CARE HOMES FOR OLDER PEOPLE
Mellowes The Common Mead Lane Gillingham Dorset SP8 4RE Lead Inspector
Chris Gould Unannounced Inspection 4th October 2005 10:00 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 Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 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. Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Mellowes The Address Common Mead Lane Gillingham Dorset SP8 4RE 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) 01747 824400 01747 826699 BUPA Care Homes (CFC Homes) Limited Mrs Jane Jones Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home may accommodate a maximum of 39 service users who require nursing care. Maximum of 3 double bedrooms in use at any one time, no`s 2, 25, 26, 36, 44 & 45 (referred to as `guest suite`). The home may accommodate a maximum of 2 service users between the ages of 35yrs and 65yrs at any one time, not exceeding the registration number of 48 27th April 2005 Date of last inspection Brief Description of the Service: The Mellowes is a purpose built care home situated on the outskirts of Gillingham and was purchased by BUPA in June 2002. It is registered to accommodate forty-eight residents with a maximum of thirty-nine requiring nursing care. The service users accommodation is spread over two floors with a passenger lift enabling easy access throughout the home. There are 45 bedrooms, all with en-suite facilities, three communal lounges and a large dining area. The home has five assisted bathrooms and an assisted shower available for use. The extensive grounds have lawns, seasonal flower borders, a sensory garden, an Italian style courtyard with water feature, and a gravelled driveway with a car parking area. Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over four and a half hours on one day in October 2005. This inspection assessed 14 standards and the outstanding requirements from the previous inspection. A tour of the premises took place and three staff files and three residents care records were inspected. Sixteen residents, three visitors to the home and the staff on duty were spoken with during the inspection. Jane Jones the registered manager was available throughout the inspection. This report should be read in conjunction with the report of the previous inspection that took place in April 2005. What the service does well: What has improved since the last inspection?
Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 6 The recommendations provided following the assessment by a qualified Occupational therapist have been addressed since the last inspection to assist residents to maintain their maximum level of independence. What they could do better: 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. Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 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 the following standard(s): 3, 4 and 5 The systems in place ensure that the resident knows that the home they are moving into will meet their needs. EVIDENCE: Individual records are maintained for each of the residents. Inspection of the records for the two most recent admissions contained a detailed pre admission assessment of care needs including information from professionals previously involved in providing their care. Discussion with staff confirmed that they were aware of the resident’s needs at the time of their admission. A letter is provided to the prospective resident advising them that following assessment the home is able to meet their needs. Residents spoken with confirmed that they or their family had visited the home prior to making the decision to move in. The Mellowes does not provide intermediate care therefore standard 6 is not applicable.
Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 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 the following standard(s): 7 and 9 The care plans do not consistently include the detail required to adequately provide staff with the information they need to satisfactorily meet residents’ needs. The procedures in place for dealing with medication are not always implemented to ensure that residents’ medication needs are met EVIDENCE: All residents have individual plans of care based on a pre-admission assessment of need. The three residents care records inspected had been reviewed at least monthly. Two records inspected included information relating to wounds. The care records did not include a clear assessment, plan of care or evaluation of the wounds. Discussion with staff and residents confirmed that the care plans reflected the care provided. The home has a comprehensive administration of medication procedure. One resident’s Medication Administration Record (MAR) for one medicine had not been completed for two days. An audit system is in place for medication but on this occasion it had not been implemented so it was not possible to identify if the medicine had been administered.
Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 Residents are offered a menu that provides a varied and well balanced diet that is served in pleasant surroundings. EVIDENCE: All the residents who commented on the food said it was ‘very nice’, ‘excellent’, ‘a good choice’ and ‘first class’. A menu to order breakfast, lunch and supper is provided for the following day. Further choice is also available if the items on the menu are not suitable. The menus were viewed and found to be varied and well balanced offering at least five pieces of fruit and vegetables a day. Meals are served in the ground floor dining room but can be served in the resident’s bedroom if that is their choice. Residents who choose to remain in their own room confirmed this. Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 The systems in place provide residents with the confidence that their complaints will be taken seriously and acted upon. Residents’ legal rights are protected. EVIDENCE: The home has a detailed complaints procedure that is included in the service user guide. Residents and visitors spoken with said that they were aware of the procedure and what to do if they had a complaint. One resident said that ‘they always listen to me about other things so I’m sure they would if I had a complaint’. Inspecting residents care records and speaking with residents confirmed that they have representatives including family and solicitors to manage their affairs and act as their advocate. Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21 and 22 Residents have access to all indoor and outdoor facilities that are safe and comfortable. Sufficient toilets and washing facilities are available to meet the residents’ needs. Equipment is provided to assist residents to maintain their maximum level of independence. EVIDENCE: The home provides a total of three communal rooms with sufficient space and comfortable seating, one of which can be used for activities/hobbies or as a place for residents to receive visitors. A passenger lift provides access to the first floor. The garden is readily accessible and residents confirmed that it is very well used when the weather is appropriate. Handrails and ramps are provided as appropriate. Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 13 The Mellowes provides five assisted bathrooms and one assisted shower. All residents’ bedrooms have en-suite facilities with toilet and wash hand basin. Separate toilets are situated close to communal rooms. A resident commented that they ‘really looked forward to soaking in the bath’. Recommendations provided following the assessment by a qualified Occupational therapist have been addressed since the last inspection. Individual items of equipment have been provided for residents following assessment. A resident who has been provided with equipment to assist them to walk without assistance from a carer commented that ‘I can now do so much more for myself without having to ask for help, Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The recruitment procedures in place are not consistently implemented to ensure that residents are supported and protected. EVIDENCE: Three staff files contained an application form, two written references, proof of identity, a health questionnaire, a job description and contract. A Criminal Records Bureau check was available for two members of staff. For one member of staff a satisfactory enhanced CRB or POVA first, a full employment history and a reference relating to their most recent employment had not been received prior to their commencement in post. Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 35 The systems for consultation with residents in this home are good and residents’ views are sought and acted upon. Residents’ personal monies are kept secure and with appropriate records ensure financial interests are safeguarded. EVIDENCE: The organisation has developed a quality assurance system that includes published manuals of the standards expected in all departments in the home. A questionnaire is sent annually to all residents and their representatives, the results are collated and an action plan drawn up to address any issues identified. The home has regular residents meetings that are open to relatives to attend. This was confirmed by residents and visitors spoken with. The organisation is accredited under a nationally scheme as an ‘Investor in People’.
Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 16 Residents either manage their own finances or were assisted by family, friends or professional advisors. A number of residents have arranged for the home to hold some monies on their behalf. Records were available to show that these monies are held in individual bank accounts and each resident is provided with an invoice including earned interest monthly. Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 17 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 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 x x 3 3 3 x x x x STAFFING Standard No Score 27 x 28 2 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 x x x Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 18 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 Requirement Timescale for action 31/12/05 2 OP9 13(2) 3 OP29 19 schedule 2 The registered person must ensure that the resident’s care plan sets out in detail the action to be taken by the registered nurses and care staff to ensure that all aspects of the resident’s health, personal and social care needs are met. The registered person must 31/12/05 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person must 31/12/05 ensure that all staff have received a satisfactory CRB or POVA first check and a full employment history and appropriate references have been obtained before they commence employment. Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mellowes The DS0000028980.V255491.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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