Inspection on 07/03/08 for Rose Lodge

This inspection was carried out on 7th March 2008.

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

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

Rose Lodge 16/01/10

Rose Lodge 29/07/09

Rose Lodge 29/07/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Mulberry Residential Home 2 Isca Road Exmouth Devon EX8 2EZ Lead Inspector Sue Dewis Unannounced Inspection 7th March 2008 09:35 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.V360555.R02.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.V360555.R02.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 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.V360555.R02.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. 31st August 2007 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 persons 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.V360555.R02.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 0 star. This means the people who use this service experience poor quality outcomes. This unannounced visit was made by two inspectors over 9 hours, one day at the beginning of March 2008. Written information provided by the owner and manager for the last key inspection (20 June 07) was also used for this inspection. This confirmed the dates of maintenance of equipment and what policies and procedures were in place. Information from this document was used to write this report. During the inspection 3 people were case tracked. This involves looking at peoples’ individual plans of care, and where possible speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. Most people living at the home have limited verbal communication skills, and as we are not skilled in their other methods of communication it was difficult for us to have any meaningful communication with them. However, the interaction between the people living at the home and those who care for them was closely observed. We spoke with 4 staff and the owner of the home. A full tour of the older part of the building was made and a sample of records was looked at, including medications, care plans, the fire log book and staff files Since the last key inspection the home has also had several random inspections in response to two separate sets of concerns being raised. The first set of concerns related to the experience of an agency worker who was sent to the home for the first time. Among their concerns were that they were not asked for proof of identity or given a handover when they first arrived at the home. They were also concerned about unexplained bruises on one person living at the home, about how medication was administered and the inappropriate restraint of another person living at the home. A Random Inspection visit was made with police and social services workers to investigate these concerns. Several requirements were made as a result. Another Random Inspection visit took place several weeks later to check on the progress made towards meeting the requirements made. It was found that in response to the requirements made by the Commission almost all of the areas of concern had been addressed by the provider. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 6 Further concerns were raised following the death of an individual after they had been admitted to hospital from the home. Some of the concerns related to the temperature within the home and the general care given to the individual prior to their admission to hospital. A total of three visits were made, as part of one overall Random Inspection, to look at the concerns that had been raised. Copies of Random Inspection Reports on these Random Unannounced inspection visits are available on request from the Commission and contain details of the concerns raised, the investigations and the outcomes. What the service does well: The home was generally warm, clean and nicely decorated and furnished, with a relaxed and unhurried atmosphere. People living at the home looked well cared for. Age appropriate activities are provided on a regular basis. The person most recently admitted had had a detailed pre-admission assessment completed and there are good admission procedures in place. Everyone living at the home has a care plan that is accessible to care staff are understood by care staff. The care plans contain some good directions to staff and are regularly reviewed. The daily notes contain good information and show involvement with health care professionals. The privacy and dignity of individuals was seen to be respected. One person’s relative that we spoke with told us they were happy with the care the home gives. People are provided with a well balanced diet that takes into account their likes and dislikes as well as any special dietary requirements. There is a formal complaints procedure and complaints are dealt with in an appropriate way with investigations and outcomes being recorded. Staff are generally aware of their duty to report bad practice which helps safeguard people from the risk of abuse. Staff are generally well trained and staffing levels are good so that people are able to receive the care they need. All radiators are covered to minimise the risk of burning from the hot surfaces and windows above ground floor level are restricted to minimise the risk of people falling from them. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Some information in care plans needs updating. For example, information relating to how diabetes is managed should have been removed when it was found the person was not diabetic. Care plans did not show where goals that had been identified had been met. All recordings relating to an individual should be kept confidential and should not be accessible to others who may wish to see their own information. There is inconsistent monitoring of people’s nutritional needs other than when they have been diagnosed as diabetic. For example not everyone, and not the most recently admitted have had a nutritional needs assessment completed. This means that people may be at risk of not receiving the diet they need. More information is needed on the social and activity preferences of people living at the home as well as their individual means of communication. This is so that people can receive care that is individual and tailored to them. The monitoring and storage of some medications is poor, for example there are no records of creams having been applied or inhalers having been used. His puts people at risk of not receiving medications that have been prescribed for them. There was little explanation of when medication that had been prescribed to be given ‘as required’ was to be administered. This means that The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 8 people who are unable to ask for painkillers may be at risk of not receiving them. A copy of the most recent Quality Assurance report must be sent to the Commission and the procedures for the testing of fire safety equipment need to be improved. Several untoward incidents have occurred at the home and have not been reported to the Commission or to the Devon Adult Safeguarding Team, and not all staff are aware of their duty to report poor practice. Confirmation of satisfactory Criminal Records Bureau (CRB) checks had not been received for all staff. This means that people living at the home may be at risk of abuse. 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.V360555.R02.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission procedure ensures that there is a proper assessment prior to people moving into the home, and that they can be assured that their care needs can be met. EVIDENCE: We looked at the file for a person who had recently moved into the home. The file contained comprehensive information about their health, welfare and social care needs. Information had been gathered from the person’s family, doctor and other health care professionals. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 11 There is a system in place that allows the progress of individuals to be monitored from the pre-admission stage and right throughout their stay at the home. This system consists of a series of forms that are completed and show a ‘score’ for the person. These forms can be completed at regular intervals so that any changes to the person’s needs can be identified and arrangements made for a change in their care plan. The home does not provide intermediate care. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are detailed, but do not always provide staff with clear information that would enable staff to meet people’s health and social care needs, and although the management of medication has improved, there is still the potential for people to be at risk of not receiving their prescribed medication. EVIDENCE: All people living at the home have an individual plan of care. We looked at the care plans for four people, including one person who had recently moved in to the home. Care plans have improved since the last inspection and those looked at contained information about peoples’ basic care needs, and directions to staff on how these needs should be met. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 13 There were no risk assessments for tissue viability or nutrition for the person most recently admitted to the home, although there was a plan for “settling in” The daily reports written by staff did not include how the goals identified in care plans had been met. For example it was recorded that a person needed to wear “ hip safes” to prevent injury if they fell, but there was no mention of whether in fact staff made sure that the hip safes were always worn. Another example is that a care plan detailed how to prevent skin soreness by applying cream, but there was no mention in the daily report as to whether this was being done. However, it was later noted in the daily report that this person had developed soreness and that cream was to be used. There were no details in their care plan as to how this was to be monitored or how the person’s changing needs would be met. Staff had written in another daily report that a person was “pale and vomiting a lot” and thought the person had suffered a small stroke, as “ this is what happens” when the person had a stroke in the past. However, there was no care plan informing staff of a past history of strokes or of what to do if the person suffered another stroke. One care plan described how to care for a person’s diabetes. The care plan had been reviewed on 28/02/08 as “ no change”. However, it was later discovered that this person does not have diabetes yet the care plan had still been reviewed showing no change. Staff said that they are now able refer to care plans more often as they are now stored in a place more accessible to them. One staff also told us that the owner was always telling them to read the care plans and to get to know about any changes in individuals. We also saw some good observations recorded by staff. A carer had noted that a person had been prescribed antibiotics by a dentist, following emergency dental treatment. The carer was aware that this person was already prescribed antibiotics by their doctor and so phoned the doctor to confirm how medication should be given. The doctor told the carer to give only those prescribed by the dentist. This is an example of how the health and welfare of people living at the home is protected. We spoke with a visiting District Nurse who felt that the home ‘had really picked up’, they said that although there had been issues in the past the owner had addressed these. They were really pleased with the fact a ‘DN box’ was provided in each room, where notes and dressing for each individual can be kept. However, they felt concern that often nutritional information was missing or not taken into account for some individuals. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 14 Recordings were generally non-judgemental and showed that people are thought of as individuals. Senior staff now have a booklet in which they write information on each person in order to handover anything still to be done from their shift. Personal information is kept on each person in these notes. This contravenes the Data Protection Act, as it means that a person wishing to see notes made about them would have access to person information about other people. Information about visits from chiropodists, district nurses, doctors and dentists had been recorded in individual care plans, showing clear evidence This means that people are supported to maintain access to specialist medical services. All people we saw during this visit looked well cared for. They were all wearing their own clothes, which were clean and well ironed. However, we did see two people whose nails were dirty and needed cleaning. We saw that people who were assessed as being at risk of developing pressure sores had been given specialist mattresses to sleep on and pressure relieving cushions when sitting in the lounge. Since we discussed ‘Person Centred Care’ with the provider at the last inspection, a new system of working with people has been introduced at the home. Rather than staff being allocated a list of tasks to complete during their shift, they are allocated a small group of people and are responsible for all aspects of their care throughout the shift. This means that people receive care in a more focused and person centred way from one or two staff who can ensure that the individuals needs are met. There is now some detail of how staff should communicate with individuals for example ‘deaf – speak clearly’. However, there is no record of the person’s individual methods of communication, which means that one staff member may understand what someone is trying to communicate while another may not. It is particularly important with people who have a dementia type illness that individual methods of communication are recorded as they may not be able to communicate verbally. The storage of medication has improved since the last inspection. A record is now kept of medications no longer being used before being sent back to the pharmacist to be destroyed. We noted that a cream was being stored in a cupboard at room temperature when it was indicated it should be stored in a refrigerator and this was pointed out to the owner. We looked at the medication administration record [MAR] sheets for all people living at the home. We saw that some medicines for 6 people had not been given as prescribed and no codes to describe the reason why they were not given/taken were used. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 15 There were no recordings on the MAR sheets to indicate why prescribed eye drops, inhalers and creams had not been given/taken by one person. Another person was not given prescribed antibiotics until 2 days after they were received at the home. The owner told us that there was some confusion as to where they were stored. This puts people at risk of not having medication administered safely, as prescribed, and could lead to a further deterioration of their condition. Some medication that is prescribed as an emergency, such as antibiotics, had been hand written on to the MAR. The entries had not been signed by two members of staff, which is recommended good practice. The MAR sheets showed that several people had been prescribed creams and ointments, but there is no record kept of the application of creams. This means that people are at risk of not receiving their prescribed treatment. We discussed this with the owner who said he didn’t want all staff to have access to the medication charts. We suggested that records be kept in the person’s room as this is where most creams would be applied. We were told that a signature on a sheet was no guarantee that the cream had been applied, and he also felt that staff would not bother to complete them. We saw several containers of creams in people’s rooms with no indication of either when they had been opened or when they expired. This puts people at risk of having creams applied that are past their expiry date and therefore ineffective. We saw that some medications have been prescribed to be given ‘when required’. However, there is no information indicating the reason the medication would be given. For example, we saw an entry for one person that stated the medication should be given when required “for self harming”. The MAR sheet or care plans did not include information that might help staff recognise the need for the medication to be given, or actions to take to help manage the situation. We were concerned to see a notice in the kitchen about “missing medication”, as the Commission had not been notified of this. There was no evidence that any action had been taken by the provider other than to put up the notice asking staff if they knew what had happened to the missing medication. However, the provider has since informed us that “two sleeping tablets were unaccounted for” and that an investigation was undertaken at the time this was noted. All bedroom doors have locks fitted to them. The doors lock when they are closed from the outside and need a coin to gain access, but the person inside The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 16 can still open them easily to get out. Screening is provided in the shared rooms at the home, protecting peoples’ privacy. All of the people seen during this visit were treated with respect by the staff and their right to privacy was upheld. Personal care was offered in a discrete manner. Staff told us how they respect peoples’ privacy when helping them with personal care, assisting them to bath or dress or assisting them with personal needs when in the lounge or dining room. We saw staff speaking to people in a kindly, friendly way. However, staff referred to people who need two carers to assist them with bathing, going to bed or getting up as “the doubles”. This puts people at risk of being depersonalised and loss of their identity. This was discussed with the owner who said that they had fallen into using this terminology, as it was a convenient term that used less words and could be understood by everyone, but he agreed that this was unacceptable. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: During the visit there was a relaxed, unhurried atmosphere throughout the home. Most people were sat asleep in the lounge during the morning of the visit, but there was much more activity during the afternoon. We were told that daily routines, including getting up and going to bed and mealtimes, were flexible and we saw several people coming down to breakfast throughout the morning. However, we also saw a notice on the back of a person’s door instructing staff to “ Assist to wash immediately on getting up, wake if not already up”. This puts people at risk of not being able to make choices about how they live their lives at the home. This was discussed with The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 18 the owner who said the notices were not in use and he thought they had all been removed. He said the notice would be removed straightaway. Peoples’ interests and preferences, in relation to social activities, had not been consistently recorded in their care plans, which means that staff did not have information with which to engage people in conversation or activities relevant to their likes and dislikes. A member of staff has recently been recruited to arrange and undertake activities at the home. We were told that recently two people had visited a local hotel for coffee. This member of staff was keen to involve other staff and to ensure staff engagement with individuals was not limited to activity sessions provided. They said that since the home had changed they way they work (see previous section) they were encouraging staff to spend more social time with the people they were caring for on their shift. During this visit we saw several people taking part in an Easter Bonnet making session. People were relaxed and happy to be taking part. There was much laughter and people were seen wearing their hats throughout the rest of the visit. Staff were seen spending time chatting with people sat in the lounge who were not taking part in the bonnet making. We spoke to a carer about what activities a person who is blind takes part in and were told they like to stay in their room and listen to the radio. We spoke with one representative whose relative had been at the home for sometime and who they visited several times each week. They told us that continued to be satisfied with the way the home cared for their relative. Menus that were seen in the kitchen showed that people were offered a variety of food that was balanced and nutritious. Preferences of people were listed as well as anything they may be allergic to and if they needed a sugar free diet. All food was stored in an appropriate way, for example covered or in the fridge, to minimise the risk to people’s health. Lunch was relaxed and unhurried and people were given help to eat when needed. One member of staff told us that she had noticed people tended to eat better when sat at the dining tables, and therefore they always encouraged to move to the tables rather that sit in the easy chairs with a small table in front of them. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a clear and simple complaints procedure that ensures complaints are responded to promptly with satisfactory outcomes. However, the owner does not appear to fully understand the adult protection procedures, which potentially places people at risk EVIDENCE: There is a formal complaints procedure for the home that is displayed in the hallway. A file is maintained that records any complaints that have been made, how the home has dealt with the complaint and what the outcomes were. People living at the home who were spoken to during this visit were unable to tell us whether they knew about the home’s complaint procedure or whether they would feel comfortable making a complaint. Staff told us that they felt sure they would be able to recognise if someone was not happy about something, and would take steps to rectify the matter. All staff have received training in safeguarding people and were able to discuss different forms of abuse. All but one member of staff said that they would not The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 20 hesitate to report any suspicion of poor practice. One said that there is always a senior or a manger on duty and it was their job to deal with this. A number of concerns have been raised with the Commission since the last Key Inspection Visit. These have included the lack of handovers for agency staff, apparently unexplained bruising to an individual and needs of people living at the home not being met. The issues raised during this investigation have been dealt with by the home. There is currently an investigation taking place into the death of someone living at the home who had been admitted to hospital with hypothermia. It was concerning that we were told on arrival at the home that an individual had been found with unexplained bruises and that when staff had been questioned about this, they had left the home. The owner was asked if he had reported this to either the Commission or the Safeguarding Adults team and they said they had not thought it necessary. We said they should contact the Safeguarding Adults Team as soon as possible. (The owner was contacted on Wednesday 12 March 2008 to ask if they had reported the incident. We were told that as Social Services staff and the police had known about this when they visited the home on 11 March 2008, he did not feel it necessary to make a full report to the Safeguarding Adults Team.) In light of previous investigations, as well as the above incident, it was concerning to see a notice in the kitchen referring to bruising to an individual and missing medication (dated 12 February 2008). Neither the Commission nor the Safeguarding Adults Team had been notified of either of these matters. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home generally provides a comfortable and safe environment for those living in, working at and visiting the home. EVIDENCE: We looked around the building as part of this inspection and most of the bedrooms in the older part of the home were looked at. The home was warm and generally clean and fresh, it is pleasantly furnished and decorated in a homely manner. However one room did not smell fresh, and in three other rooms the beds had dirty duvet covers on them. One had The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 22 ripped and dirty pillowcases, three beds were poorly made with rucked, soiled sheets, vents of an air purifier were blocked with dust, a carpet was badly stained and a special mattress on one bed was dirty. Several rooms had commodes in them, one of which was dirty. Black mould was seen growing on two window frames. However, the bedrooms were very individual and reflected the personality of the people living there. There were many photographs and ornaments around the rooms. Several rooms had been fitted with vanity units that provided extra storage facilities. There is one room that is outside of the main home, just off the entrance area. This room is not being used at present as concerns had been raised about access to the main part of the house. The owner told us that they had received funding from Devon County Council in order to refurbish all three bathrooms and provide a automated hi-lo bath, a Parker sit bath and a shower room. They also said that they had ordered a new dishwasher with a 3-minute cycle to improve the kitchen facilities. During this inspection a maintenance person was working at the home, fitting hand-washing facilities in all rooms, and this was completed during the day. This is part of the home’s action to improve infection control practices at the home. All bedrooms, bathrooms and toilets now also have disposable gloves and aprons in them, so that staff have easy access to the items and do not go from room to room wearing the same gloves and aprons. Staff told us that they were very pleased with these improvements. However, we observed a member of staff (not wearing an apron, and only one glove) carrying an uncovered, full commode from a bedroom through the hallway to a bathroom. The home employs a laundry person at the home. The laundry was generally clean and organised at the time of this inspection, although a lot of dust had accumulated behind the equipment and this is a possible fire risk. The laundry person told us how staff deal with laundry, including soiled laundry, at the home, which prevents cross infection. We saw peoples’ clothes that had been laundered being ironed and hung, waiting for staff to take it to individual rooms. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are good, which ensures that people’s health and social care needs are being met. However, the procedures for the recruitment of staff are not robust and therefore do not always ensure protection for people. EVIDENCE: Staffing levels have improved at the home since the last inspection. On duty during the morning of this visit were 5 carers, a cook, a kitchen assistant, a laundry person, a cleaner, a maintenance person and the owner as senior carer. At 2pm this changed to 3 carers and an activities organiser on duty. Staff said that the improvement in staffing levels meant that they could spend more time with people and did not have to rush to get things done. One staff member was eager to tell us about how they were going to ensure that having a bath was a more pleasurable for people. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 24 Kitchen assistants have been employed so that care staff no longer have to go into the kitchen. This has improved infection control procedures and enables staff to spend more time with individuals. Two staff were observed transferring a person from an easy chair to a wheelchair using a mobile hoist. They were careful to ensure the person was comfortable as well as safe and used good moving and handling techniques. Staff were aware of the needs of the people they were caring for and were keen to provide a good service. One member of staff had returned to work at the home after a number of years and said that there had been many improvements. We looked at the recruitment files for 3 members of staff employed since the last inspection. Only one of them fully met the standard required. Two people had only one reference on file, there was no evidence of a police check being undertaken for one person and two people had started working at the home before the result of a POVA (Protection Of Vulnerable Adults) check had been received. This puts people who live at the home at risk of being cared for by staff who are unsuitable for work with vulnerable adults. Staff were happy with the training provided at the home. Recent training includes moving and handling, fire training, infection control and training on understanding dementia. One carer told us they had learned that people with dementia “ are the same as us and need what we need”. The owner told us that he had decided to initially provide training to staff on the new way of working, on a day to day basis in a practical way. Staff have received good training in infection control procedures. The owner told us that he had initially observed the way that staff were working, gave them feedback, looked at ways of improving the procedures and then observed staff again to ensure they were following the new methods. Several members of staff are undertaking NVQ (National Vocational Qualification) training. We looked at the induction training given to new staff to help them understand the philosophy of the home and how to work safely. We were told that this training follows the Skills for Care model, which provides a good grounding for new staff. One staff member had recently completed induction training but her training file could not be found to verify all the necessary subjects were covered. We were shown an induction programme dated 1995, which had not been reviewed. Staff that were spoken with were unsure of the content of induction training. In view of the fact that six new staff are due to start working at the home very shortly, attention should be given to ensuring they receive a structured and relevant induction. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 25 The owner said that in order to monitor the training that staff received, they had produced a ‘training matrix’. A copy of this was not available during the inspection, but the owner agreed to send a copy to the Commission. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35,37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home lacks robust management systems to check the quality of the services and facilities provided, resulting in practices that do not always promote and safeguard the health, safety and welfare of people who live and work in the home. However, there have been improvements since the last inspection. EVIDENCE: The home does not currently have a registered manager. The provider has taken over this role with the support of the staff and is now living at the home. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 27 We were told that they had placed an advert for a new manager in a Nursing magazine and wanted to recruit as soon as possible. There is a Quality Assurance system at the home, and questionnaires are sent out to people living at the home, their representatives, staff and health and social care professionals each year. The owner told us that a report has been produced that shows how any issues highlighted will be managed and has supplied the Commission with a copy of this report. We saw a number of staff questionnaires that had been completed at the end of 2007. There were very mixed responses on the forms, with some staff being very unhappy. The owner said that the forms had given him the impetus to begin to change things. The home does not manage any money for anyone living at the home. Accounts for any money spent on behalf of individuals, such as hairdressing and chiropody are sent to each month to the individual or their financial representative. Although record keeping has generally improved since the last visit, with peoples’ individual files being more accessible to staff and stored securely, a book that included details about people living at the home and staff had been left on a table in the dining room where it could be easily read. The home has developed a “to do” file to ensure that staff are aware of tasks, such as appointments that people may have, medications that needs to be ordered or care that needs to be carried out. However, this contravenes the Data Protection Act in so far as no-one can access their own information without seeing information on other people. Several serious incidents have occurred at the home, including missing medication and unexplained bruising to individuals that have not been reported by the owner to the Commission or to the Safeguarding Adults team. Recruitment procedures need to improve to ensure the suitability of staff working at the home. We looked at the home’s fire logbook to check that equipment was being tested as recommended for safety. We found that fire alarms and fire extinguishers are not being checked weekly as recommended in the guidance of Devon and Somerset Fire Service. The owner was unaware of this guidance, even though it is in the front of the Fire Log Book. Records show that staff have received training in the prevention of fire every 6 months as recommended, with the most recent training session being held in March 2008, but not all staff attended. All radiators are covered in the home except one, which is permanently turned off, this ensures that people at protected from the risk of burning on hot The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 28 surfaces. Restrictors are fitted to all windows above ground floor level, which minimises the risk of people falling from them. The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 29 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 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 1 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 1 X The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO 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 You must ensure people’s care plans are reviewed regularly (this relates particularly to health care matters You must ensure there is a process to monitor the administration of prescribed creams, inhalers and antibiotics You must ensure that clear guidelines are available to staff so that they know when to administer medicines that have been prescribed to be taken ‘when required’ You must ensure that all recruitment procedures are robust, including POVA, CRB checks and two references for all staff You must ensure all staff receive a structured induction to skills for Care standards The home must be managed with sufficient care competence and skill. You must send a copy of the report on the quality of care to the Commission You must notify the Commission DS0000059793.V360555.R02.S.doc Timescale for action 26/05/08 2. OP9 13(2) 26/05/08 3. OP9 13(2) 26/05/08 4. OP29 18 sch 2 26/05/08 5. 6. 7.. 8. OP30 OP31 OP33 OP37 18 1(c)(i) 10 (1) 24 (2) 37 26/05/08 26/05/08 26/05/08 26/05/08 Page 31 The Mulberry Residential Home Version 5.2 of all untoward incidents that occur in the home 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. 5.. 6. 7. Refer to Standard OP7 OP7 OP7 OP8 OP12 OP19 OP38 Good Practice Recommendations You should ensure that the individuals’ means of communication are recorded You should ensure that care plans show when people’s identified needs have been met You should ensure that all recordings are confidential to the individual the information is about You should ensure people’s nutritional needs are assessed and monitored You should ensure that a full social history is obtained for all individuals. You should ensure the home is clean and reasonably decorated throughout You should ensure all fire equipment is tested in line with the requirements of Devon and Somerset Fire Service The Mulberry Residential Home DS0000059793.V360555.R02.S.doc Version 5.2 Page 32 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.V360555.R02.S.doc Version 5.2 Page 33 - 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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