Care Home: Miramar Nursing Home

What the care home does well Residents are consulted about what happens in the home, and staff listen to their views and wishes. They have good care plans that tell people how they want to be supported. The service helps residents to stay safe by, for example, making sure they know how to complain if they are not happy with anything, and supporting them to understand things like the fire evacuation procedures. Staff also get training about how to identify different types of abuse, and what to do if it occurs. The staff are recruited safely and they are given lots of training to help them understand the needs of the residents. They also get good support from the manager, so that they can use what they learn to benefit the residents. What has improved since the last inspection? Since the last inspection there have been lots of improvements in the home. Care plans and risk assessments now have more detail in them, and they include needs such as pressure area care and social needs. Records of activities are also kept, to show what residents have joined in with or been offered. There has been redecoration in many areas of the home, and some new flooring and furniture has been provided. The home is now a `no smoking` environment, after consultation with residents, and a shelter has been provided outside for those who wish to smoke. A new induction programme for staff has been introduced, and there is an ongoing training plan for the year ahead. Staff also have regular supervision sessions. A new acting manager was appointed in June 2007, and she is in the process of applying to register with us. What the care home could do better: We made a requirement at the last inspection visit for the provider`s representative to visit the home regularly and make a report of the visits. The requirement has not been fully met, as the reports are still not available to be inspected. The requirement remains in place, but we have agreed to a new short time scale so that the reports can be made available at the home for inspection. We will review the situation at the end of the new time scale. We did not make any other requirements during this visit, but we did make some recommendations for good practice. We said that as most of the residents have lived at the home for a long time, their initial assessments should be reviewed, so that there is an up to date view of their needs. Although care plans have some information about how residents are supported to make decisions, we suggested that plans show how recent legislation about the subject has been considered. This will help to show how the home protects resident`s rights. We also said that the way risk assessment reviews are recorded should be looked at, so that information is made easier to read. We have suggested that formal processes and specific formats are used to record audits of things like care plans and medication records. We said that the formats should show what was looked at and what the outcomes were. This is so that the home can show how they dealt with the things that they identified. We also said that the abbreviation key on medication records should be reviewed, so that the records are easier to audit. CARE HOME ADULTS 18-65 Miramar Nursing Home Miramar Nursing Home 20 Trusthorpe Road Sutton On Sea Lincs LN12 2LT Lead Inspector Wendy Taylor Unannounced Inspection 22nd April 2008 09:30 Miramar Nursing Home DS0000066650.V362865.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 Miramar Nursing Home DS0000066650.V362865.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. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Miramar Nursing Home Address Miramar Nursing Home 20 Trusthorpe Road Sutton On Sea Lincs LN12 2LT 01507 442484 01507 443313 elliesmee@yahoo.co.uk 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) Super Care Limited Manager post vacant Care Home 28 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (28) of places Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide personal care for service users of both sexes whose primary needs fall within the following categories:Mental Disorder requiring Nursing Care, not falling within any other category (MD) 24. Mental Disorder requiring Personal Care, not falling within any other category (MD) 4. The maximum number of service users to be accommodated is 28. Date of last inspection 26th April 2007 Brief Description of the Service: Miramar is a detached property located near to the sea front and the town centre of Sutton on Sea, which has a range of local shops and facilities. The home is registered to provide nursing and residential care to people with mental health needs. Accommodation is provided on 2 floors in 12 single and 8 double bedrooms, with communal areas being situated on the ground floor. A lift allows access to the first floor. A car park is available at the front of the building. There is a purpose-built day centre next to the home but this is currently not in use by service users, though it is used occasionally for accommodation for staff in flats on the second floor. At the time of the inspection the home confirmed that the weekly fees were £544:00 per week. Information about these costs as well as the day-to-day operation of the home, including a copy of the last inspection report, is available from the main office of the home. Miramar Nursing Home DS0000066650.V362865.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 key unannounced inspection took place on one day in April 2008 and lasted for approximately 7 hours. The care and support received by four residents was followed in detail, using a method called case tracking. This method involves talking to the residents and observing the care and support they receive. It also involves looking at their care plans, medical records and daily notes. Some of the general house records and staff records were also looked at. Staff and the acting manager were spoken to during the visit, and information already held by the commission, such as a self-assessment and notifications, were also used as part of the inspection process. Residents said that they were very happy living at the home, and staff said they enjoy there. Other comments from residents and staff are contained in the body of the report. What the service does well: What has improved since the last inspection? Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 6 Since the last inspection there have been lots of improvements in the home. Care plans and risk assessments now have more detail in them, and they include needs such as pressure area care and social needs. Records of activities are also kept, to show what residents have joined in with or been offered. There has been redecoration in many areas of the home, and some new flooring and furniture has been provided. The home is now a ‘no smoking’ environment, after consultation with residents, and a shelter has been provided outside for those who wish to smoke. A new induction programme for staff has been introduced, and there is an ongoing training plan for the year ahead. Staff also have regular supervision sessions. A new acting manager was appointed in June 2007, and she is in the process of applying to register with us. What they could do better: We made a requirement at the last inspection visit for the provider’s representative to visit the home regularly and make a report of the visits. The requirement has not been fully met, as the reports are still not available to be inspected. The requirement remains in place, but we have agreed to a new short time scale so that the reports can be made available at the home for inspection. We will review the situation at the end of the new time scale. We did not make any other requirements during this visit, but we did make some recommendations for good practice. We said that as most of the residents have lived at the home for a long time, their initial assessments should be reviewed, so that there is an up to date view of their needs. Although care plans have some information about how residents are supported to make decisions, we suggested that plans show how recent legislation about the subject has been considered. This will help to show how the home protects resident’s rights. We also said that the way risk assessment reviews are recorded should be looked at, so that information is made easier to read. We have suggested that formal processes and specific formats are used to record audits of things like care plans and medication records. We said that the formats should show what was looked at and what the outcomes were. This is so that the home can show how they dealt with the things that they identified. We also said that the abbreviation key on medication records should be reviewed, so that the records are easier to audit. Miramar Nursing Home DS0000066650.V362865.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. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 8 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 Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory assessment process ensures that resident’s needs can be met, and they have enough information to make a choice about where they live. EVIDENCE: There is clear information available to people who may wish to come and live at the home. The information is provided in an up to date statement of purpose and service user guide. The service user guide was available in resident’s bedrooms on the day of the visit, and the statement of purpose was available in the office area. Pre inspection information told us that people are invited to visit before they move in, and that the statement of purpose and service user guide are updated every year. Copies of individual terms and condition for the placement were also seen in personal files. The manager told us that she plans to develop a brochure to advertise the services they provide in a better way. There are initial basic needs assessments in place, however some of the residents have lived at the home for a long time, and it was recommended that their initial assessments be updated. Other parts of the assessment package cover needs such as perception, communication and personal hygiene. OnMiramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 10 going assessments are in place for needs such as pressure area care and nutrition. People’s general likes, dislikes and preferences are recorded in clear personal profiles. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to make choices and decisions about their daily lives, and care plans ensure that support is provided in the way that they prefer. EVIDENCE: Each resident has a personal file, which contains things like their care plan, risk assessments and daily records. Each file has an index of what care plans are in place, for example, personal hygiene, continence, mental health needs, pressure care, behaviours, communication and vulnerability. The plans refer to maintaining resident’s privacy, dignity, personal preferences and wishes. They also refer to health promotion with issues such as smoking. Although the plans make some reference as to how residents are supported with decision-making, it was recommended that they contain more details to show that recent legislation about the subject has been considered. Information about the recent legislation is available in the home. Records show that staff some staff have received training in the subject, and more training is booked. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 12 Residents said that they look at their care plans with staff, and the plans contain their signatures to show that they agree with them. There are also records to show that reviews are carried out every month and residents are involved with them. Residents said that staff help them to do whatever they want to do, and one person said that staff help them to decide things if they get confused. They said that their personal money is ‘kept safe’ in the home and they can have it whenever they want. Record keeping processes for personal money were satisfactory and residents had signed the records when they had taken their money. Risk assessments are in place for needs such as scalds, locked bedrooms, self harm, moving and handling, falls and neglect. Care plans refer to the use of lap belts on wheelchairs, but the manager said that she would also put risk assessments in place regarding this. Records show that the risk assessments are regularly reviewed. Review details are written on the bottom of the assessment but they were difficult to read. A recommendation was made to develop a clearer way of recording the reviews. The minutes of residents meetings show that they are consulted about issues such as meals, laundry, staffing, smoking and social activities. Staff were seen offering choices about daily activities, for example, what they want to eat, where they want to spend their time and who they want to spend time with. They spoke to residents in a calm and respectful manner, and they were also encouraging residents to talk to each other in a similar way. During discussions staff showed a good understanding of how to maintain people’s dignity and privacy. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Activity arrangements currently meet the wishes and needs of residents, and they benefit from a varied and balanced diet. EVIDENCE: There are care plans in place for social and leisure activities, and there are daily records to show what activities residents have been offered or joined in with. Some of the residents said that they ‘don’t want to do much’ during the day, and others said that they can go to the pub or the shops when they want, or get a bus into Skegness. Most residents spoken to said that they did not want an activity plan, and they said that if they want to do anything different they can say so at meetings. Minutes of meetings show that activities are discussed, and two residents have asked to go on a mini bus trip. The manager said that individual arrangements would be made to accommodate this. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 14 Residents said that they can spend time on their own when they wanted to, and the home demonstrated that it meets the needs of couples in regard to privacy and space. They also said that they could have visitors when they wanted, and they were supported to visit their families. Staff were seen encouraging residents to join in with puzzles and writing, and they were spending time talking to residents. The menu for the lunchtime meal was displayed in the dinning room, and residents knew what they were having. A four weekly guide menu is available, and residents said that they could choose what they want to eat and the staff talk to them about menus at their meetings. Again minutes of residents meetings confirmed this. Residents said that the food is very nice and ‘there is plenty of it’. At lunchtime some residents were having different foods to the advertised menu, and they said that had asked for the alternative earlier in the day. Alternatives were also provided during the meal when residents changed heir minds about what they wanted to eat. Extra food was provided when asked for. Care plans show any needs associated with eating and drinking, and there is a nutritional assessment in use. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have good support for health and personal care, according to their individual needs and wishes. There are satisfactory arrangements for the administration of medications. EVIDENCE: Care plans are in place for health and personal needs such as diabetes, continence, pressure area care and other specialist medical needs. The plans set out signs and symptoms of specific health needs that staff should be aware of, and staff demonstrated their knowledge of these issues. The plans refer to maintaining privacy and dignity for residents when supporting them with personal care needs, and pre inspection information told us that emotional health needs are also now included in care plans. Records show when residents have received input from health professionals such as GP’s, psychiatrists, community nurses and chiropodists. There is also lots of information available in the home about health needs, for both Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 16 residents and staff. The manager said that they are in the process of formulating plans to show people’s end of life wishes. Residents said things like ‘I can see my doctor when I need to’, ‘don’t like hospitals but staff help me with this’, ‘there are good nurses here’, and ‘I can see someone about my eyes and feet when I need to’. Staff were observed making health related appointments for residents, alerting other health professionals to changing needs, and supporting residents to have health appointments in places that suit their needs. Administration and storage of medications was satisfactory, and there were no residents self-administering medication at the time of the visit. Care plans show where residents are not able to self-administer medication, and they also give details of any side effects to look out for, where appropriate. The manager said that the local pharmacy now visit four times a year to support them with medication issues. It was discussed with the manager that photographs should be available on medication records, and this was done on the day of the visit. Recommendations were made to review the abbreviation key on medication records, so that the records are easier to audit; and for medication audits to be recorded in a specific format and contain more details. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s procedures for managing complaints and allegations of abuse. They are confident that any concerns will be taken seriously, and they feel safe living at the home. EVIDENCE: Records show that there have been no complaints made about the service since the last inspection. A copy of the complaints procedure was seen in resident’s bedrooms and in the entrance hall. Residents said that they can talk to staff about anything that they are not happy with, and they said that staff always listen and help them to sort things out. They also said that they feel safe living at the home. Minutes of residents meeting show that complaint issues are a regular item on the agenda, and minutes of staff meetings show that safeguarding adult issues are regularly discussed. The manager said that she also plans to put whistle blowing and safeguarding adult issues on the agenda for staff supervision sessions. Records show that staff receive training about keeping residents safe, and they demonstrated their knowledge of the subject during discussions. There is a copy of the latest Local Authority safeguarding adult’s policy within the home, and the manager described arrangements that are in place for the use of independent advocates. Records show there have been two referrals made to the Local Authority Safeguarding Adult team since the last visit. One referral is currently being looked into, and investigations showed that there was no Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 18 foundation the other referral. Both issues have been reported and managed appropriately by the home. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have use of a generally personalised and comfortable environment, but some areas of the home need attention. EVIDENCE: A partial tour of the building showed that redecoration and renewal of furniture has taken place in the dinning room, games room, a lounge area and the entrance hall. New flooring and carpets have also been laid in some bedrooms and communal areas. After consultation with residents, it was agreed to make the home a smoke free environment and there is now a shelter outside for those who wish to smoke. There is a maintenance programme in place and work such as glazing, cleaning gutters and treating damp is booked to take place in the very near future. Pre inspection information tells us that there is also a programme in place to paint Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 20 the outside of the building in the near future. Records show that general maintenance work is carried out in a timely manner. The home was very clean and tidy on the day of the visit and residents said that they had been helping to clean their bedrooms. They also said that staff talk to them about the work needed in the home, and ask them what colours and fabrics they would like. Bedrooms were personalised to individual tastes and wishes, but many were in need of redecorating. The manager said that the maintenance programme for the coming year includes redecorating bedrooms and renewing bedroom furniture. Most of the outside areas are laid to concrete, and the manager said that the housekeeper would be helping residents to grow plants in pots to brighten up the areas. There are temperature control valves on all hot water taps, and there are sinks available around the house for hand washing. Staff were seen using gloves and aprons where appropriate. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A safely recruited and knowledgeable staff team supports residents. Training arrangements are based on residents needs. EVIDENCE: Staff files contain records such as criminal record bureau checks, application forms, two written references and personal identification. Current application forms do not contain a section about the health of the applicant, and two files for staff employed several years ago only contained one written reference. The manager made sure that on the day of the visit, the application format was revised, and she took steps to obtain the outstanding references. Nationally recognised induction packages are in place for new staff, as well as an in-house induction pack. Records show that staff receive training in subjects such as administration of medicines, infection control, mental health awareness, promoting equality, Mental Capacity Act, fire safety, care planning, and moving and handling. There is a training plan in place for the coming year, and it shows plans for training in subjects such as diabetes awareness and up Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 22 dates for training already undertaken. Pre inspection information tells us that two staff are undertaking a nationally recognised course about customer care, and two staff were commencing a nationally recognised course in care practice during the visit. Staff said that the training package at the home is ‘very good, and they are always learning new things. Supervision records show that staff receive this support on a regular basis, and they confirmed this during discussions. They said that the sessions help them to review progress as well as learn new things. The manager said that she is in the process of carrying out yearly appraisals for all staff. Staff said they feel well supported by colleagues, and their views are listened to. They demonstrated a good knowledge of residents needs, likes and dislikes. Residents said that staff are ‘really nice’, ‘they know how to help you stay calm’, and ‘they are always around and helpful’. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The leadership, support and communication within the home means that residents receive a good standard of care. However the external systems that monitor and evaluate the level of service being provided are not robust enough. EVIDENCE: The acting manager has been in post since July 2007, and is in the process of registering with us. She is a registered nurse and is currently undertaking training in mental health needs at diploma level. She is also due to attend a course about new legislation that is due to come into force next year. Residents and staff said that they get good support from the manager, and she is very approachable. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 24 Staff said that communication within the home was good and they get to know about whatever is happening. Records show that there are regular qualified nurse meetings, which include discussions about things like recruitment, leadership, commission information and staff rotas. General staff meetings also take place and include discussions about management plans, the manager’s role, activities, environmental improvements, and menus. Residents’ surveys are carried out at various times through the year and are done in small batches so that views are current. The latest surveys show mainly positive responses about the level of service that residents receive, however they said that they wanted more trips out. As mentioned in an early section of this report, the manager said that individual arrangements for outings are being looked into. The manager said that there is an informal auditing process for care plans, and a recommendation was made that this becomes a formal and recorded process (also see Standard 20 for additional audit reference). Fire safety notices are displayed around the home, and residents described the evacuation procedures that are in place. The report from a recent Fire Officer inspection shows satisfactory outcomes, and the fire risk assessment has recently been updated. Information is in place about substances that are hazardous to health, and the manager said that she is in the process of reviewing the risk assessments for these and general environmental issues. A recent inspection from the Environmental Health Officer gave generally satisfactory outcomes, but there was one recommendation made about documentation. The manager showed that she is in the process of addressing the issue. A requirement was made at the last inspection visit for the provider’s representative to carry out regular monitoring visits to the home. The manager, staff members and the provider’s representative said that monthly visits now take place and reports are written, however the reports were not available within the home. The requirement remains in place and a further short time scale for action was agreed with the provider’s representative, for the reports to made available in the home. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 X 4 X 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X 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 X 3 X 3 X 2 X 3 Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 26 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA41 Regulation 26 Timescale for action The provider must visit the home 02/05/08 unannounced at least monthly and produce a written report of his findings so that he can evaluate the level of service being provided and any issues which needing addressing. This requirement had a time scale of 01/06/07, which has not been fully met. A further time scale to fully meet the requirement has been set. Requirement 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. Refer to Standard YA2 YA7 Good Practice Recommendations It is recommended that initial assessments are reviewed and updated, so that they better reflect resident’s current needs. It is recommended that care plans contain details about how recent legislation (Mental Capacity Act, 2007) has been considered, so that resident’s rights are better protected. DS0000066650.V362865.R01.S.doc Version 5.2 Page 27 Miramar Nursing Home 3. 4. 5. YA9 YA20 YA20 6. YA39 It is recommended that the format for recording risk assessments is reviewed, so that the information is easier to read. It is recommended that the abbreviation key on medication records be reviewed, so that the records are easier to audit. It is recommended that audit of medication records be recorded in a specific format that records the issues looked at and the outcomes. This is so that there is clear evidence that any issues have been identified and dealt with. It is recommended that informal processes for auditing care plans become formal and recorded ones. This is so that the quality of care plans can be monitored more effectively. Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 28 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. Extracts may not be used or reproduced without the express permission of CSCI Miramar Nursing Home DS0000066650.V362865.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!