CARE HOMES FOR OLDER PEOPLE
The Mulberry Residential Home 2 Isca Road Exmouth Devon EX8 2EZ Lead Inspector
Michelle Oliver Annual Inspection 8 September 2005
th 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 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 D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Mulberry Residential Home Address 2 Isca Road Exmouth EX8 2EZ Telephone number Fax number Email 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 Eminence Care Ltd. Mr William Warr CRH PC Cae Home providing Personal Care 25 Category(ies) of DE Dementia (25) registration, with number DE (E) Dementia - over 65 (25) of places MD Mental Disorder (25) MD (E) Mental Disorder - over 65 (25) The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 9th June 2005 Brief Description of the Service: The Mulberry is registered to provide personal care for up to 25 older persons suffering a dementia type illness. They may also care for older persons with mental health problems.The property is a detached, extended house in a secluded residential area of Exmouth. The accommodation is arranged over the first and ground floors. The home has 21 rooms for single, and 1 for double, occupancy. The lounge and dining areas are designed in an open plan arrangement and are situated on the ground floor. There is a passenger lift to the first floor. The a home is approached by a private driveway, has pleasant secure gardens and parking on site The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was a follow up to the unannounced inspection that took place in May 2005. Michelle Oliver and Teresa Anderson undertook the inspection. The inspection was completed over 8 hours. There were 24 residents living at The Mulberry on the day of inspection and the inspector saw the majority of them. The home has a large number of residents who have a dementia related illness and some do not have the capacity to communicate fully or understand the inspection process. The inspectors spoke at length with 3 service users and 2 members of staff. The inspector toured the premises and inspected a number of records. The management and care staffs were friendly and professional throughout the inspection and helped where they could. What the service does well: What has improved since the last inspection? What they could do better:
Three requirements were made at the time of this visit. The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 6 Two were Immediate and related to a fire exit door being open and access to the door being partially blocked. This presented a risk to service users, staff and visitors. The provider did respond to this immediately. Care planning must be improved. The manager and provider were aware of the need for training in the development of care plans and had already made arrangements to attend a workshop later this month. Since the inspection they have submitted their plans for an improved format to the Commission. 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 Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed at the time of this visit. EVIDENCE: The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 &9 Individual care plans have been developed but not all aspects of health; personal and social care needs are identified or planned for. Medication is managed well. EVIDENCE: All service users have a plan of care. The home is developing a system for charting some routine care needs. The inspectors looked at a number of service users’ care plans. Not all included details about service users preferences, how their care needs will be met, goals for service users or the involvement of service users or their families in the review of the plans. The manager and provider were aware of a need for training in the development of care plans and had already made arrangements to attend a workshop later this month. The home has worked hard to improve its medication procedure. A Pharmacist and the home’s Inspector have visited The Mulberry since the last inspection. All procedures for the safe management of medicines were being undertaken at that time. Throughout the inspection staff were seen to address service users in a respectful and friendly manner.
The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 10 The provider has converted a double room to two single rooms since the last inspection as he appreciated the need of privacy for the residents. The home has one double room. The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 Service users are encouraged to maintain contact with their families or friends as they wish and to take control as much control of their lives as they are able whilst living at The Grange. EVIDENCE: Since the last inspection seating arrangements have been redesigned at the home. A larger dining area has been created and the dining room furniture has been replaced. This has created an area where service users sit, have drinks and meet with others and socialise and where activities are planned to take place. Three “ bays” have been created in the lounge, which have increased choice to service users of where they sit and whom they sit with. At the time of the visit the atmosphere at the home was comfortable and homely. Service users were agitated when there was a lot of activity e.g. cleaning, hairdressing, but were relaxed and comfortable when this stopped. The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were assessed at the time of this visit. EVIDENCE: The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 The standard of the environment within the home is very good providing the residents with an attractive and homely place to live. EVIDENCE: This standard was not fully assessed at the time of this visit. The home was clean with no offensive odours at the time of the visit. Air purifiers have been installed in the home and are effective. A housekeeper has been employed since the last visit and is to be commended for the high standards of cleanliness throughout the home. The hall has been redecorated and is light and airy. The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 The numbers and skill mix of competent staff are sufficient to meet residents’ needs. EVIDENCE: Staffing levels were satisfactory on the day of the inspection. The provider said that 6 carers on duty throughout the morning, 4 carers during the afternoon and two waking staff throughout the night. The manager and provider are on duty throughout the day and at least two afternoons a week an additional member of staff is on duty to involve service users in activities. Two members of care staff are due to attend a training course, given by the Alzheimer’s Society, in undertaking activities for [people with dementia. A member of care staff said that it would “ nice to have extra staff sometimes so that we could spend more time with the residents”. The provider is committed to providing a good standard of training for all staff. Six staff are currently undertaking NVQ training, one is completing their assessors award and five have already attained an NVQ award at either level 2 or 3. The home is well on target for meeting the standard that 50 of staff has an NVQ qualification by the end of 2005. All newly employed staff undertakes induction training within the first 6 weeks of employment and foundation training within 6 months. Training in Dementia care, low arousal techniques, POVA, manual handling and infection control are undertaken at the home. The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Some practices within the home are unsafe potentially putting service users, staff and others at risk. EVIDENCE: This standard was not fully assessed at the time of this visit. During a tour of the home a fire door on the first floor was open and partly blocked by a mattress. The provider was told about this and an immediate requirement was made. The provider responded immediately to this situation. At the time of the visit a number of service users were walking around the home some with limited understanding of risks and this open door not only compromised the fire precautions but also the safety of service users. The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 x
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 1 The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 17 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard op7 Regulation 15[1] Timescale for action The registered person shall, after 08.10.05 consultation with the service user or a representative of his, prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. The registered person shall 08.09.05 ensure that all parts of the home to which service users have access are so afr as reasonably practicable free from hazards to their safety. The registered person shall make 08.09.05 adequate arrangements for the evacuation in the event of fire, of all persons in the care home and safe placement of service users. Requirement 2. op 38 13[4][a] 3. op38 23[4][c][ 111] RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations The Mulberry Residential Home D54 D06 S59793 Mulberry V248238 080905 stage 4.doc Version 1.40 Page 18 Commission for Social Care Inspection Suite 1, Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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