Inspection on 02/06/05 for 230a Mountnessing Road

This inspection was carried out on 2nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

230a Mountnessing Road 29/08/08

230a Mountnessing Road 03/09/07

230a Mountnessing Road 17/10/06

230a Mountnessing Road 03/11/05

230a Mountnessing Road 02/11/04

230a Mountnessing Road 25/05/04

230a Mountnessing Road 08/12/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Mountnessing Road (230a) 230a Mountnessing Road Billericay Essex CM12 0EH Lead Inspector Bernadette Little Unannounced 2 June 2005 10:15 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 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 Stationary 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. Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Mountnessing Road (230) Address 230 Mountnessing Road Billericay Essex CM12 0EH 01277 632914 01277 632914 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Estuary Housing Association Limited Yolanda Inciong CRH Care Home with Nursing 8 Category(ies) of LD Learning disability (8) registration, with number of places Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing and personal care to be provided to 8 service users with learning disability. 2. Nursing and personal care to be provided excluding any service users liable to be detained under the Mental Health Act 1983. Date of last inspection 2nd November 2004 Brief Description of the Service: Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection that took place on a Thursday at 10.15am. The deputy manager was in charge of the home during the morning shift and the registered manager was on duty during the afternoon shift. All parts of the premises were looked at, as were records and other documents. As most of the residents could not speak, time was spent looking at and listening to the everyday routines and ways of the home. Some of the residents had relatives that visited, but none of these happened to be at 230 Mountnessing Road on the day of this inspection. Time was also spent with staff and five staff were spoken with. The help given by all staff at 230 Mountnessing Road was appreciated. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 6 contacting your local CSCI office. Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 4, 5 230 Mountnessing Road provided interested people with information and opportunity to visit to make an informed decision about taking up a place there. The home’s admission process was detailed to ensure that the home could meet the needs of prospective residents. Residents’ terms and conditions were written in a pictorial format to make them easier to understand. EVIDENCE: Each service user had a folder in their bedroom that contained a copy of the Statement of Purpose, Service User Guide, and statement of terms and conditions. The terms and conditions had been read by, and signed as in the residents best interest, by an independent advocate. There had been no new admissions to the home for some time, but discussion with staff on past practice and inspection of records confirmed an appropriate pre-admission assessment process with trial visits. Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 8, 9 Care plans had a good standard of detail that provided staff with information on consistent care approaches for each person. They were supported by risk assessment to protect residents. EVIDENCE: Detailed care plans were in place that generally covered all aspects of residents care needs. Some areas did not have enough information, for example a plan of care management for epilepsy, the times the resident preferred to go to bed and get up, or how to care for their needs where they regularly woke during the night.. Regular reviews of care plans were recorded. The home continued to develop Person Centred Planning files for service users. It is acknowledged that, due to service users complex needs, opportunities for residents to offer input to activities and processes within the home, is limited. Discussion with staff and inspection of records showed that staff tried to interpret residents’ wishes and preferences. Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14,15,17 Residents were provided with opportunity for some meaningful activities and leisure pursuits in the community, in line with their age and abilities. Visits from relatives had been encouraged. Residents were offered a variety of foods and drinks, served in a manner appropriate to meet their needs. EVIDENCE: Inspection of care plans, care notes and financial records showed that residents go out for meals and to the pub, to the cinema, shopping to the circus or the theatre. Staff confirmed the activities but advised of limited time to interact individually with residents at home and of some restrictions on outings due to a limited number of staff who are drivers of the home’s vehicle. Two residents had recently been on holiday at Disneyland Paris and two others were packed for a trip to the Lake District. Two residents attend day resource facilities. The meals served were well presented. Meals are cooked in the kitchen of one unit. One staff stays with the residents in a unit while the meal is served to the other group of residents, to ensure adequate assistance with feeding and to respond to a choking risk identified in individual risk assessments. A nutrition record was maintained but did not show all specific dietary needs. Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21 The home supported residents to access healthcare services to meet their individual needs. The medication system was generally well managed, but would benefit from updated protocols in some cases. There was insufficient information on residents’ wishes and needs at the end of life. EVIDENCE: Records showed detailed information of all the healthcare professionals involved for each resident, as well as of the appointments and contacts made. This included regular contacts with the Consultant Psychiatrist, which included medication review. Medication, storage and administration records sampled were satisfactorily completed. Some protocols did not show recent review. A protocol for a PRN (as required) medication was not available for one resident. The registered manager advised of the difficulty in ascertaining residents views and needs at the end of life. The home plan to seek support from the independent advocate and record outcomes in relation to resident wishes. Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 Estuary had provided residents with a user friendly version of the complaints procedure, and made it readily available to all. Residents were protected by the staff’s ability to recognise forms of abuse and their expressed confidence to report it. The whistleblowing policy would benefit from review to further support this. Residents were not best protected by the lack of clarity for staff on the use of residents money. EVIDENCE: Staff spoken with advised that no complaints had been received by the home since the last inspection. Records sampled showed that Estuary provided staff with training on Protection of Vulnerable Adults. Some staff had also had training on management of challenging behaviours. Staff spoken with confirmed the view that the whistleblowing policy was not written in clear language. Records showed that all residents were charged an equal amount for items such as wipes and sweets. Some residents’ rooms had wipes, some did not. A resident’s account showed they had bought themselves a digital camera for their birthday, although staff confirmed the resident had no understanding of what this was or what is was used for. Initially, the camera could not be found in the home when requested and was not logged on the residents inventory of possessions. There was some clear possibility that this would be used by the home generally, for all residents, or for the photographs of staff or residents required to be in the home’s records. Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28, 29, 30 The home provided residents with adequate living space and equipment appropriate to their needs. The premises was not well decorated or appropriately clean to provide a pleasant living environment for residents. Infection control practices in the laundry did not best promote resident welfare. EVIDENCE: The décor in residents bedrooms was individual and personal. Records sampled showed that residents had had assessments and appropriate equipment, for example to assist in maintaining independence. Portable heaters, labelled with residents’ names were seen in some bedrooms, but not necessarily in the room of the resident they were said to belong to. Most rooms in the home were in need of redecorating as paint was damaged and marked, as were radiator covers. Staff were shown several areas where the home was dirty, for example on walls, skirting boards and in the laundry. The washing machine had a label requesting the knob not be moved from 50 degrees. When asked about this a staff member said ‘accident’ (wet/soiled) sheets would be turned up to 60 degrees. Records sampled and discussion with the registered manager confirmed that staff had not had recent training on infection control. Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 14 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35, 36 The core group of permanent staff offered consistency of care for residents. Supervision of staff needed to be more effective. Staff training was not appropriate or current in all cases. Staff enthusiasm and commitment to training was varied. EVIDENCE: Rosters showed a trained nurse on duty each shift, and that the agreed minimum staffing levels of four staff all day and two at night were being met. Some staff were working planned long day shifts of twelve and half hours. This is not best practice as it could put residents and staff at risk. The roster did not include the name of all staff and show the hours they were to work. Agency staff were being used regularly. An agency staff member, who had sole supervision of residents in a lounge, confirmed to the registered manager that they had fallen asleep. Formal one to one staff supervision of staff was recorded as occurring sporadically. Minutes of regular staff meetings were available. Training records were well organised and supported by certificates in the main. Updates on some mandatory training were needed, for example fire training, as was training on issues relevant to residents, for example, epilepsy. One staff was interested in NVQ training and one staff was said to have achieved NVQ3 training. No care staff were currently undertaking this training. Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 15 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 42 The home was capably managed and efficiently run. There had been good efforts to ascertain the views of residents, but this was not continued in Estuary’s external quality review. Sampled safety procedures and checks protected residents, with the exception of the some fire safety issues. EVIDENCE: The registered manager advised that she had achieved NVQ4 Registered Managers Award. A copy of the certificate was not provided. The registered manager and deputy manager showed appropriate management actions in response to situations in the home during the inspection. Residents have access to an independent advocate. Staff will consider inviting the advocate to the regular resident meetings. Each resident’s file contained a satisfaction survey. Estuary had produced a quality review public statement. Residents or staff at 230 Mountnessing Road had not been involved. Fire doors were being wedged open to allow residents freedom of movement, which is not safe practice. Safer magnetic closures were not fitted. Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 16 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 x x 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 2 2 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mountnessing Road (230a) Score x 3 2 2 Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 2 x I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 17 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 6 Regulation 15(1) Requirement A care plan to be in place for each resident that shows how all areas of their health and welfare is to be met The registered person must establish the residents wishes regarding serious illness and death(Previous timescale of 20.12.04 not met). The person registered must ensure the protection of residents by ensuring the appropriate use of their finances. The person registered must maintain a record of any valuables kept for the residents or any furniture belonging to them. This refers to the camera and the portable heaters. The person registered must keep all parts of the home clean and reasonably decorated. The person registered must make arrangments to manage infection control in the home. This is to include training for staff. The roster to show the full name of all staff and the hours to be worked. The person registered must Timescale for action 15 July 2005 15 August 2005 2. 21 12(3) 3. 23 13(6) 1 July 2005 4. 23 17(2) Schedule 4 1 July 2005 5. 6. 24 30 23(2)d 13(3) 15 July 2005 15 August 2005 7. 8. 33 33 17(2) Schedule 4 18(1)a & 1 July 2005 1 July 2005 Page 18 Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 18 (2) 9. 35 18 10. 39 24 11. 12. 42 42 23(4)d 23(4)a ensure that there are competent staff on duty at all times. This refers to the agency staff apparantly sleeping on duty while caring for residents. The person registered must ensure that staff are provided with training appropriate to the work they are to perform. The person registered must ensure evidence of a quality assurance and monitoring system which includes all aspects of the service. The person registered must make arrangements for all staff to have fire training The person registered must ensure that the requirements set out on the fire authority certificate are implemented. These include break glass units and magnetic door closures. (Previous timescale of 20.12.04) 15 July 2005 15 August 2005 15 August 2005 1 July 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard 17 20 23 32 32 36 Good Practice Recommendations The nutrition record should show contain information on all special dietary needs, including liquidised foods Protocols should be in place for all as required medications and these should be kept up to date. The whistleblowing policy should be written in plainer language. 50 of care staff should undertake NVQ training Staff should not work long shifts Staff should be provided with formal supervision at least six times annually Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 19 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mountnessing Road (230a) I56 I06 S15548 Mountnessing RD V229340 240505 Stage 4.doc Version 1.30 Page 20 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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