Care Home: Mellish House Residential Home

What the care home does well The home provides prospective residents and their families with good information about how the home works and the aims of their care for people with dementia. The home monitors residents` health closely, with good support from local health professionals. Residents can expect to be cared for in the home for as long as they wish, unless there is an overriding medical need for hospital admission. The development of the work of meeting residents` wishes for activities, and for stimulating and maintaining their interests, is covered by the two activities coordinators. These staff work mostly with residents on a one to one basis to ensure that their needs are met.The provider has a comprehensive quality assurance programme including regular visits from senior managers, and monthly, quarterly and annual audits of key areas of operation. There is an in-house training unit which organises and delivers the majority of induction and refresher training. The tutors are able to tailor their sessions to ensure full understanding from staff with different language abilities. What has improved since the last inspection? The new extension has been opened in the last year and provides excellent and well planned facilities for residents. The manager told us that the provider had used best practice guidance on designing facilities for people with dementia. The home has built in several ways of assisting residents to find their room. Memory boxes filled with items of significance for each person are inset beside the door, as well as a picture of family or other reminders that this is their room. The rooms are equipped to increase resident`s dignity with lighting that reacts to when they get out of bed and the bed positioned for ease of accessing the ensuite. The home has found it difficult at times to recruit care staff, but nine new care staff started in April and May this year. This has reduced the number of agency staff used and provided more stability for residents in who cares for them. The frequency of staff supervision sessions has improved and the schedule is up-to-date. This ensures that staff training needs are monitored and residents are care for by competent staff. What the care home could do better: The home must be fitted with a controlled drug cupboard that meets current regulations, for the safety and security of the medication stored. The daily written reports should be monitored to ensure that staff use nonjudgemental words and expressions to describe resident actions to maintain the dignity of residents and support the home`s aim of person-centred care.. The stated intention to increase the capacity of the laundry and to refurbish it should be undertaken as soon as possible to ensure a prompt and efficient service for residents. CARE HOMES FOR OLDER PEOPLE Mellish House Residential Home Kings Hill Great Cornard Sudbury Suffolk CO10 0EH Lead Inspector John Goodship Unannounced Inspection 18th June 2008 09:00 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 Mellish House Residential Home DS0000024446.V366660.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. Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mellish House Residential Home Address Kings Hill Great Cornard Sudbury Suffolk CO10 0EH 01787 372792 01787 377953 mellish@CaringHomes.org 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) Stour Sudbury Limited Suzanne Elizabeth McKeon Care Home 48 Category(ies) of Dementia (48) registration, with number of places Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th July 2007 Brief Description of the Service: Mellish House provides care for 48 older people who have dementia. The home is located in a residential area of Great Cornard on the outskirts of the market town of Sudbury. There is a Public House close by, and the town of Sudbury provides a range of shops and eating-places. The home shares grounds with another registered care home, which is also owned by Stour Sudbury Ltd. Mellish House is a purpose built home arranged on two floors. There are passenger lifts and stairs to the first floor, and ramped access to an enclosed garden. The thirty-four single rooms in the original building have a wash hand basin and en suite toilet. The fourteen newer rooms all have en suite toilet and shower. Fees at the date of this inspection visit ranged from £495.00 to £596.00. Mellish House Residential Home DS0000024446.V366660.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 2 star. This means the people who use this service experience good quality outcomes. This inspection visit was unannounced and focussed on the outcomes for residents under the headings listed under each Outcome Group. The inspection took place on two weekdays and lasted a total of nine hours twenty minutes. The first day was spent observing the care of a group of residents for two hours who were using one of the communal areas. The second day included time following up the care of three of these residents by discussions with staff and examination of records. On the second day, we toured the home, and spoke to three residents in detail (two in their rooms) about their experience of the home and chatted to others sitting in the communal areas. We interviewed three staff about their work and training and spoke to and observed other staff in the course of their duties. We also examined care plans, staff records, maintenance records and training records. This report includes evidence gathered during the visit together with information already held by the Commission. The provider was required to complete an Annual Quality Assurance Assessment (AQAA) for the Commission and information from this has been used in the report. Survey forms were also sent out for residents, relatives and staff but none had been returned by the time of writing. What the service does well: The home provides prospective residents and their families with good information about how the home works and the aims of their care for people with dementia. The home monitors residents’ health closely, with good support from local health professionals. Residents can expect to be cared for in the home for as long as they wish, unless there is an overriding medical need for hospital admission. The development of the work of meeting residents’ wishes for activities, and for stimulating and maintaining their interests, is covered by the two activities coordinators. These staff work mostly with residents on a one to one basis to ensure that their needs are met. Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 6 The provider has a comprehensive quality assurance programme including regular visits from senior managers, and monthly, quarterly and annual audits of key areas of operation. There is an in-house training unit which organises and delivers the majority of induction and refresher training. The tutors are able to tailor their sessions to ensure full understanding from staff with different language abilities. What has improved since the last inspection? What they could do better: The home must be fitted with a controlled drug cupboard that meets current regulations, for the safety and security of the medication stored. The daily written reports should be monitored to ensure that staff use nonjudgemental words and expressions to describe resident actions to maintain the dignity of residents and support the home’s aim of person-centred care.. The stated intention to increase the capacity of the laundry and to refurbish it should be undertaken as soon as possible to ensure a prompt and efficient service for residents. Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 7 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. Mellish House Residential Home DS0000024446.V366660.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 Mellish House Residential Home DS0000024446.V366660.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): 1,2,3,5. Standard 6 is not relevant to this home. Quality in this outcome area is good. Prospective residents and their families are given full and attractively presented information on the home to enable them to decide if they wish to live there. Pre-admission assessments ensure that their needs are identified and that the home is able to meet them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and the Service Users Guide had been revised in November 2007 following the registration of the additional fourteen rooms. Although it clearly set out the people for whom it provided a service, the Statement of Purpose also stated that “it provides care……for sensory impairment and all medical conditions associated with ageing and physical frailty.” This description could be misunderstood to mean that Mellish House Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 10 provided specialist services in these categories. The manager confirmed that the primary reason for all admissions was a diagnosis of dementia. The Service User’s Guide was written in plain language with brief information under each heading, such as care planning, choice of doctor, laundry, meals, finances, activities, visitors and comments/complaints. We noted that under Finances, it stated “we do not hold residents’ money. Services such as hairdressing will be invoiced directly.” However the manager told us that some relatives did ask them to keep a cash float for their relative. Prospective residents, and their relatives, were given a brochure which explained how the home tried to meet its aims, using the latest research into the care of people with dementia. We examined three files for recent admissions. These all held a copy of the Contract of Residence signed by the next of kin or a power of attorney. All residents received one of these, irrespective of how they were funded. The Contract showed clearly what the fees were, who was responsible for their payment, and how they were to be paid. These files also held the pre-admission assessments covering the appropriate aspects of the person’s health and social care needs, such as communications, mobility, nutrition, behaviour, and recreational and spiritual activities. This assessment then formed the basis of the initial care plan. One of the assessments was not dated. The brochure clearly stated that prospective residents and their families were welcome to visit the home, with information on how to contact the manager to do so. Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10,11. Quality in this outcome area is good. Residents can expect staff to identify and review their care needs to ensure appropriate care is given. Their safety is protected by the home’s medication procedure and medication audits. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined three care plans. All had a photograph attached. Two of the three had a care plan summary at the beginning of the file, highlighting key aspects of the person’s needs and how they should be supported. Any significant changes, eg weight loss, were briefly explained in this summary for the benefit of staff. We saw that each aspect of the plan was reviewed monthly and this review was logged. One person had been reassessed in May 2008 because of concerns over their weight loss. A specific plan had been set up which identified the need, the objectives of the plan, and the care interventions required. This plan Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 12 had already been reviewed once following the referral to the GP. In this case the advice had been to continue to encourage the resident to eat and review again in one month. Incidents and accidents, such as falls, were reported monthly to the provider for analysis. All residents were weighed monthly and the results were recorded in the care plan. The home had a weighing chair for the convenience and safety of residents. The home used the Malnutrition Universal Screening Tool to highlight changes in body mass index and to set down nutritional guidelines for each resident. This ensured that the cause of weight loss or gain was identified and medical assistance sought when necessary. Two residents were being cared for in bed. One was receiving palliative care at the end of their life. A relative was staying overnight and was reported as having thanked the night staff for their help. They had wanted their family member to remain in the home at this time. The other resident was visited by the GP during the visit. The manager told us that the GP wanted to transfer them to hospital but the family would not agree, believing they were in good hands at Mellish. The district nurse also visited the home during our inspection and was pleased with the improvement in the condition of a resident they were treating. We saw that all visits by health professionals were recorded in the care plan file. The daily record was completed at the end of each shift. Professional Information was recorded in a professional way on the whole with few instances of inappropriate words. These were brought to the manager’s attention. We noted that one resident was reported several times as “wandering”. The home’s brochure stated “We see walking as walking and not wandering. For a person with dementia, every journey has a purpose, but often…….the purpose is forgotten and the person is seen as a wanderer.” We observed a senior carer carrying out the lunchtime medication round in one of the communal areas and when medications were taken to some bedrooms. The session was conducted in an unhurried way giving residents plenty of time to take their medication. A sample of Medication Administration Records was examined. All were completed fully. One resident had been refusing to take some of their medication. This had been recorded properly. The resident had been referred to the GP but continued occasional refusals. One resident we observed refusing their medication in their bedroom. They demanded to see the doctor. The record showed that the same request had been made the previous week and the resident had been visited by the GP. The senior carer suggested that they would come back later, but the actual tablet was correctly recorded as refused and destroyed. It was placed in the appropriate container. We visited the medication room. It contained the two trolleys and the drug fridge. There was a daily record of the temperature of the fridge, and of the room. These were within the permitted range. The home was storing one controlled drug, Temazepam, in a locked wooden cabinet inside the locked Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 13 drug room. This was no longer legal after the law changed in 2007. Controlled drugs must be kept according to The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. The senior carer told us that they had received training in the safe administration of medicines. The manager was unable to find their certificate which they thought had been taken by the trainer to head office. Staff showed by their tone of voice and the language used that they were sensitive to residents’ and respected them. The design of the extension with sensor lights in the bedrooms to help residents reach their toilet at night, and glass-fronted cupboards to help them see where crockery was kept helped to retain residents’ dignity. We did see one carer leading two residents at the same time by the hand out of the dining room after lunch. Supporting and guiding one resident could be done appropriately, but two at a time did not maintain their dignity. When we spent time observing residents’ daily life in one of the communal areas, and also observing staff interactions with residents at other times, we found staff to be patient and respectful to residents, speaking to them in a kindly and appropriate way. Two carers did not speak to residents when serving them cups of tea, but others spent time talking and stimulating them. Residents responded to this by smiling and replying to questions. Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15. Quality in this outcome area is good. Residents can expect to be stimulated and given support to choose what they wish to do. They can expect to be offered a choice of meals to be taken where they choose. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had recently taken on a second part-time activities organiser, so that each weekday was now covered. We observed one of them in the morning in one of the communal areas, initially talking to two residents, and then going round talking to some of the other residents, and then sitting for some time with one of them, looking at a book, finding which photographs were of interest to the person and letting them talk about what those pictures meant to them. Both activities organisers told us that working with individual residents was more meaningful and productive than trying to set up group activities. They suggested that most residents had a short attention span which mitigated against longer activities. Trips out were arranged to local cafes and places of interest using a local disabled access minibus. However the activities Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 15 organiser told us that these trips could be stressful for some residents, so they were only suitable for a small number of residents. We were told that cake making was popular and there was an area in one of the new kitchen areas in a lounge which was used for this activity. The two new communal areas had a dining area and kitchenette at one end. The worktop and sink could easily be adjusted in height. The activities organiser told us that some residents liked to assist in washing up. One of the wall cupboards could be lowered by a switch at waist height to allow residents to take out a mug or item of crockery when they wished. We were told that music was a popular and successful way of helping residents join in an activity and getting some exercise. On our last visit, we saw the organiser dancing with a resident, to their obvious enjoyment. The organiser told us:“The entertainers who visit the home are excellent”. The home had held a fete the week before our visit just outside the front entrance. The manager told us that £300 was raised for the residents fund, and some residents were able to visit the stalls. The organisers record what they do and with whom in a log book. They are also working on life stories with the help of relatives to give staff more understanding of each person’s journey to the present, and to enable staff to relate residents’ comments to events in their lives. We observed residents in one lounge where a dog had been brought in under the Pat Dog scheme. The owner brought the dog in each week and we saw residents stroking and cuddling the dog. The owner took the dog round to other communal areas later. We noted that some residents moved from one lounge to another during the day. They were not restricted to the lounge closest to their room. Two residents were seen sitting together during the day in various locations. We were told they were old friends who had met up again in the home. We saw that residents in the communal areas were given drinks during the day. In one lounge, the staff handed out mid-morning cups of tea. In another lounge there were glasses of squash with a jug ready for the staff to top them up. In the afternoon of our visit, a local vicar came in and conducted a short service in one of the communal lounges. Eight residents attended. We heard staff asking others if they wished to attend. A resident told us that Mellish was a very nice home. “I get myself up when I choose. I usually go to the dining room for meals.” Another resident was looking through their photo albums in their room. They told us they were content in the home. “I cannot fault it.” Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 16 With the new extension, there were now four smaller dining areas. In addition some residents chose to stay in a lounge to eat. Food was taken from the main kitchen to three of the dining rooms in heated trolleys. We saw staff serving the food from them. There were good portions which most residents finished. The main choice was chicken, with fish cakes as an alternative. Residents told us that they liked the food. It looked appetising and well cooked. In the ground floor dining room in the original part of the building, food was served directly from the kitchen. This room had been made to appear smaller by putting up screens at one end, decorated with artwork produce by residents. The other original dining room on the first floor had been refurnished with fewer dining tables and some easy chairs and a three-seater sofa. Staff told us that residents did not yet use this area to sit in but they were hoping to use it when relatives visited, to encourage residents to go there at other times. Tables were covered with tablecloths. The manager told us that for safety reasons, cutlery was not put on the tables until residents were seated. Visitors were welcomed in the home, and the monthly reports by the provider recorded their comments. All appreciated the care given. Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 17 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): 16,18. Quality in this outcome area is good. Residents can be assured that their concerns will be listened to, taken seriously and acted upon. There is a proper policy, procedure and training programme in place to give residents confidence that they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints log was inspected. There were six complaints received since the last inspection. Three concerned aspects of the personal care of a resident. One commented on a stain on a carpet, and one, still under investigation, concerned the attitude of a carer. Those investigated had led to action to put right the deficiencies. There was a notice on the board in the hall displaying the providers whistle-blowing policy. It displayed prominently the phone number of the responsible senior officer in the organisation whom staff should ring in confidence. There had also been one complaint which had been dealt with through the Adult Safeguarding procedure. The home was found not to have put the resident at risk. Another complaint direct to the Commission for Social Care Inspection had drawn attention to very low staffing levels at a particular date. The provider was required to investigate this allegation. A thorough report of Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 18 staffing on each shift over a five week period by the provider showed that 16 out of 70 daytime shifts in that period had not been staffed to the providers own staffing policy. Residents had not therefore had the staff support that was necessary for their quality of life. The reasons for the home’s staffing difficulties are covered in the “Staffing” section. Two staff files which were examined contained a record of the training sessions on adult protection which staff had received. These were repeated annually. Also kept in the files were the test questionnaires completed by staff at the end of each training session. A member of staff was asked how they would react to seeing or suspecting any form of abuse. They were able to give the appropriate response. Staff files held evidence of the recruitment checks and identification checks that had been made for the protection of residents. The home did not handle the financial affairs of any resident. Some residents, and their relatives, had asked the home to keep some petty cash for them to pay for day-to-day items. These were topped up regularly by relatives. We checked the records and cash for two residents. The amount of cash in both locked cash boxes tallied with the record book. However two invoices for a haircut listed in one book were missing from that resident’s box. The manager told us how this might have happened and that she would ask the hairdresser for copies at her next visit. This would ensure an audit trail so that residents could see that their money was properly accounted for. Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,24,25,26. Quality in this outcome area is good. Residents can be assured that the home provides a comfortable and wellmaintained environment and that the home is clean and odour free. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An extension of 14 rooms was registered by the Commission in October 2007. In the extension, each of the new bedrooms had an ensuite, each with dimmed lighting that is connected to a sensor system that operated when the service user got out of bed and as the user approached the bathroom the light brightened. The manager told us that that this allowed a person to find their way safely and also can prevent incontinence issues that could otherwise be caused. The ensuites had coloured tiles, shower and hand wash basins and cabinet. The shower rooms had different coloured grab rails to distinguish Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 20 them from the walls and the toilet seats were wooden for orientation. Communal toilets also had contrasting coloured grab rails to make them easier to find. We noted that these communal toilets did not have a toilet roll holder. The bedrooms had them fitted as part of the grab rail, but this design had not been fitted to the communal toilets. Each of the new bedroom areas was designed with the bed positioned to face the toilet. There was a bedside cabinet with lockable drawer, chest of drawers, wardrobe and table. Some of the rooms had carpet, others had vinyl flooring. The manager told us that one resident’s room had been refloored with laminate to improve hygiene but it retained a homely feel. Vinyl flooring was used in the non-sitting areas of the communal areas. All thirty-four original single rooms had a wash hand basin and ensuite lavatory but no shower. There were shaft lifts at both ends of the building. There was a new separate communal area on the ground and first floor with tables and chairs for dining and easy chairs for comfort. There were induction cooking hobs in each of the new communal areas, cabinets, fridge and a sink to enable activities for daily living. The height of part of the worktop and sink could be changed by minimal pressure to make it easier for residents to help in food and drink preparation or in washing up. One of the wall cupboards could also be lowered by residents to access cups and other crockery. A call bell system was in place in the extension with the sensor system alerting staff by way of a light outside the bedroom door. This system was not yet attached to the main care home alarm system. There were two additional assisted bathrooms with electrically raised baths. One of the bathrooms had overhead tracking installed for the comfort of residents and the safety of staff. From the new ground floor communal area there was access to a decking area that was protected and enclosed by a Perspex fence for safety and security. All room doors had the names of each occupant in large print against a background which reflected an interest of theirs.Some rooms had a photo of the inside of the room, or a photo of the family . The walls of rooms were decorated in deeper colours than other surfaces to allow residents to differentiate. The new rooms also had memory boxes built into the wall outside each bedroom. These contained mementoes, photos and items of importance in the life of the resident. These boxes had clear fronts and were locked. Not all of them had yet been filled as the home were waiting for families to bring items in. The rooms we went into, with the residents present, had all been decorated with pictures, ornaments and items of significance to the resident. The occupants told us they were happy with their rooms. Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 21 The front door had a keypad entry system which required all visitors and residents to be let in and out by staff. However the other external doors around the building were linked to the call system, so alerting staff if a resident went into the garden. The manager told us that the home was intending to put keypad entry onto the doors at the end of the corridor leading into the hall area. This would be a safety measure to stop residents accessing without supervision the kitchen and laundry areas. We noted that several residents came into the hall during the day, either to sit down, sometimes in the manager’s office, or to look out of the front door, and sometimes try to open it. The home should be able to show how it has assessed the risk of restricting people, and has considered other options for reducing the risk of accessing the kitchen and laundry. The inspector was able to discuss with a member of the domestic staff the methods used to maintain the cleanliness and atmosphere of the home. They were aware of those residents who needed surveillance of rooms for staining and odours. Control measures were in place and we did not detect any unpleasant odours. The monthly report by the regional manager for May had noted that there were three rooms with an unpleasant odour. These had been dealt with. We visited the laundry where the manager told us that an additional washing machine was to be installed. The carer in the laundry room said that the extra machine was needed to ensure a faster throughput of washing for the residents’ use. The laundry room was to be upgraded and extra boxes installed for the sorting of residents’ clothes. We had been told last year that this would be done when the extension was finished. The home had suffered an outbreak of the winter vomiting virus in December 2007, which it had reported to the health authority’s health protection unit and had instituted infection control measures. Staff were observed on both days of this inspection wearing protective aprons and using protective gloves when doing personal care tasks. Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30. Quality in this outcome area is good. Residents can be assured that residents’ needs will be met by the numbers and skill mix of staff and that the home will provide training to ensure that the staff are competent to do their jobs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files for three recently appointed staff were examined, two carers and one domestic. Both contained all the recruitment and identification documents required. For the two people who had come from Poland, the “references” were testimonials translated by a registered agency. None had started work until the POVA First confirmation had been received by the provider. One of the files held a record of a supervision session in June 2008. We interviewed two members of the care staff. One person had only been in post a short time. They had previous care experience. They described the induction training they had received, and were intending to start an NVQ Level 2. The other person had worked at the home for some time and had been promoted to Team leader earlier in the year. They had particular responsibility for the induction and supervision of staff, and for the administration of drugs. They confirmed that the staffing level was five carers including a team leader Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 23 on each floor. This would give a ratio of one carer to five residents. Both felt that this was sufficient for the needs of the residents. The home had five vacancies at the time of our visit. These were being covered by agency staff. Because many of the care staff worked a double shift, with suitable breaks, they were not often able to provide cover themselves. There were 17 full time care staff, including three males, and only one part-timer. The AQAA told us that eight staff had left the home in the previous year. This is a significant number partly accounted for by the overseas staff moving on. Nine new care staff had been recruited in April and May 2008. This had reduced the number of agency staff used and provided more stability for residents in getting to know who was caring for them. We observed two agency carers during our visit and during our observation session. Both had worked at the home before. One was working with a resident cutting up material to make patchwork. The other spent time with a resident looking through a book. The resident appeared to enjoy and respond to this. The manager told us that the night staffing level was going to be raised from three to four now that there was only one resident vacancy. The AQAA told us that there were nine residents who required two carers to support them at night so this increase was necessary. The regional manager’s monthly report noted that the manager and the deputy had done a night visit to the home and found that one member of staff was asleep. This person had subsequently been dismissed. This had been reported to the Commission in the proper way. We inspected the staffing rota for one week, and the correct staffing levels were planned on each day, with changes showing who actually worked as well as who was rostered to work. There were the correct numbers on duty on the day of inspection, including two agency carers. In addition to the care staff, there were two activities organisers, three domestic staff, a cook and a kitchen assistant, and a maintenance man was shared with the home next door. About three-quarters of the care staff were from overseas, many of them from Poland. The manager explained that this was the only way they could fill all their vacancies. Previous reports had commented on the lack of fluent English amongst foreign staff and their ability to communicate easily with residents. However during our observation session, we noted that all the carers spoke to residents in a friendly and intelligible way, and all the residents understood what they were saying. Staff who spoke to us were able to express themselves well with only occasional hesitation over words or expressions. The home had encouraged staff to attend language training. The regional manager’s report for May 2008 noted that the tutor from the local college was in the home when they visited, enrolling five staff in an English language course. The manager told us that because the home used the provider’s in-house training unit for most short course training, the tutors were able to tailor their sessions to Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 24 ensure that staff with differing language abilities understood the learning points of the sessions. Training records were up-to-date for all staff. The provider had their own training organisation so induction training and mandatory courses such as moving and handling, protection of vulnerable adults, and food hygiene awareness were held in-house with a trainer. Other courses covered pressure area care, dementia awareness, medicine administration and infection control. Some staff were working through the Dementia training pack produced by the Alzheimer’s Society with video and training manual covering topics at NVQ Level 2. This learning would increase the competence of the staff to support residents. Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 25 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): 31,32,33,35,36,37,38. Quality in this outcome area is good. There is appropriate leadership providing staff with guidance and direction to ensure that residents receive consistent good care. Residents’ safety and welfare is assured by the home’s system of quality assurance, and the regular maintenance checks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was registered by the Commission in 2003 and had been working in the home for some years prior to that. She had gained the NVQ Level 4 in care and management. The management style of the home was open and Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 26 informal. Residents were able to enter the manager’s office if they wished, and one did so several times during the inspection. The environmental health officer from the local authority had inspected the catering arrangements earlier in the year. They had required some improvements to documentation and record keeping. The dishwasher had also needed to be repaired. The manager told us that it had been replaced. The provider had a comprehensive quality assurance process. A monthly visit report by the Regional Manager acted as the report required by Regulation 26 of the Care Homes Regulations. It was also a useful management document identifying the need for action and whose responsibility it was to take action. There was a system of monthly and quarterly audits by the manager and regional staff, with a full audit of the home annually. There were numerous audits including cash, care records, training, and medication. All these checks ensured that residents’ health and welfare were under scrutiny at all times. Staff meetings were held monthly. The dates were displayed on the noticeboard. The minutes of the latest one included discussion of care plans, serving lunches and staff changes. Health and safety meetings were also held. These meetings kept staff up-to-date with aspects of care for the benefit of residents. We examined the fire safety records which showed that all system checks were up-to-date. The last fire drill had been held on 11th June 2008. Regular room checks were also made including checking the nurse call system, window restrictors, and the hot water temperatures. Any action needed was logged. We inspected the record of accidents to residents. There were twelve minor incidents in May 2008 mostly where residents had been found on the floor of their room. There was no pattern to these, either by resident or by time of day. We were shown the schedule for staff supervision sessions, and also some of the records of recent ones. The schedule was up-to-date. These sessions helped to identify any training or practice issues which would improvetheir care of residents. The home did not handle the financial affairs of any resident. Some residents, and their relatives, had asked the home to keep some petty cash for them to pay for day-to-day items. These were topped up regularly by relatives. More information on this is given in the section “Complaints and protection”. Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 27 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 2 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 3 3 Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13(2) Requirement The controlled drugs cupboard must be fixed to the wall in compliance with the Misuse of Drugs (Safe Custody)(Amendment) Regulations 2007. Timescale for action 01/08/08 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. Refer to Standard OP1 OP8 OP19 Good Practice Recommendations Information supplied by the home to prospective residents and their families should accurately reflect the primary reason for admissions. The expressions used in the daily reports should be professional and non-judgemental. The plan to stop free access to the hall by residents with the installation of a keypad system should be supported by an assessment of the risk of not doing this, compared to the restriction in the freedom of movement of residents. DS0000024446.V366660.R01.S.doc Version 5.2 Page 29 Mellish House Residential Home 4. OP26 The plan to upgrade the laundry capacity and fittings should be implemented as soon as possible to meet the increased load from the additional beds. Mellish House Residential Home DS0000024446.V366660.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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