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Care Home: Miramar

  • 145 Exeter Road Exmouth Devon EX8 3DX
  • Tel: 01395264131
  • Fax:

The home is registered to provide personal care for up to 14 people over the age of 55 who may have a learning disability, mental illness or dementia. Miramar is an older adapted end of terrace house, close to the centre of Exmouth. Accommodation is arranged over the ground, first and second floors. There are two stair lifts, one to the first floor and another to the second floor. There are ten single and two double sized bedrooms. Individuals who have a room on the second floor may need to be able to manage stairs, as two further steps lead to some of the rooms making these unsuitable for people with limited mobility or who have cognitive or sensory impairment. Many of the bedrooms are small but have toilets and washbasins provided in them, one room also has a shower. A lounge, separate dining room and conservatory/entrance hall are situated on the ground floor. There are steps leading up to the front entrance and a ramp to the side entrance. To the rear is a small courtyard/patio which has level access. There limited parking in the private road immediately outside the courtyard back gate entrance. The homeâs statement of purpose and service user guide is available at the home, which includes details about the philosophy of the home and details about living at the home. This is available to anyone thinking of moving into the home before they make a decision about living at the home. A copy of the most recent inspection report is pinned up on the office wall and is also available on request. Information received from the home indicates that the current fees are £372 £550 weekly. Services not included in this fee include hairdressing, chiropody, hairdressing and dentist fees.MiramarDS0000021983.V378361.R01.S.docVersion 5.2

  • Latitude: 50.626998901367
    Longitude: -3.4110000133514
  • Manager: Mrs Nicola Jayne Inglis
  • Price p/w: £461
  • UK
  • Total Capacity: 14
  • Type: Care home only
  • Provider: Mr Andrew Sloman
  • Ownership: Private
  • Care Home ID: 10824
Residents Needs:
mental health, excluding learning disability or dementia, Learning disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Miramar.

Key inspection report CARE HOMES FOR OLDER PEOPLE Miramar 145 Exeter Road Exmouth Devon EX8 3DX Lead Inspector Sue Dewis Key Unannounced Inspection 29th October 2009 10:00 DS0000021983.V378361.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Miramar DS0000021983.V378361.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Miramar DS0000021983.V378361.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Miramar Address 145 Exeter Road Exmouth Devon EX8 3DX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01395 264131 nikki.inglis1605@btconnect.com Mr Andrew Sloman Mrs Nicola Jayne Inglis Care Home 14 Category(ies) of Learning disability (14), Learning disability over registration, with number 65 years of age (14), Mental disorder, excluding of places learning disability or dementia (14), Mental Disorder, excluding learning disability or dementia - over 65 years of age (14) Miramar DS0000021983.V378361.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age range 50 years and over Date of last inspection 5th February 2009 Brief Description of the Service: The home is registered to provide personal care for up to 14 people over the age of 55 who may have a learning disability, mental illness or dementia. Miramar is an older adapted end of terrace house, close to the centre of Exmouth. Accommodation is arranged over the ground, first and second floors. There are two stair lifts, one to the first floor and another to the second floor. There are ten single and two double sized bedrooms. Individuals who have a room on the second floor may need to be able to manage stairs, as two further steps lead to some of the rooms making these unsuitable for people with limited mobility or who have cognitive or sensory impairment. Many of the bedrooms are small but have toilets and washbasins provided in them, one room also has a shower. A lounge, separate dining room and conservatory/entrance hall are situated on the ground floor. There are steps leading up to the front entrance and a ramp to the side entrance. To the rear is a small courtyard/patio which has level access. There limited parking in the private road immediately outside the courtyard back gate entrance. The home’s statement of purpose and service user guide is available at the home, which includes details about the philosophy of the home and details about living at the home. This is available to anyone thinking of moving into the home before they make a decision about living at the home. A copy of the most recent inspection report is pinned up on the office wall and is also available on request. Information received from the home indicates that the current fees are £372 £550 weekly. Services not included in this fee include hairdressing, chiropody, hairdressing and dentist fees. Miramar DS0000021983.V378361.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 1 starThis means the people who use this service experience adequate quality outcomes. This unannounced visit took place over 14 hours, 2 days at the end of October and beginning of November 2009. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This shows us how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. This document was not returned to us when we asked for it. Part of the document was given to us during the visit but it did not contain all the information we asked for. We received the full document just before we completed this report. Information from this document was used to write this report. Although only one inspector undertook this inspection, throughout the report there will be reference to what we found and what we were told. This is because the report is written on behalf of the Care Quality Commission (CQC). During the inspection 3 people were case tracked. This involves looking at peoples individual plans of care, and, where possible speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process CQC likes to ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to 10 people living at the home, 10 staff and 3 healthcare professionals. At the time of writing the report, responses had been received from 5 people living at the home, 5 staff and 2 healthcare professionals. Their comments and views have been included in this report and helped us to make a judgement about the service provided. During the inspection 2 people living at the home were spoken with individually and 4 in a group setting, as well as observing staff and people living at the home throughout the day. We also spoke with 1 representative on the telephone, 4 staff and the manager and owner. A full tour of the communal areas of the building was made and a sample of records was looked at, including medications, care plans, the fire log book and staff files. All key standards were inspected. Miramar DS0000021983.V378361.R01.S.doc Version 5.2 Page 6 We were joined for part of this visit by an Expert by Experience. Experts by Experience are people who have used the services we are inspecting. Their role is to bring a different and independent view to the inspection process by working alongside inspectors, observing and gaining the views of people who use the service. The Expert by Experience’s background knowledge of using services enables them to ask different questions and explore different themes. They are able to pick up on and note details, such as care practices, accessibility within the home, interaction and non-verbal communication between staff and people who use the service. People who use the service are able to talk openly and differently to the Expert by Experience and this makes them feel valued. What the service does well: People living at the home were generally very happy with life at the home and all five people who returned surveys told us that staff ‘always’ listen and act on what they say and that they ‘always’ get the care and support they need. Two health care professionals who returned surveys, told us that ‘They know their patients well and contact me appropriately’ and ‘staff are always friendly and helpful. Very homely atmosphere’. The home provides a warm and friendly atmosphere, and good relations were witnessed between those who live and work at the home. There are generally good admissions and care planning procedures that assure individuals their personal and healthcare needs can be met. Visitors are made welcome and there are some activities, entertainments and outings available to people living at the home. A member of staff is employed for three afternoons each week to provide activities and outings. Staff told us that when they have time they are encouraged to chat with people living at the home. There are generally good recruitment procedures and staff are well trained and know their duty to report poor practice. There is a clear and simple complaints procedure and the home generally ensures safe health and safety practices. Miramar DS0000021983.V378361.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Two requirements and 19 recommendations for good practice have been made as a result of the findings of this inspection. Most of these were originally made at the visit in February 2009 and which had not been fully addressed. Not all areas of the home are kept clean at all times to make sure that people live in a clean, fresh and hygienic environment and any risk of infection is minimised. Evidence that proof of identity for staff employed at the home had been obtained was not available. Assessments do not provide enough information to ensure the home can establish whether they can meet people’s needs and do not form the basis of individual care plans. Care plans do not include details of how staff are to meet individual care needs, information is not regularly reviewed with the involvement of people or representatives. There were no assessments relating to falls or nutrition, putting people at risk in these areas. Daily records were not detailed and were not always respectful of the person. People’s privacy and dignity is not always respected. Miramar DS0000021983.V378361.R01.S.doc Version 5.2 Page 8 Details about people’s past hobbies and interests have not been recorded to ensure that they might continue to lead their lives as they wish. The home needs to provide more social stimulation for people. People told us on their survey forms that they would like more activities and outings. No record is kept of complaints that are made, including details of any investigations and outcomes. People do not live in a safe well-maintained environment, and not all areas of the home are kept clean, fresh and free from odour. There is not enough moving and handling equipment to meet the needs of individuals whose rooms are above the ground floor. The laundry does not have paper towels or soap to prevent cross infection and maintain cleanliness. Staff rotas do not show who is the senior person on duty, therefore staff do not know who would be in charge in an emergency. More staff on duty would ensure people’s needs can be met in a safe manner and also ensure that contact with staff is not purely task orientated. There is no formal quality assurance system which means that people cannot be assured the home regularly reviews and plans to improve the quality of care at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedure generally ensures that there is a proper assessment prior to people moving into the home, and that they can be assured that their care needs can be met. The home does not provide intermediate care. EVIDENCE: There is a Statement of Purpose available to people thinking of moving into the home. However, this has not been updated for some time and now contains some incorrect information. There is no brochure or service user guide available at the moment, although the manager did show us some of the ideas the home has for its new brochure. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 11 Four of the five people who returned surveys to us felt that they had received enough information about the home before they had moved in. We looked at the files of three people living at the home, including that of the most recently admitted person. The manager told us that this person had attended the home for sometime on a daily basis until a bed had become available for them to move into the home. The manager told us the procedure that is usually followed when a person is referred to them. This is usually inviting the person to visit the home and visiting them to complete a pre-admission assessment. We did not see fully completed preadmission assessments on people’s files, but the manager told us that she completes the care plan assessment and not a separate assessment when visiting people prior to their admission. This means that the person is potentially at risk of their individual needs not being fully met by the home, as sufficient information has not been provided before their admission. A comprehensive assessment of individuals needs is required to ensure that staff numbers, knowledge and experience, environment and equipment are sufficient to meet the people’s needs. We saw that everyone living at the home now has a contract. However, the home does not write to people to confirm that their assessed needs can be met before they moved in. The home does not provide intermediate care. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans do not provide staff with clear information that enable them to meet peoples health and social care needs on a day to day basis. Recordings are not always appropriate. People are not aware of their care plans. EVIDENCE: All people living at the home have an individual plan of care. We looked at the care plans for three people. Care plans have not changed since the last visit and there was no evidence that people and their representatives had been involved in updating them. The manager told us that they were planning to start involving people in drawing up their plans. People were unaware of what a care plan is and did not know that the home kept one about them. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 13 There is no record in the care plan of the persons individual methods of communication, which means that one staff member may understand what someone is trying to communicate while another may not. Care plans included details of the individual’s needs and goals to be achieved. However, they did not include any strengths or abilities individuals may have. For example, how much help they want or need in relation to their personal care, what they can do for themselves or what degree of privacy they would like. Individual plans of care did not include enough information to enable staff to carry out care in a person centred way. For example, information did not provide staff with details of how individuals choose to have their personal care delivered, and there were no details relating to what, why, when or by whom assistance should be provided. We looked at the care plan for one individual whose behaviour can be challenging to other people. It would seem from the care plan that the main way of dealing with the behaviour is to remove the person to their room. There was little information for staff on how to deal with this behaviour in other ways, for example means of diverting the person’s attention. We were told by staff that sitting with this person often calms them, but that they do not always have the time for this. This lack of recorded detailed information potentially puts people at risk of receiving inconsistent care and puts a great responsibility on staff to remember how people choose to have care provided. It also means that some staff might not be aware of people’s needs or risks. This could be unsafe and people may be at of not having their needs met. There was little evidence that people receive ‘person centred care’ other than that the staff team have worked at the home for many years and therefore know people living there well. Staff told us about people’s individual likes and dislikes and how they choose to be cared for. We were told that there were no ‘routines’ at the home and people could choose what they did and when. We saw a risk assessment for one person relating to their behaviour, but this was not dated so there was no way to know if it was still relevant. Assessments of risks associated with falls and nutritional needs had not been undertaken for people living at the home. This means that people may be at increased risk as no information has been recorded to enable staff to prevent these risks. One person uses a mobility scooter to access the local community and nor assessment of risks associated with its use had been completed. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 14 Care plan files include daily recording sheets that are divided into sections relating to shifts worked by staff each day. The sheets include sections for medical appointments, achievement of goals, weight and foods eaten. However, staff record very little on these sheets and information about care plan goals are left blank. This means when care plan reviews take place there is no record of the individual’s progress. Some recordings were inappropriate and disrespectful. For example, ‘demanding as usual’ and ‘very rude’, there was no indication that explanations for the behaviour had been looked for. We saw that staff were consistently recording information about an individual’s blood sugar levels. However, there were no directions to staff as to what ‘normal’ levels were for this person, or what to do if the levels rose/fell above/below these ‘normal’ levels. During the second visit we saw that ‘normal’ levels had been identified, but there were still no directions as to what staff should do if the levels rose/fell above/below these levels. We also saw evidence of staff’s differing approaches to people’s care. For example, some night staff were waking an individual to remind them to go to the toilet, while others were not. There was no evidence of an assessment to determine which approach was appropriate. We spoke at some length with staff about the importance of completing records appropriately and fully so that there is evidence that identified needs and goals have been met, and any concerns highlighted. People told us that they have regular check-ups for their eyes, teeth, and feet and that if they need a doctor what ever the time of day or night they can get one. Information about visits from chiropodists, district nurses and doctors had been recorded in individual care plans, showing clear evidence that people are supported to maintain access to specialist medical services. However, there was no evidence that people receive Annual Health Checks Medication administration was generally well managed and all staff who administer medication have received training. However, staff were seen taking medication from the blister pack and then putting it into a pot, rather than ‘popping’ the medication straight into the pot. It was pointed out to staff that there was a danger of cross contamination when medication is being touched. There were several pots contained differing medication and we were told this was medication that had been refused by individuals and was due to be returned to the chemist. Practice would be improved if the medication was kept separately and labelled accordingly. We were told that the home does not have a homely remedies policy as it only administers medication that has been prescribed for the individual. We were also told that no-one at the home self medicates. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 15 People’s privacy and dignity is generally met and promoted by the staff and management at the home. However, one ensuite toilet in a shared room does not have a door fitted. This means that people who share this room do not have any privacy or dignity when using this toilet. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although activities are provided at the home there is not always adequate stimulation and daily variation for all people currently living at the home. People enjoy a balanced diet which takes into account the likes and dislikes of individuals. EVIDENCE: All of the people living at the home that we spoke to during this inspection told us they were very happy. We were told by the manager and staff that there are a variety of activities and entertainments on offer for people living at the home. These included Bingo, Tranquil Moments and a guitarist and organist. We were also told that people enjoy watching films and often watch an afternoon movie together. For Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 17 three afternoons a week a member of staff is employed to spend time engaging people in activities and taking people out on 1:1 trips. However, people living at the home that we spoke with told us they do not do much in the day except watch TV either in their rooms or in the lounge or just sit about. Another person told us they do nothing all day. Three people who returned surveys to us said that they would like more opportunities for activities and to go out. We were also told ‘Staff change the channel on the TV, we are not allowed to. This does not encourage people’s independence or choice. Staff said that they change the channel as people wouldn’t be able to work the remote. We suggested a big buttoned remote control may be easier for people to use. Of the five surveys that were returned to us by people living at the home, 1 person felt that the home ‘always’ had ‘fun things to take part in’, 2 felt there were ‘sometimes’ ‘fun things to take part in’ and 2 felt there were ‘never’ ‘fun things to take part in’. Care plans did not include information relating to people’s interests or past hobbies. This means that people may not be encouraged to continue with a pastime they enjoy, as information is not available and they may be at risk of not continuing to lead their lives as they wish. People benefit from being encouraged and supported to maintain contact with family and friends. We were told that he home has an open door policy and relatives, visitors and friends are welcome at any time, made to feel welcome and have a meal if they wish. Throughout this visit relatives and friends visited the home and were welcomed and made to feel at home by all those living there and staff. We spoke with one relative on the telephone and they told us they were happy with the care their relative receives and that they were always made very welcome whenever they visited. Some people living at the home are independent and come and go as they please. However, they do let staff know when they are going out and generally where they are going. One person goes independently to various local pubs. They usually walk but also have a bus pass so they can travel free. People also told us that they go to a drop-in centre, out to lunch with their relatives or just walk into town. One person goes on regular trips with their church and does voluntary clerical work. People are able to go on holiday regularly, usually with staff from the home. We were told by differing people how much they enjoyed their holidays. People told us that they do not have house meetings, they said ‘Staff have meetings, we are not allowed to go’. People tell the staff any problems and then staff talk about it at the meetings’. Some people said they would like to Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 18 be involved with the meetings, others said they didn’t. It would be good practice to have an advocate at meetings so people can have their say independently. People can make or take phone calls in the office and are given privacy to do so. There is no charge for the calls. One person told us that staff does things for them that they could do for themselves. Staff should ensure that individuals are encouraged to remain as independent as possible, while making sure they stay safe. We were told that the cook normally draws up the menus based on people’s likes and dislikes and that there is always an alternative on offer. We were told that no one cooks or helps prepare meals as the home employs a cook and some people said they do not like to cook or prepare the meals. One person told us they would like to cook as they had previously worked as a cook. Staff told us that they are trying to encourage this person to cook but they lose confidence and won’t go in the kitchen, but that they are continuing to work with them on this. People told us ‘We can’t make our own drinks but can have one anytime even if you wake up during the night’. Staff told us that people are given the choice of being served their meals either in their rooms or in the dining room. However, when we asked people if they could have breakfast when they wanted it in the morning, they said ‘Breakfast starts at 8am, they give you a knock, if you don’t come, you don’t get it’. People should be able to get up when they like and still have their meals when they want to. It is appreciated that this would be very difficult as there are only 2 staff on duty. However, this means that the care provided is not particularly person centred. Lunch is at 12pm and dinner is at 5pm. Drinks come round at 11am and 3pm and people can have them at other times. Of the five surveys returned to us, 2 ‘usually’ and 3 ‘always’ like the meals at the home. Lunch served during this visit was seen to be well presented and staff supported people needing assistance with eating, sensitively and discreetly. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a clear and simple complaints procedure but complaints are not recorded appropriately. Not all staff have received training in safeguarding adult procedures, which potentially places people at risk. EVIDENCE: There is a formal complaints procedure for the home that is displayed in the hallway. Although the procedure is simple it would be more accessible to people if it was in an ‘easy read format’. People spoken to during this visit said they had never had cause to complain, but were sure that if they did have a complaint that staff would listen and take it seriously. One person told us ‘I have made a complaint and it was sorted out’. A complaints file is still not being kept at the home even though the manager assured us at the last visit that one would be kept. The manager told us that they deal with all concerns straight away but do not record them. Everyone has the manager’s mobile telephone number in case they have any concerns they wish to discuss with her. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 20 Five people living at the home who responded to questionnaires confirmed that they always know who to speak to if unhappy and know how to make a complaint. One concern had been raised with the Commission with regard to the noises being made by someone living at the home. The people who raised the concern were worried that the individual may be being treated inappropriately. We looked at the care plan for this individual and there were some directions to staff on how to deal with the individual’s behaviour when they began shouting. However, these can be difficult to follow when there are only 2 staff on duty. The home should look for more ways in which to divert the individual when they begin to get distressed. Two of the three staff that were spoken with had not received formal training in POVA (Protection of Vulnerable Adults) issues although they were able to discuss different forms of abuse and said that they would report any suspicions they had. They were all also clear about who they would report any concerns to, outside of the home. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a home that has a friendly family atmosphere. However, improvements to the level of cleanliness and maintenance and the provision of equipment are needed. EVIDENCE: A full tour of the communal areas of the home was made and many of the bedrooms were looked at. Communal areas include a lounge, conservatory, a dining room and a small outside area. There are 10 single rooms, 2 shared rooms, and all bedrooms have toilet and hand washing facilities. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 22 The house was generally clean though some areas were in a poor state of repair, particularly bedrooms and some paintwork was dirty and chipped. We were told that some areas, including the hall stairs and landing had recently been decorated and that carpet throughout these areas had been replaced. During the first visit bedrooms were very untidy, cases and continence pads were stored on top of wardrobes. However, these had been tidied away by the second visit. Bedrooms are very small and ensuite facilities are not always private. For example, the walls do not reach the ceiling and doors are louvered. One toilet in a shared room did not have a door fitted, there was a curtain across the doorway, but this could not be pulled completely over. This is unacceptable and promotes neither the dignity nor privacy of the people who share the room. However, at the second visit the provider told us that they were fitting a door to the ensuite in the shared room. The owner was unable to provide evidence that building control approval had been granted in relation to the installation of the ensuite toilets. He told us this was because they had been installed prior to him purchasing the home. We have written to East Devon District Council for their advice on this matter. The shower room on the first floor is part of the fire exit route, therefore the lock to this door can be over-ridden. There was no shower curtain across the cubicle which again means that people’s privacy and dignity is not respected. There were no signs on bathroom and toilet doors, which means that people with a poor memory may not be able to find the toilet unaided. There was a strong smell of urine in several areas including the lounge and hallway. The home is in general need of refreshing and updating. The overall feel was somewhat depressing. This is concerning as current thinking suggests that people’s environment impacts on their state of mind and well being. There is very little outside space for people to enjoy and at present it is full of items that have been removed from a shed that has been taken down and there is nowhere for people who smoke to shelter from the rain. A stair lift enables people living at the home to reach the first and second floors. The home has a mobile hoist but which is located on the ground floor. Staff told us that there is no means of getting this hoist to the upper floors which means that if people fall staff have to manually lift them. We were told that this may also mean having to make the person comfortable until another member of staff was available to help. This is contrary to good moving and handling practice and does not meet the needs of the individuals living at the home. All three staff that we spoke with were able to describe procedures followed at the home to prevent cross infection and to maintain adequate hygiene. They spoke about wearing protective gloves and aprons and how these are disposed Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 23 of. They also spoke about the procedure followed when undertaking laundry tasks. All of the procedures met with current good practice guidelines. Staff also confirmed that they had received training in infection control procedures. Care staff are responsible for laundry while they are on duty. The laundry facility is located outside the home, it is very small and there was no soap or paper towels in there. This means that staff who had been dealing with soiled laundry could not wash their hands before returning to the home, presenting a risk of cross infection. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels are not always sufficient to ensure that peoples health and social care needs are being met at all times. The procedures for the recruitment of staff are not entirely robust and therefore do not always ensure protection for people living at the home. EVIDENCE: On the day of the visit there were 13 people living at the home with 2 care staff on duty, plus the manager and provider. There was also a cook and a cleaner at the home. The manager told us that at night time there is one staff member awake and one asleep. The rota did not indicate who was the senior person on duty. This may cause confusion in an emergency with no-one being sure who is responsible for taking action. We were also told that one member of staff was due to work 24hrs without a break. We pointed out the dangers of this and shifts were changed. The rota Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 25 was not accurate as it did not show the staff working these hours, but indicated that another person was working one of the shifts. The manager told us that she was unaware that the rota had been changed and that she fully understood the dangers of staff working for such long periods. We spoke with 3 members of staff and all said they felt that sometimes there was enough staff on duty, but that sometimes there was not. In particular there was little time to spend with people chatting or taking them out as most of their time spent with people is while performing care tasks. Staff told us about training they had received which included medication administration, fire training, infection control and dealing with challenging behaviour. They also said that they had received training in working with people with dementia, which they had found very useful. Staff were aware of the needs of the people they were caring for and were keen to provide a good service. They told us that they enjoyed working at the home and making people feel that it was their home. However, staff felt that their views were not always taken into consideration and that there was sometimes a ‘If you don’t like it….leave’ attitude from senior staff. We were also told that staff meetings were not held regularly. The files of three staff were looked at, all contained satisfactory CRB (Criminal Records Bureau) checks, full employment history and two written references. However, one did not contain proof of identity. None of the files contained information about people’s health. However, we were told that new application forms were being drawn up and that these would ask people to declare that they were physically and mentally fit to do the job. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally run in the best interest of the people living there. Systems are in place to promote the health and safety of people living and working at the home although recruitment procedures and poor maintenance could place people at risk. EVIDENCE: People living at the home and staff benefit from the experience of the current manager who has worked at Miramar for 22 years and in a managerial position Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 27 there for the last 8 years. During this time she has gained experience of working with people with mental health problems as well as older people. The owner is also involved in the day-to-day running of the home and staff and people living there spoke highly of them. The manager told us that due to the size of the home people are consulted on all aspects of their life at Miramar on a daily basis when staff chat with them. The manager and owner told us they ask for opinions and make sure that people know that staff and management are open for any comments. The manager told us she operates ‘an open door approach’ to people living at the home, staff and visitors, which encourage good communication and standards. However, staff told us that they sometimes felt that communication was only one way, with them being told what to do and them not being listened to. Staff told us that they do not receive regular supervision and that they would welcome the opportunity to receive feedback on their work. The manager told us that there was no-one living at the home that is subject to a deprivation of liberty authorisation. We saw no evidence to show that anyone living at the home is having their liberty deprived without an authorisation. There is no formal quality assurance system in place at the home that shows that people have been consulted about the quality of care provided by the home. Although some questionnaires have been sent out to people living at the home the system is haphazard. All the individuals have their own money which they sign for. Staff support people with handling their money. The AQAA (Annual Quality Assurance Assessment) was not submitted when we asked for it, but was submitted following our visit, just before the report was completed. It provided evidence that Miramar complies with health and safety legislation in relation to maintenance of equipment, storage of hazardous substances, health and safety checks and risk assessments. The record of fire safety training and accident and incident records were found to be accurate and up to date. Policies and procedures are not always inspected during the visit but the information provided on the AQAA helps us form a judgement as to whether the home has the correct policies to keep people living and working at the home safe. Information provided by the home, evidenced that policies and procedures are in place and along with risk assessments are reviewed regularly and updated where necessary, to ensure they remain appropriate and reduce risks to people living and working at the home. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 28 So that the risk of burning from hot surfaces is minimised, radiators within the home are covered. All windows above ground floor level are fitted with restrictors, in order to minimise the risk of anyone falling from these windows, and so that the risk of burning from hot water is minimised temperature controls are fitted to bath taps. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 X 2 2 X 1 2 2 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 30 Are there any outstanding requirements from the last inspection? YES 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 OP29 Regulation 19 Requirement The registered person shall not employ a person to work at the care home unless he has obtained the information and documents specified in paragraphs 1-7 of schedule 2. (This relates to proof of identity) (This requirement has been partially met since the last inspection) 2. OP26 232d Arrangements must be made to 31/03/10 ensure that all areas of the home are kept clean at all times. This is to make sure that people live in a clean, fresh and hygienic environment and any risk of infection is minimised. (Previous timescale of 05/04/09 not met) Timescale for action 31/03/10 Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 Good Practice Recommendations Each person living at the home should be provided with a contract or statement of terms and conditions, to ensure they are aware of their rights. Assessments should be up to date and provide enough information to ensure the home can establish whether they can meet the individual’s needs and should form the basis of individual care plans. The service should confirm in writing that they can meet individuals assessed needs before they move to the Home. 3. 4. 5. OP7 OP7 OP7 Daily recordings should be specific, detailed and appropriate. Risk assessments relating to falls and nutrition should be completed to minimise risks to people in these areas. Care plans should detail how care is to be given and all information should be regularly reviewed with the involvement of people or their representatives. Medication to be returned to the pharmacy should be stored and labelled individually. People’s privacy and dignity should be maintained at all times. People should have more opportunities for social interaction made available to them, including outings. People should be supported to maintain their independence and helped to make real choices. A record should be kept of all complaints made and includes details of investigation and any actions taken. 2. OP3 6. 7. 8. 9. 10. OP9 OP10 OP12 OP15 OP16 Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 32 11. 12. 13. 14. 15. 16. 17. 18. OP18 OP19 OP22 OP26 OP27 OP27 OP30 OP33 All staff should receive formal Safeguarding Adults training. People should live in a safe well maintained environment. Moving and handling equipment should be available in all areas of the home. The home should be kept fresh and free from odour. There should be enough staff on duty to ensure interactions with individuals are not purely task focused. The staff rota should indicate who is the senior person on duty. Staff should receive up to date training in moving and handling. The quality assurance system should be formalised with the results being made available to people living there and other interested parties including the Commission. Staff should receive formal recorded supervision at least 6 times a year. 19. OP36 Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 33 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Miramar DS0000021983.V378361.R01.S.doc Version 5.3 Page 34 - 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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