Inspection on 12/09/06 for Maurice House

This inspection was carried out on 12th September 2006.

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

Maurice House 30/05/08

Maurice House 25/05/07

Maurice House 06/03/06

Maurice House 17/10/05

Maurice House 07/03/05

Maurice House 14/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Maurice House Callis Court Road Broadstairs CT10 3AH Lead Inspector Clair Brown Unannounced Inspection 11:15 12 & 15 September 2006 th th X10015.doc Version 1.40 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 Maurice House DS0000037465.V305169.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 Older People. 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. Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maurice House Address Callis Court Road Broadstairs CT10 3AH 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) 01843 603323 The Royal British Legion Post Vacant Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To admit one (1) Service User, under the category of MH, whose date of birth is 18.09.1911. To admit one(1) Service User, under the category of DE, whose date of birth is 15.01.1917. To admit one Service user D.O.B 08/03/1942 under the age of sixty five years old not falling into any other category. 6th March 2006 Date of last inspection Brief Description of the Service: Maurice House is a large detached purpose built care home, which is set in accessible attractive grounds in a semi-rural location. Nearby towns and amenities are only a few minutes drive away. The Home is registered to provide nursing care and therefore employs a number of registered nurses. The Home has a hotel type atmosphere. The Home has a number of shaft lifts to access all levels of the Home. The grounds have had pathways built so that service users can access them and appreciate the views over the sea. The fees are: £490.00 residential; £600.00 low nursing; £700.00 medium nursing; £760.00 high nursing per week. Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection consisted of an unannounced visit to the home on 12th & 15th September 2006 by one inspector. The newly appointed manager was on leave and the deputy manager took the inspection. The inspection takes account of information received from a variety of sources including written information from the registered providers, relatives, service users, care managers and general practitioners. The previously made requirements and recommendation from other inspections were inspected and all key standards. Eight service users completed comment cards. The inspector spent time talking the care staff to gain their views. A partial tour of the premises was conducted. Documents and records were seen and service users files were case tracked. What the service does well: What has improved since the last inspection? The statement of purpose has been updated to show the changes to the organisational structure. A successful application for a variation to the homes registration was made to care for two service users with dementia and mental health needs. Staff have undertaken training in writing care plans and daily reports, these are detailed and informative, this shows in the overall quality of records assessed, however, there is further work needed to ensure these are completed fully. The registered person has carried monitoring visits, however these have not always occurred monthly as required. Service users money is now held individually and no longer pooled together. Staff now adhere to health & safety policies and the uniform policy in relation to the wearing of jewellery and piercings, the majority of the time. Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12346 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service user guide does not provide up to date information to enable prospective service users to make an informed decision. Pre-admission assessments are conducted however, insufficient information is gathered to enable the manager to make an informed decision. Limited progress has been made with the review of the contract. The home does not provide intermediate care. EVIDENCE: The statement of purpose had not been updated since the last inspection, however the deputy manager made the appropriate amendments before the completion of the inspection visit. The service user guide has been amended, resulting in much of the required information having been removed. The preadmission assessment of a recently admitted service user was examined, this consisted of a tick chart and failed to provide sufficient detail about the individuals needs to allow the home to make an informed decision about it’s ability to meet the prospective service users needs. Since admission the service users needs have found to be greater than identified at the preMaurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 9 admission assessment and may not be within the registration of the home. The deputy and operational manager confirmed that the service user contract is under review. Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and health assessments are incomplete. The home works closely with healthcare professionals to access medical services. Medication practices by some staff are unsafe and place service users at potential risk. EVIDENCE: A service user admitted 3 weeks earlier care plan was case-tracked. The care plan had not been completed and many of the assessments were incomplete or blank. Those sections of the care plan written were quite detailed and well written. The reason given for the incomplete care plan was due to staff not having enough time to write them. The deputy manager stated that the new manager had been working hard with staff to improve the quality of the care plans and some had been rewritten. Although the home works closely with the community health care professionals, the failure to ensure that in-house health assessments are completed is a failure to monitor the service user health needs. Seven service users surveys said they always receive the medical support they needed. Part of a medication round was observed that was being conducted by a registered nurse, they were observed not to comply with the homes policy and procedure and their practices were unsafe. This included Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 11 signing for medication before they had administered it to the service user. An audit of residential medication records showed that there were gaps in records, receipt records were incomplete and there was an excess of stock of medicines. There were poor procedures identified for the recoding of controlled drugs. Service users surveys say a mixture of comments, these include: six said they usually receive they care and support they need, 1 said always and another said only sometimes. Other comments included: well cared for and overall standard near excellent. Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The current range of activities provided are limited and do not meet the needs of all of the service users. Service users are supported and encouraged to maintain independence and contact with relatives and the local community. A nutritionally balanced diet is offered however permanent records are not kept. EVIDENCE: There is only one part time contracted activities person employed, although two of the care staff are actively involved in the activities programme. The activities notice board for the week of the inspection visit consisted of the home bar being open for an hour a day, musician (who cancelled), PAT dog, clothes sale and bingo, other activities said “to be arranged”. The home has a large dedicated activities room, which is well equipped. There is no provision for ensuring that those who are unable to leave their room are given the opportunity to enjoy and participate in a range of activities. One service users survey commented that the activities are not always suitable. Relatives and friends are made welcome when they visit. The menu shows that there is a minimum of two choices of meals every day, each service user Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 13 completes a menu card, these showed that a wide variety of food is provided and enables service users to choose daily and enjoy what they wish to eat that day. Permanent records of meals provided were not kept, by the second day of the visit a procedure for keeping the records had been introduced. Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The response to complaints can be slow but are fully investigated. Procedures are implemented to protect service users from abuse but these still need updating. EVIDENCE: There has been an on going complaint for a long period of time, the Royal British Legion has fully investigated this matter and the Commission has observed the overall proceeding between the complainant and the Home. The Royal British Legion has recently produced an action plan in response to their findings of the investigation however, it is awaiting full implementation. The deputy manager was able to demonstrate the course of action she was taking in dealing with a more recent complaint, the process was thorough and actively involved the complainant, keeping them informed throughout the process. The service user surveys showed that they know who to speak to and how to make a complaint. The adult protection policy and procedure has not been updated since the last inspection visit. Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The building is well maintained providing a hotel style environment for service users. EVIDENCE: There has been routine maintenance work carried out as well as long -term planned work. The water damage on the main stairway has been resolved and the area redecorated. The work and redecoration has been completed to a good standard, including all new décor matches or co-ordinates with the other areas of the home. The inspector conducted a partial tour of the building and the Home employs it’s own team of maintenance people. The Home is located in a semi-rural area with views across the sea and neighbouring fields. The nearest town is a short car journey away and the local village is within a short walking distance. The Home is a purpose built, with substantial sized gardens, which have paths ways wide enough for wheelchair users. The Home has a variety of communal space that includes activity rooms, bar, dinning room, lounges and conservatories. All of these areas are furnished appropriately and all are areas of the Home and grounds are accessible to those with mobility Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 16 problems. The Home exceeds the minimum number of required bathrooms and toilets. All bedrooms are en-suite and some also have showers. The shared bathrooms are good in size with shower curtains fitted around the doorways to maintain privacy and dignity. The types of baths and fittings are appropriate to the category of service users. The areas of the Home seen during the course of the inspection were seen to be clean and free from offensive odours. Infection control procedures and equipment are in place. One service users survey commented that it was “first class” another “overall standards near excellent”. Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At times staffing levels are low and could compromise the quality of care. Carers have the skills and knowledge to fulfil their role and responsibilities. EVIDENCE: In 2004 there were 7 carers and at least 1 registered nurse on duty in the mornings. At the time of the visit duty rotas showed that this has been reduced over a period of time and now there is at least 1 registered nurse on duty and between 4-6 carers on duty in the mornings. The home now has a condition on its registration to care for two people with mental health and dementia. Service users surveys give a mixed response to them receiving the care when they need it and if staff are available when they need them, with 5 out of 8 saying they usually get these. One service user commented that the availability of staff depended on the time of day. A new induction programme has been introduced but it has not been checked against the specifications of the skills for care council to ensure it meets the required standard. Recruitment procedures are adequate, however the interview records were brief and failed to provide evidence that gaps in one carer’s employment history had been investigated. Details and copies of staff that require work permits were not included in their file. Over 50 of the care staff have completed the NVQ training, other training course have been attended by staff such as movement & handling and other mandatory subjects. Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 35 36 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A manager has been appointed who has relevant qualifications and experience in the care sector. There are limited quality assurance processes implemented within the home. Procedures for the safe handling of service users money are in place. Health & safety environmental checks and procedures are satisfactory. EVIDENCE: The relief manager has been appointed permanently in post, with the plan to make an application for registration. The manager has the appropriate qualifications for the position but is yet to make a formal application to become the registered manager and to be assessed through the fit persons process. The manager was on leave at the time of the inspection visit. The changes of management of both the home and that within the Royal British Legion have had an impact on communication and the outcome of previously made requirements. Limited progress and action has been taken to meet some of Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 19 these and the management of the home appears to have been in limbo since the last visit. Staff supervision has not been completed as frequently as required. The Royal British Legion has recently appointed a person to implement its quality assurance procedures. There have been some gaps in the monthly provider visits. The annual quality programme has not been carried out for this year. The procedures for managing service users finances have been changed to met the requirement made at the last inspection. The records of service users money corresponded with cash held. The environmental certificates and health & safety records were seen to be completed and in date. Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 4 4 4 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 X 3 Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Requirement Required to update and review the service user guide to comply with the National Minimum Standards & Regulations Timescale for action 30/11/06 2. OP2 5 The Service Users terms and 31/12/06 conditions must be reviewed to comply with the National Minimum Standards and Regulations and the Office of Fair Trading. (Previous timescale 21.12.04, 30.09.05, 31/03/06 & 31/07/06) All prospective service users must have a full and detailed pre-admission assessment completed prior to admission, gathering sufficient information to enable the manager to make an informed decision. The registered person must review service users identified at the inspection visit who’s needs may be outside of the registration, following an assessment the manager is required to make an application for a variation to the homes DS0000037465.V305169.R01.S.doc 3 OP3 14 15 31/12/06 4. OP4 12 14 18 31/12/06 Maurice House Version 5.2 Page 22 registration for those found to be outside of the current registration. No service user is to be admitted that does not meet the homes current registration. Previous timescale: 30/01/06 & 14/04/06 5. OP7 12 13 14 15 16 17 All service users must have a completed care plan, that identifies all of the service users needs and how to meet those needs, this must be completed prior to admission and then reviewed regularly and those admitted in emergency situation have the care plan completed within 5 days of admission. All service users must have care plans written, despite the duration of their stay. Previous timescale: 17/03/06 31/12/06 6. OP7 12 13 14 15 16 17 31/12/06 7. OP8 12 - 17 sch 3 8. OP9 12-17 20 sch 3 All health care assessments must 30/10/06 be completed and reviewed at least monthly with the outcomes and actions needed crossreferenced to the care plan and appropriate action taken. The medication policy must be 31/12/06 updated to provide details of current practices. Proper reviews must be conducted of the policies and procedures. Previous timescale: 31/03/06 & 31/07/06 All staff must adhere to the policy & procedure for administering medicines. The manager must ensure that monitoring systems are in place and appropriate action is taken when unsafe practice is identified. 23/10/06 9. OP9 12 -14 17 sch 3 Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 23 10. OP12 12 14 15 16 23 11. OP16 17 22 sch 4 12. OP18 12 13 17 20 23 sch 3 The activities programme must be reviewed to ensure that a meaningful and varied range of activities are provided, this must include activities suitable for those cared for in their bedrooms. The manager must ensure that complaints are responded to quickly. The manager and the registered individual must ensure that the findings of an investigation following a complaint and the action plan is implemented as soon as reasonably possible, ensuring all staff are aware of the content and action required. The adult protection policy must be updated to provide details of current practices. Proper reviews must be conducted of the policies and procedures. Previous timescale: 31/03/06 & 31/07/06 The manager must review the number of qualified nurses & care staff on duty and the needs of the service user and the home throughout the course of the 24hr period and provide sufficient staff accordingly. The registered person must review staff working practices and procedures - relating to noncare duties performed and numbers of staff performing these at anyone time. Previous timescale: 31/03/06 & 31/07/06 30/12/06 23/10/06 30/11/06 13. OP27 12 16 18 30/11/06 14. OP29 7 9 12 19 Sch 2 Recruitment procedures must show recorded evidence of exploring gaps in employment history and include references from last care employer. 23/10/06 Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 24 15. OP30 12 18 16. OP32 4 10 12 18 21 24 17. OP33 24 26 The new induction programme 30/11/06 must comply with the requirements set by the Skill for Care Council. The registered person and 23/10/06 manager must ensure that there are clear paths of communication and that essential information is cascaded to all relevant parties. The quality assurance 30/12/06 programme must be conducted and completed this year. Registered provider monthly visits must be conducted and a report produced. Previous timescale: 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations To reduce the amount of medicine stock held to a manageable level, that process are implemented to ensure proper stock rotation and only ordering medication that is required. Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Maurice House DS0000037465.V305169.R01.S.doc Version 5.2 Page 26 - 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!