative. The home does not provide intermediate care. The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 10 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): We looked at standards 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further improvement is needed to make care plans effective tools to help ensure people are cared for appropriately. Medication practice is improving and there is regular contact with health professionals. However, people living at the home do not currently have their dignity respected, which has the potential to undermine their well-being. EVIDENCE: All people living at the home have individual plans of care. We looked at plans for four people. Staff have worked hard to improve the plans since the last inspection so that there is clearer guidance about how people’s health needs are met. However, the need for improvement and consistency continues. The acting manager told us that they plan to introduce a new system. We spoke to the staff on duty at the time of this visit who were able to tell us how they care for people in an individual way and could tell us how individuals like to be cared for. Systems in place generally inform staff about people’s The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 11 care needs, although lack of adequate detail in some care plans may prevent truly individualised care for everyone. We observed staff adopting strategies in care plans to manage inappropriate behaviour, and saw from daily notes that identified risks such as pressure area care are being monitored and managed as the care plan highlights. However, some guidance in care plans was not followed, for example one person was served lunch when sitting in an easy chair in the lounge, despite their care plan stating that they should be encouraged to sit at a dining table to socialise with others. In another case, a care plan for a skin condition had been written but the incorrect treatment was being carried out. This included the use of a cream that had not been directed in the care plan. We spoke to staff about this and the outcome was due to a lack of communication and not updating knowledge of the person’s needs. Monthly reviews take place and are generally up to date, and records are kept about people’s fluid and food intake to help monitor people’s health. In one care plan a person had gained weight in line with their nutritional care plan. However, one review was positive about a person’s nutrition when weight charts showed a significant weight loss showing a lack of consistency in reviews. As part of our inspection, we looked at how people’s health care needs are met. Care plans show that people have access to outside professionals such as G.P, community nurses, chiropodist and optician in order to ensure their health care needs are met. Two GPs said that the home always sought advice and acted upon it, although one person felt these were sometimes inappropriate requests for advice and visits. One GP said that individuals’ health care needs are always met by the home and two said this was usually the case. Relatives told us that people living in the home either always or usually received the medical care they need. We heard a staff member discussing medical treatment with a person, which helped reassure them. Risk assessments are in place and generally reflected behaviour or situations that may cause harm to people, for example poor mobility and falls. Moving and handling assessments and plans, nutritional needs skin care and tissue viability and continence assessments are in place and generally provided staff with the instructions needed to deliver care. However, in one care plan, it is identified that a person was at risk of falling out of bed and the care plan details how a chair is to be placed by the bed until bed rails are fitted. However, there is no risk assessment to ensure that the chair did not pose a risk and no assessment to indicate that bed rails were the best outcome. There is documentation that the GP has been involved in assessing the person’s needs. The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 12 We looked at records of medication administration, records of medicines returned when no longer needed and storage of medicines at the home. Administration records were accurate, well documented and up to date. Medicines, including controlled medicines, were well managed and stored safely. Where variable doses of medication are needed, accurate records were available with the actual dose given. The home does not have a homely remedies policy despite this being discussed at the last inspection when it was noted that medication that had not been prescribed was being administered to a person. This was discussed with the manager who told us he was considering only administering prescribed medication. However, this puts those people who are not prescribed pain relievers at risk of being in pain/ discomfort until a GP has been consulted and has prescribed. A GP told us in their survey they had been consulted about a person using ‘over the counter’ medication. As part of the inspection, we looked to see how people’s dignity and privacy is maintained. People’s personal care is well attended to and their clothes are well cared for and discreetly labelled. People were well dressed and groomed, and attention to their personal care was good. Many female residents were wearing make up and jewellery. We heard people being called by their preferred name as recorded in their care plans. The owner has provided instructions to staff to ensure that the language they use is not demeaning e.g. feeders. We heard staff correcting one another and saw how one member discreetly advised another carer about what they needed to do next without using people’s names. We also saw a carer sitting with someone to chat about the flower book they were reading, which was done in a gentle and respectful manner. We spent a considerable amount of time sitting in the lounge leading up to and including lunch. During this time, we also saw that some staff practices do not respect people’s dignity and showed us that some staff interactions with people living at the home indicated a lack of awareness of person-focused care. (See standard 30). For example, some staff spoke to people without encouraging or supporting them to take part in a conversation or replying, some spoke loudly, which caused people to withdraw. Another staff member carried on a conversation with another carer when assisting a person to eat and some care staff ignored one person when they were calling out for help on several occasions. Another example of not maintaining people’s dignity was when, before lunch, a carer put an apron around a person’s neck but did not speak to them. Their lunch was simply put on a table in front of them. The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 13 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): We looked at standards 12,13,14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is little mental or physical stimulation for people living at the home, which has the potential to undermine their well-being. People living at the home benefit from kitchen staff who understand their individual needs but the morning routine of the home may infringe on people’s choice. EVIDENCE: During our observations, two people slept for the majority of the time except for being woken to be assisted to eat lunch. One person had very little interaction with staff. When staff walked by their chair the person looked directly at staff but was ignored. There was little mental i.e. reminiscence activities or physical stimulation i.e. gentle exercise for people living at the home, which we also observed during our last random inspection. This means that few activities take place, although there was a trip to a local hotel, and for some people there is little interaction during daily living tasks i.e. mealtimes or being moved with equipment. (See standard 10). Visitors told us that there were usually or sometimes activities that relatives could take part in. The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 14 In people’s care plans, their social interests and hobbies are recorded i.e. ‘loves animals’, ‘really enjoys musical afternoons and dancing’, and ‘enjoys music’. However, records show intermittent activities and generally do not reflect people’s recorded interests, although one person was given paper and pen to write stories, which was identified in their care plan. Lack of stimulation and interaction may lead to people becoming withdrawn and may cause a loss of identity and well-being. Relatives told us that staff listened to them and one person told us staff kept them up dated and made them welcome when they visited what ever time of the day that they came. Another person said ‘everyone is very kind and helpful’ and another relative said that the home always responds to their phone calls. We saw one relative visiting during the inspector and they told us they were ‘quite pleased’. We looked at how people are offered choice. We saw that the same people are generally got up before the night staff go off duty, and tend to be the people who have more complex moving and handling needs. It was unclear if this was people’s choice or whether this suited the home’s routine. At the time of the inspection two bathrooms were being refitted/ refurbished, leaving only one bathroom which had limited access to a hoist, available to people living at the home. This limits people choice of bathroom and could impact on their dignity. People’s nutrition is now monitored, with improved recording of people’s daily food and fluid intake. We were told during the last random inspection that the home’s menu will be rotated on a four weekly basis and menus show that teatime meals now include hot food, as well as sandwiches. Staff told us that they have been asked to introduce more fresh fruit to the menu by the acting manager, and that this has happened. We saw this from the home’s menus. They said that they listened to feedback from carers regarding people’s response to food, and have responded by adapting recipes. Care plans show likes and likes, and staff could tell us about people’s preferences and specialist diets, and what they had learnt from recent training which was catering for people with diabetes. We were told that one member of the kitchen staff without appropriate food hygiene qualifications is not currently working at the home. We were told this left the kitchen short staffed but staff told us that this post is being advertised. The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 15 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): We looked at standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Visitors feel able to make complaints on their relative’s behalf. However, a lack of guidance in how to manage negative behaviour may put people living and working at the home at risk. EVIDENCE: Relatives told us that they knew how to make a complaint and generally knew who to speak to if they were not happy. One person said ‘I am always able to speak to someone at the Mulberry about any concerns’. They described how their relative is unable to verbally express unhappiness but that staff observed for any changes to their body language. We looked at how the home has responded to complaints, those recorded were ones between staff members and we could see the outcome of the complaints. There has been one complaint from a visiting health professional linked to end of life care, which the owner has responded to. There has been a safeguarding concern at the home relating to one person’s care, and a multi-disciplinary approach has been taken by health and social care professionals to monitor the well-being of people through reviews of people’s care and visits to the home. During this process the owner was open to recommendations and worked with the visiting professionals. This safeguarding review has now been closed with no further action needed. We saw from some staff files that staff have received training in safeguarding and reporting on poor practice. The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 16 From looking at care plans, from observing what happens in the lounge and looking at accident records, we can see that there are regular incidents of negative behaviour towards staff from people living at the home. One care plan advises holding a person’s hands to prevent staff being hit whilst assisting with personal care. These types of incidents also raise issues about how staff are supported through their training to reduce incidents. For example, we saw how one person’s distress and a delay in staff response then impacted on other people who became agitated and angry, which has the potential to result in negative physical behaviour towards each other or towards staff. The Mulberry Residential Home DS0000059793.V366245.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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been some improvement in the cleanliness of the home and the laundry is well managed but there are still areas that require more attention. EVIDENCE: We looked around the building, visiting individual rooms, bathrooms and communal areas. The home was generally clean. Rooms were personalised and looked well cared for, an improvement since the last inspection. We noted three rooms that did not smell fresh. We spoke to the owner about this and were told that there are plans for the carpets to be replaced. We saw one room that had recently been refurbished but still needed a wardrobe. Some improvements have been made in the standard of cleanliness of the kitchen since the last inspection. However, the pantry area continues to need The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 18 improvement. The floor and fridge in this area remain dirty. Work has been undertaken in the kitchen area but two freezers need to be defrosted. The home has a domestic appearance but does not currently have an interior design that promotes people’s independence or help them make sense of their surroundings i.e. landmarks. However, the large lounge does have separated seating areas, which is less intimidating than one large space. We talked to staff about how the laundry was managed and what steps were taken to promote infection control. They were clear about their role and how they managed infection control, particularly around soiled laundry and keeping the laundry area clean. They were positive about the investment in good quality equipment and how quickly repairs were carried out. The Mulberry Residential Home DS0000059793.V366245.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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 27,28 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate staffing levels and a good recruitment process help to keep people living at the home safe. However, staff training needs to be improved to increase the skills of staff to support people living at the home. EVIDENCE: On the day of the inspection, we saw that there were appropriate levels of staffing, and the rota showed us that generally there are six carers in the morning, six in the afternoon and five up until 8pm in the evening. The cook and domestic staff support them. There are two night staff. However, the manager’s hours are not recorded on the rota. The home is currently reliant on agency staff to make up the staff complement. Relatives told us that staff are available when they needed them and can give up to date information. Some staff have worked additional hours to try and provide continuity of care, and have remained at the home throughout a number of changes. The home is still working towards achieving the recommended fifty percent of care staff holding an NVQ 2 in care. Since the last inspection, we were told that one member of staff had been employed. We looked at their recruitment file and saw that two written references, ID and a POVA First/CRB check (police checks to ensure that The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 20 people are suitable to work with vulnerable people) were in place before they started working at the home. We also looked at two employment files that were work in progress and saw that the home has now started to use interview assessment forms, which is good practice. We looked at the staff files for seven people and saw that there was a range of training in medication, moving and handling, first aid and for some people infection control. Some of this training was from an external trainer and others were from training videos with a questionnaire afterwards. Some staff have received basic training in ‘caring for confusion’ through watching a video and some others have attended a four hour course by an external trainer. However, we saw examples that showed us that some staff lack appropriate skills and require further training to improve their practice. (See also standard 10). For example, one carer began to assist one person and when they did not eat, the carer asked another carer assisting a person sitting close by to “swap”. This was done with no explanation to either of the people being assisted. We observed that staff have different skill levels. One carer spoke to a person throughout assisting them, telling them about every day things such as the weather, holidays and the carer’s children. The person being assisted responded to this positively. The carer also told the person what they were eating whereas the other carer did not but asked the person whether they wanted more with each mouthful. We saw two people being taken to their rooms for an afternoon rest, which was confirmed in their care plans. Only one person was told what was happening when being hoisted and how staff were going to move them. (See standard 12). The Mulberry Residential Home DS0000059793.V366245.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. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 31,33,35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home would benefit from a registered manager to help create a stable atmosphere for staff and from better communication about changes to the home. Generally, the home is a safe place to live. EVIDENCE: The home is currently without a registered manager but an acting manager has been in place since May 2008. The home’s AQAA provides basic information. It states that in July 2007 the general feedback from the home’s quality assurance surveys was that the care had improved and the general cleanliness had deteriorated. The home needs to carry out this year’s annual quality assurance. Currently two bathrooms are The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 22 being refurbished. When we asked the owner what bathing arrangements were being carried out, we were told that people were being “ bed bathed”. They confirmed that people had not been consulted before two bathrooms became unavailable and that one bathroom should have been completed at a time. The owner told us that the home is not involved in people’s personal allowances. We looked to see whether the home is a safe place to live. We saw from staff files that a number of staff members have received first aid training, including two members of the night staff, and the home’s AQAA states that six staff have received infection control training, however this is only a third of the staff team (See standard 30). The home’s AQAA also records that equipment has been maintained and serviced. We noted that a previously unrestricted first floor window has been fitted with a restrictor since the last inspection. The home has improved in the way that it reports adverse events in the home to CSCI. This helps us monitor the well-being of people living at the home. The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 23 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 2 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x N/A x x 3 The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15(2)(b) Requirement Care plans must be reviewed with staff to ensure that they are clear about the recorded goals and to ensure that monthly reviews contain accurate information. Staff interaction with people living at the home must be monitored, and the home must be able to evidence how people’s dignity is respected. There must be a range of activities/ gentle exercise/meaningful occupation to suit the individual needs of people and promote their wellbeing. You must ensure all staff receive a structured induction to skills for Care standards. (This could not be inspected as no new care staff have been recruited). Staff must receive suitable training in dementia awareness/mental health needs and communicating with people with dementia. Timescale for action 01/10/08 2. OP10 12 (4) (a) 01/09/08 3. OP12 16 (2) (n) 01/12/08 4. OP30 18 1(c)(i) 01/12/08 5. OP30 18 (1) (a) 01/12/08 The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 25 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. 3. 4. Refer to Standard OP8 OP9 OP14 OP18 Good Practice Recommendations When risks are identified, assessments should show how decisions have been made regarding approach and action. The manager should develop a policy about non-prescribed medicines. The manager should ensure that people are given choice as to when they are got up or how personal care is given and ensure that the home’s routine supports choice. The home should have a policy, which is read by all staff, that ensures that physical and/or verbal aggression by people living at the home is understood, and where physical intervention is used as only as a last resort and in accordance with current guidance. Work should continue to ensure all areas of the home are clean and odour free. A minimum of 50 of the care staff should be qualified in NVQ 2 in care. Staff training should be reviewed to ensure that it has been provided at an appropriate standard. The home should have a manager registered with CSCI to help ensure they are competent for this role. People living at the home and their representatives should be informed when major work is undertaken to the home, and given information about how this will be managed. 5. 6. 7. 8. 9. OP19 OP28 OP30 OP31 OP33 The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Mulberry Residential Home DS0000059793.V366245.R01.S.doc Version 5.2 Page 27 - 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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