Care Home: Melrose

What the care home does well Melrose provides a relaxed and well-maintained environment for people with mental health problems. Records are detailed and well kept and the Registered Person puts great emphasis on the use of information technology for the efficient maintenance of records. What has improved since the last inspection? New UPVC double glazing has been fitted throughout the home, improving its appearance and insulation. The home has maintained its high physical standards. Arrangements for the recording of any allegations of abuse have been improved (though there have been no such allegations since the last inspection). Staff are preparing a detailed fire safety risk assessment using the latest guidance issued by the government. What the care home could do better: CARE HOME ADULTS 18-65 Melrose 8 Melrose Avenue Hoylake Wirral CH47 3BU Lead Inspector Peter Cresswell Key Unannounced Inspection 7th November 2006 09:30 Melrose DS0000018912.V310243.R01.S.doc Version 5.2 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 Melrose DS0000018912.V310243.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 Adults 18-65. 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. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Melrose Address 8 Melrose Avenue Hoylake Wirral CH47 3BU 0151 632 4669 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) louise@poldercare.com Mr Hendrikus Gerardus De Rooij Mrs Alexandra De Rooij Mr Hendrikus Gerardus De Rooij Care Home 29 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (29) of places Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twenty nine (29) adults with a mental disorder, aged 18 - 64, and may from time to time care for adults with a mental disorder over the age of 64. The total number not to exceed 29. 1 adult with a mental disorder who additionally has a mental handicap may be accommodated. 1 named adult with a mental disorder and physical disablement may be accommodated. 8th March 2006 2. 3. Date of last inspection Brief Description of the Service: Melrose is located just off the main road in Hoylake, within easy walking distance of a wide range of shops, restaurants, churches, other community facilities and the shore on Deeside. Hoylake is well served by public transport. Melrose was originally built by the local authority as a care home for older people and was converted by the present owners to accommodate people with mental health problems. The home has 29 bedrooms on two floors. Many of the rooms are spacious and two of them can be used as flats to aid rehabilitation. There are three lounges: a large, well furnished TV lounge, a medium sized ‘quiet’ room and a very small smoking room, plus a dining room. Smoking is only allowed in the smoking lounge. Melrose has a lift but it is not in everyday use and residents are encouraged to use the stairs. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this inspection was unannounced. The inspector spoke to five residents, staff, the Registered Manager (who is also the owner), the assistant manager and the Residents’ Services Manager. He examined documents including care plans, staffing files and fire safety records. He also toured part of the building, including all of the lounges and the kitchen. The Registered Person did complete a Pre Inspection Questionnaire but this was unfortunately not received by CSCI. A number of service user survey forms were sent out but no responses were received. What the service does well: What has improved since the last inspection? 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. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4. Quality in this outcome area is good. Residents are only admitted to Melrose if their needs have been adequately assessed, thus ensuring that their needs can be met. EVIDENCE: A number of residents have been admitted to Melrose since the last inspection and the case files for three of them were examined. All of the files contained detailed assessments made by health and social services professionals. They also contained detailed care plans drawn up by staff at Melrose. There was little written evidence on the file of the assessment carried out by the home. The care services manager said that the Registered Manager or another senior member of staff normally assessed a prospective resident when they visited the home or had a trial stay. The assessment is included in case notes but it would be more appropriate if they were put in the form of an assessment document. Prospective residents normally visit the home and make a trial stay before they make a final decision. This was conformed by one of the new residents who spoke to the inspector. Fees range from £363.73 to £544.23 a week, depending on the level of support specified in the contract. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is good. Care plans are detailed and are reviewed regularly, ensuring that up to date information is available to staff responsible for the day to day care of the residents. EVIDENCE: Care plans are on file for each resident and they incorporate appropriate risk assessments. A member of staff reviews the care plans each month and they are updated on the computer if any changes are made. More thorough, annual reviews tend to be arranged by external professionals such as social workers or consultant psychiatrists. Staff from the home attend these meetings and there was evidence of this on the files examined during the site visit. The care plans are detailed and practical, dealing with issues such as hygiene, medication, activities, motivation and behaviour. Daily reports are made on a dedicated computer programme that does not allow the retrospective alteration of records. The programme can only be accessed by staff using a password and information is backed up on a central server. Hard – paper – copies are kept of basic details, including the care plan. Care records have been held on computer for some time at Melrose and this has proved to be a highly efficient means of record keeping. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 9 Smoking is restricted to one small, very well used smoking room. The room has an extractor fan is furnished with high bar stools and wall shelves (in the style of a breakfast bar). One resident said that they did not find the room comfortable and a low chair was in the room for her use. The style of the room is not popular with the residents, but they continue to use it as it is the only area in the home where they can smoke. The Registered Manager confirmed that he did indeed want to discourage residents from spending long periods of time in the smoke room or indeed from smoking at all, though he acknowledged people’s right to smoke if they chose to do so. He also has wider concerns about the effects of smoke in the workplace and said that staff were not allowed to smoke at all on the premises. The issue did not figure highly in recent minutes of residents’ meetings and it appears that they have accepted the situation, albeit in some cases reluctantly. Residents’ meetings are held regularly, though attendance is often poor. The inspector examined records of the last three meetings. Issues discussed included food and activities. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17. Quality in this outcome area is adequate. Daily routines in the home are informal. Some activities are provided but most residents follow their own preferences by taking part in everyday activities in the community. The meals in the home offer some choice, flexibility and a nutritious diet for the residents, though not all of the issues raised by residents have been addressed. EVIDENCE: One of the senior care staff also has the responsibilities of an activities organiser as part of her duties. A detailed activities programme is in place but includes some items which are really part of the everyday routines of care and life in general rather than specific activities (e.g. “X had a shower assisted by staff and had …..hair done by staff”). Activities are recorded in some detail. The home has the use of a vehicle which is used for some trips though some residents said that the charges for some of the longer trips discourage them from joining in. Recent trips have been to Chester, Cheshire Oaks and Parkgate. The home is in the middle of Hoylake and most residents freely go out to local shops, cafes, pubs and other local facilities in the village. Some go to jazz nights at a local club. Staff also accompany those residents who need Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 11 to have someone with them. During the site visit a member of the care staff accompanied a resident to have his hair cut in the village. One resident continues to do voluntary work with a local charity. Some residents attend day or drop in centres in accordance with their care plan. Some residents told the inspector that they were often bored. The menu is varied and there is always a vegetarian option available. The main meal on the day of the site visit (pork curry) was home-made, using fresh ingredients. The alternative was vegetable curry. If a resident does not want the main meal the other choices are sandwiches, salad or soup. Some residents felt that they would prefer – at least occasionally – some more choices on the menu. Issues about the menu (quality of juice and coffee, roasts, fresh fruit) were also raised at a residents’ meeting in October and the minutes of the most recent meeting (on 6 November) said that the issue still needed ‘to be discussed with management.’ Food and nutrition is an important part of residents’ lives and it is important that concerns raised by residents are responded to promptly. The main meal of the day is usually served at lunchtime, though the evening meal is often a cooked snack (beans on toast when the inspector visited). Meal times are flexible. Tea and coffee tend to be served at fixed times throughout the day and there are no independent drinksmaking facilities for residents, though there is a vending machine. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21. Quality in this outcome area is good. Appropriate medical care and specialist mental health care is available to all residents, ensuring that they receive care appropriate to their condition. Medication is well organised and the administration of medication is accurately recorded, protecting the interests of the residents though some minor improvements could be made. EVIDENCE: Few of the residents at Melrose need physical personal support. One older person does live at the home (and the home’s registration permits this) but does not require this type of support and is placed at the home by reason of mental health issues, not old age. The inspector spoke to this resident, who was very active on the day of the site visit. Residents have access to mainstream community health services and most also receive support from Community Psychiatric Nurses and psychiatrists. All of the residents have single bedrooms and can therefore receive guests and visiting professionals in private. No residents retain their own medication and the administration and recording of medication is well organised. The home uses a monitored dosage system (MDS) with most medication dispensed in dedicated blister packs by the pharmacist. The inspector checked the medication for two residents and its administration was accurately recorded. Controlled drugs are stored in a suitable controlled drugs (CD) cabinet and their administration is recorded and Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 13 countersigned in a loose leaf CD register. Previous inspection reports refer to a bound CD register and it was not clear if this was an error or if practice has been changed. Guidance from the Royal Pharmaceutical Society of Great Britain (a copy of which is available in Melrose) is that the register for controlled drugs should either be a bound book or register with numbered pages. The Registered Person should obtain such a register. Depot injections are given by visiting Community Psychiatric Nurses and are recorded on the Medication Administration Record sheets. Medication that needs to be refrigerated is stored in a dedicated, secure fridge. It would be good practice to develop guidance for staff on when medication which is to be used ‘as required’ (PRN) should be administered in each individual case. There was evidence of how a recent death had been sensitively handled and several residents attended the funeral. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. Melrose has a complaints procedure which is available for residents and relatives to use to make their views heard and protect their best interests. Adult abuse procedures need to ensure that all relevant incidents are properly reported. EVIDENCE: The home has an appropriate complaints procedure and complaints are recorded on individual forms. Adult protection policies are available in the home and staff receive training in the protection of vulnerable adults. Some recent complaints had mistakenly been recorded on an out of date form but up to date forms are available in the home. One recent complaint was not fully recorded so it was difficult to see what the outcome was. It is important to clearly record the investigation and conclusion of complaints. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 30. Quality in this outcome area is good. Melrose provides clean, appropriately furnished accommodation that meets the needs of its residents. EVIDENCE: Melrose was originally built for the local authority as a care home for older people and the present owners adapted it to meet the needs of younger people with mental health problems. All areas of the home are accessible and a shaft lift is available if needed though it is not in everyday use and residents are encouraged to use the stairs. The areas of the home inspected on this occasion were well maintained and appropriately furnished. Since the last inspection the home has had new double glazing installed throughout, improving its appearance and insulation. The Registered Person also has plans to build a conservatory in the internal courtyard and to enclose the external porch, providing additional facilities for the residents. Melrose is within easy walking distance of public transport and other community facilities in Hoylake Village. The home is clean and adequately decorated. Residents all have single bedrooms with locks though they were not inspected during this site visit. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 16 There are sufficient toilets and bathrooms to meet the needs of the residents and those inspected were clean and well decorated. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is good. The home’s recruitment and training policies ensure that residents have their needs met by competent staff. The home’s staff supervision system needs further development. EVIDENCE: The home is adequately staffed and employs administrators, catering staff, domestics and a handyperson as well as care staff. The owners employ several staff from overseas and workers from Poland, the Philippines and Romania currently work at Melrose. These staff are recruited via a specialist agency that screens applicants, takes up references and arranges for work permits and immigration clearance where necessary. Four staff had been recruited since the last inspection and their recruitment records were examined. Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks had been carried out and nobody had been allowed to start work before at least POVA clearance had been received. Not all of the files had two written references but these were being pursued by administrative staff. The Registered Person has had the nursing qualifications of some of the overseas staff assessed by NARIC (the appropriate government agency). As their qualifications are in care professions they are deemed to be equivalent to social care NVQs for the purposes of the national standards. Seven of the eleven care staff have NVQ3 or its equivalent. New staff receive induction training, much of it based on a series of training videos. Although a record is Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 18 kept of who has completed each video module there are no dates so it is not immediately clear when refresher training is needed. Other staff training in 2006 has included Food Hygiene, Adult Abuse, Risk Assessment and Health and Safety. Melrose is making increasing use of outside training agencies. Two staff have received specialist training on Huntington’s Chorea. The Assistant Manager is introducing a system of annual staff appraisal but there is not yet a system of formal, recorded supervision and this needs to be introduced alongside the appraisal system. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 39, 40, 41, 42. Quality in this outcome area is good. The home is efficiently managed and records are properly and safely kept, protecting the rights and best interest of the residents. Safety checks are in place to ensure a safe environment for the residents but there was no gas safety certificate in place. EVIDENCE: The Registered Manager is also one of the owners and he is qualified and experienced in the fields of mental health care and management. The home operates quality assurance procedures through residents’ questionnaires and meetings. This year’s questionnaires were being sent out in December. Melrose does not yet use a national quality assurance (QA) system but the Registered Person is planning to shortly introduce ISO 9000 which is such a system and would give additional external scrutiny. Records examined were up to date and securely stored. Many of the home’s recording systems are held on the computer system and are inputted directly by staff. Staff said that they find this system easy to use and it gives management the advantage of being able to check records from either home. The kitchen was clean and food was Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 20 safely stored. Melrose is not yet using the Safer Food, Better Business programme to regulate its food safety procedures. The Registered Person may find it helpful to contact the home’s Environmental Health Officer to discuss using this programme. Fire safety checks and training had been carried out at the appropriate intervals but the home did not have an up to date gas safety certificate. It is essential that such a certificate is obtained from a CORGI registered engineer as a matter of urgency. The home is completing a fire safety risk assessment using the latest guidance (Fire Safety Risk Assessment – Residential care Premises) issued by the Department for Communities and Local Government The home’s registration certificate was displayed in the hall. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 3 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 2 x Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 22 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 YA42 Regulation 13(4) Requirement The Registered Person must eliminate unnecessary risks to the health and safety of service users and must obtain an up to date gas safety certificate from a registered CORGI engineer. Timescale for action 01/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA17 YA20 YA20 YA36 Good Practice Recommendations The management should respond to issues raised by service users in relation to the meals at the home. The administration of controlled drugs should be recorded in a hard backed register with numbered pages. It would be good practice to prepare guidance on the circumstances in which PRN medication is to be administered in each case. Staff should have regular, recorded supervision meetings at least six times a year. Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 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 Melrose DS0000018912.V310243.R01.S.doc Version 5.2 Page 24 - 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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