Inspection on 12/02/09 for The Mount Residential Home

This is the latest available inspection report for this service, carried out on 12th February 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Mount Residential Home Heydon Road Aylsham Norwich Norfolk NR11 6QT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Dragan Cvejic     Date: 1 2 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: The Mount Residential Home Heydon Road Aylsham Norwich Norfolk NR11 6QT 01263734516 01263735424 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Sunrise Care Homes Ltd care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 22 The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Mental Disorder, excluding dementia or learning disability - Code MD Date of last inspection 22 22 0 Over 65 0 0 22 Care Homes for Older People Page 4 of 25 Brief description of the care home The Mount is a care home providing personal care and accommodation for 22 older people, older people with dementia or adults with mental health needs. The home is located in the market town of Aylsham and is near to all local amenities. The home was opened in 1985 and has been modernised and extended. The home is large and detached. The original part of the building was built in the 1930s and this is complimented by a large single storey extension built around a small quadrangle. There are 16 single bedrooms, three of which are en suite and three double bedrooms. The communal accommodation is spacious and the home benefits from pleasant gardens and grounds. In April 2008, new , current owner bought the home, continued business with only minor changes that did not affect users of the service or staff. On the day of inspection all service users were male and this is usually the case. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The service was last inspected on 27/08/07, but has changed ownership in April 2008 and has been considered as a new service for the purpose of this inspection planning. The new proprietor filled in a self assessment form, AQAA, where he presented what the achievements of the home were, what has changed since the take over and what their plans for the future were. They have been informing regulators through regular reporting of accidents/incidents and events that affected people who use the service. This unannounced inspection took place on 12/02/09 in the morning hours and was conducted as the first inspection of the service under new ownership. We case tracked 3 users of the service, checked their files, their rooms, medication Care Homes for Older People Page 6 of 25 records, money records and other issues related to their their care and well being. We spoke to them and to other 4 people who use the service, to a visitor, to 3 staff members and the manager. We also checked some policies and general files kept in the home. We checked the medication records for 3 more people in the home. We observed staff administering medication, helping two people with mobility problems, addressing a withdrawn appearance for one man in the service and advising a tired man to have a rest if he wanted to. A tour of the home gave us an opportunity to check the environment. We met the propietor and talked to him about our findings during this site visit. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 provided information about services and provisions allowing users to make an informed choice. A full and comprehensive assessment was undertaken to ensure that once admitted, the users needs would be met. Evidence: The manager stated that she was just in the process of up-dating the Service Users guide and incorporated all changes already assessed in their statement of purpose. The statement of purpose was on display in the entrance hall and was available to anyone interested. All three checked files contained evidence of initial assessments, collated both from the previous place where people lived or where they were cared for and the homes own assessment conducted by the manager. The assessment included all relevant details necessary for building a care plan. The owner explained their admission process in their self assessment, AQAA (Annual Quality Assurance Assessment): Care Homes for Older People Page 10 of 25 Evidence: Discussions take place with family members and prospective service users are invited for lunch, or to stay for a night, to experience the setting before commencing their placement. Visits take place with prospective residents in their own home or hospital ward. He continued explaining how the home decide if the assessed needs could be met: Good understanding of individual prospects requirements prior to the placement starting, in order to fully appreciate the service users needs eg. layout of the rooms, personal routines, diets, cultural and religious needs, mobility and orientation needs and clothing. The home developed a different colouring system of the doors to help with orientation of people living here who suffer from dementia. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 ensured service users health care needs were met, but at the same time respected their privacy and dignity. Medication procedures were appropriate and protected service users. Evidence: With the change of ownership,the care plans were improved. All three files contained care plans drawn up from initial assessments. A case tracked man commented that he knew about his care plan, but was much very interested in what was recorded about his care. Care plans contained risk assessments. One of the these included preference the user of the service expressed: not to be checked overnight. The risk assessment was drawn up to reduce risks, but to accommodate this personal choice. In the third check file, there was a family history resume provided by the family of the user of the service. This helped staff plan appropriate care, including emotional and social support. The owner reported in their AQAA: Care plans are now more robust and involve carers and service users - a person centred approach. Care Homes for Older People Page 12 of 25 Evidence: Files contained evidence of healthcare needs and responses. The charts were used to monitor specific aspects of needs, individually asssessed for each user of the service. Records of visits by external professionals showed that various professionals were engaged when it was necessary. The medication procedure was checked. The administering process was observed. The records for case tracked users and 3 more were checked. Well documented and appropriate, the procedure enhanced users protection. Privacy and dignity of users were respected. A user fell asleep in the dining room and staff reacted by gently waking him up and suggesting he moved to his room for a rest. Staff helped him get up from the chair and escorted him to his room, ensuring his safety. Staff were aware that another users mug only needed to be half filled due to his tremor. A user and the visitor spoken to stated: They even bought a shed for my brother. A phone was available for users that wanted to make private phone calls and free telephone calls could be made to families and friends. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 met service users needs in this area. All service users spoken to were happy with provisions of activities and food provided in the home. Evidence: Food is excellent here, stated a visitor on behalf of her brother she visited at the time of the site visit. The owner reported in their AQAA: Nutritional information has been introduced, with food diaries being kept when necessary. The cook stated that users could choose alternative meal at any time. However, these changed meals were not individually recorded to ensure health and infection prevention for people that lived in the home. Themed events that were taking place regularly were introduced and enriched the choice of food. A computer was provided and made available to people that lived in the home. One of the case tracked users was involved mowing the grass in the garden in the Summer months. The manager explained the policy on users money. For those that wished the managers help with their finances, the home arranged safekeeping of their money and organised well kept records of all transactions and balances. The manager considered the Mental Capacity Act and attended recent training to ensure better Care Homes for Older People Page 14 of 25 Evidence: protection of service users. While talking to a user in front of the building, he greeted three local passers-by and it was obvious that they knew each other. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 displayed a clear complaints procedure and service users were confident that any complaint would be dealt with seriously and investigated to the complainants satisfaction. Evidence: The written procedure was displayed next to the entry to the home and was clear and accessible. People spoken to during the site visit confirmed that they were confident that any complaint would be properly investigated. The complaints records were accurate when checked, with the last entry dated in April previous year. POVA (Protection of Vulnerable Adults) training was added to the induction, thus ensuring better protection of service users. There were no allegations or issues requiring referrals to POVA register. Staff were aware of the procedure and two of them spoken to during the site visit stated that they knew about the whistle blowing policy. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users enjoyed a well maintained, well equipped and clean and bright environment. They were listened to when changes and regular maintenance was organised and executed. Under new ownership, new investments were noticed that improved the conditions for users of the service. Evidence: The owner reported in their AQAA about new investments and improvements in the home since the change of ownership: More music available/radios installed in bedrooms on request. Carpeting and general furniture for example chairs, beds and tables are provided and replaced as necessary. Domestic cleaning services are covered and all maintenance work is undertaken. More outdoor seating provided. Computer facility installed. Bird tables and bird food provided regularly. Cactus for one resident purchased. Created a more homely and safer environment pictures/ramps/handrails installed. Allotment area made available - the home is now benefiting from homegrown fresh vegetables. Monthly health and safety audits are conducted which also include a review of how to continue to make improvment designed to enhance the homely nature of the service setting. When one of the newly installed self closing devices was found broken during the site visit, the owner took action straight away and arranged for replacement then and there, showing his commitment not only to comfort, but to safety too. Care Homes for Older People Page 17 of 25 Evidence: A user spoken to during the site visit stated that the environment was much better looked since the chage of ownership. The home was inspected by the Health and Safety and their report was positive. Sharing double bedrooms was discussed with users occupying them. Th new smoking arrangement protected non-smokers much better and there was a plan to create a sheltered smoking area that would not affect others. Dedicated bed linen also improved infection control measures. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home ensured safety for service users by employing sufficient, trained and appropriately vetted workers, creating a rota that corresponded to users identified needs and by training, recruitment, stability and the observed quality of staffs work exceeded minimum standards. Evidence: Three staff members were spoken to in addition to the manager. They were generally very happy working here. Their summaries comments included: very supportive manager, excellent staff atmosphere, excellent and relevant training and NVQ training was done in work time. Three staff files were checked and showed that all necessary checks were carried out prior to staring work with vulnerable men living in the home. Staff training records were checked and showed that staff were up to date with mandatory training such as first aid, fire, infection control, manual handling and Protection of Vulnerable Adults (POVA) and also attended training relevant to users conditions, such as dementia, challenging behaviour and the manager prepared to provide training on Mental Capacity Act that would enhance users rights while still protecting them. All checked staff elements showed that minimum standards were exceeded and the owners comment in his AQAA about the rota also showed how the home exceeded standards: Staff rotas are planned with a consideration for individual skills and Care Homes for Older People Page 19 of 25 Evidence: experience. The rota checked showed 4 staff in the morning and two in the afternoon, thus responding to assessed needs and ensuring enough staff were deployed to meet all these needs. There are enough staff and they are excellent, commented a user when we spoke to him. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users were well protected by the safe working practices in place. Evidence: The manager was working in this home for 14 years and ensured stability in the dayto-day operation of the home. She completed the Registered Manager Award training and training on POVA that allowed her to train the rest of the staff on that subject. She also recently completed her training on Mental Capacity Act and planned to transfer her knowledge to the whole staff team. The last quality assurance review was conducted the year before, but new questionnaires were sent out and a planned review was to be conducted soon. Meanwhile, comments from people that used the service, their relatives and other visiting professionals were constantly sought and actions taken in response to suggestions. All users of the service spoken to commented that they felt happy with the current arrangement for handling their money. The manager was appointee for three users, but included social services in audits and checks of users money. Care Homes for Older People Page 21 of 25 Evidence: Supervision records were on the board in the office and showed regularity of these sessions. The staff spoken to confirmed that they were supervised about once every two months and added that they felt very supported by the manager and the owner. The owner was present in the home approximately 2-3 days a week, and supported the manager and the staff team. Safe working practices were in place. Observation of staff working with users of the service demonstrated that staff were confident in applying the set procedures to protect service users. The tour of the home showed that cleanliness and measures for infection control were in place. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 15 The home should arrange recording of the meals chosen as alternatives for each occassion and each individual. This would improve infection control and better protect users from potential infections. Care Homes for Older People Page 24 of 25 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - 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!