Inspection on 17/10/05 for Maurice House

This inspection was carried out on 17th October 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

Maurice House 30/05/08

Maurice House 25/05/07

Maurice House 12/09/06

Maurice House 06/03/06

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 Kent CT10 3AH Lead Inspector Clair Brown Announced 17 & 21 October 2005 at 10:35hrs 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 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 H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Maurice House Address Broadstairs, Kent CT10 3AH 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) 0207 9737200 The Royal British Legion Mrs Karen Wilkins Registered Care Home 47 Category(ies) of Older People registration, with number of places Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 07/03/05 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. Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s announced inspection. The inspection was conducted by one inspector and the duration of the inspection was 12.5 hours over two days. The Home representative was the registered manager. Additional time was spent in planning the inspection and report writing. The inspectors spent time talking to 3 service users, 1 relative and 6 staff to gain their views. Four service users and two relatives completed inspection comment cards. A partial tour of the premises was conducted, documents, medication and records were examined and service users files were case tracked. What the service does well: What has improved since the last inspection? What they could do better: The pre-admission assessment process needs to acquire more information relating to the prospective service users individual needs. The registered person needs to apply for a variation to the homes registration for those service users who are not within the current registration. The homes policies and procedures need to have proper reviews conducted to ensure they are up to date with current practices and information. The roles and responsibilities of the staff needs to be reviewed which in turn could resolve the ongoing problem of delays in answering call bells. Clarification is needed about the details on the forms for staff who require a work permit. The home can no Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 6 longer accept medication with instructions “Give as directed by doctor” on the label. The mounting of the controlled drugs cupboard needs to be brought in line with current legislation. A person needs to be nominated to cover environmental safety checks in the absence of the maintenance person. 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 H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 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 standard(s) 1,2,3,4,5 The statement of purpose does not provide up to date information to enable prospective service users to make an informed decision. Pre-admission assessments are conducted but insufficient information is gathered. No progress has been made with the review of the contract. EVIDENCE: The statement of purpose has not been reviewed to reflect the recent changes to the organizational structure. Two newly admitted service users confirmed that pre-admission assessments were conducted prior to them moving into the home. Service users files case tracked showed that insufficient information was gathered and subsequently a service user was admitted outside the homes registration. The pre-inspection questionnaire and the registered manager confirm that three service users are not within the homes category of registration. Some were existing service user who’s has developed dementia and the other was a recent admission, since admission to the home it has become apparent to staff and the registered manager that the service users has other specialist needs. The registered manager confirmed that the staff are able to provide appropriate care for these service users. The contract is a 20 plus page legal document, a requirement has been made since 2004, for Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 9 the contract to be reviewed to make it user friendly, to date the Royal British Legion has not done this. Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 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 standard(s) 7,8,9,10 Although improvements have been made the care plans, some are still inconsistent and do not provide staff with the information they need to satisfactorily meet service users needs. There is evidence that appropriate action is taken to ensure that health needs are met. Overall medication practices are safe. EVIDENCE: Although the quality of some care plans and records have improved since the last inspection these documents continue to fail to identify all of the service users care needs. The greatest improvement has been with those produced by the healthcare assistants. Records show that the home liaises closely with the local G.Ps. An audit of the medication practices are safe and staff are aware of their accountability. However the written procedure needs reviewing and updating. The registered manager expressed their concerns regarding the new procedure and equipment for the disposal of medicines. Some medicines are still being provided with “Give as directed by the doctor” instructions, which fails to provide staff with clear direction about dosage and times to administer. Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 11 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 standard(s) 12,13,14,15 Service users are supported to participate in a variety of activities provided. A balanced nutritional diet is provided. EVIDENCE: The Home has a menu that offers a number of options, if a Service User wishes something other than these options, their preference will be provided. The Home keeps a large variety and quantity of food and has a good amount of cold storage facilities, with specific contents for each. The Home caters for Service Users to take their meals in their bedrooms if they wish, which currently is a high proportion of the Service Users, at present the care staff distribute the meals and this is having an impact on the care provided. There are no restriction on visiting times and were seen to be made welcome. Visitors are able to stay for meals and take service users out on trips. The Home has it’s own transport and arranges trips and outing on a regular basis. The Home has a dedicated activity room for crafts and for watching films on the large screen projector. The Home also accesses outside organizations, such as visiting pets and involves them in their large annual events such as summer fairs. There is also a monthly newsletter, which details forthcoming activities and other relevant information required. Three service users who completed comment cards stated that only sometimes the home provides suitable activities. Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 12 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 standard(s) 16,17,18 Service users and relatives opinions are listened to and taken seriously. Procedures are implemented to protect service users from abuse but these need updating. EVIDENCE: Written records have been seen of how the home manages complaints, they are responded to and fully investigated. The adult protection policy and procedure has not been properly reviewed and updated to ensure the information is in line with current practices and up to date. Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 13 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 standard(s) 19,20,21,22,23,24,25,26 The building is well maintained providing a hotel style environment for service users. EVIDENCE: The inspector conducted a partial tour of the building but there has been ongoing maintenance work 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 care home, 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 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 Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 14 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. Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 There are sufficient numbers of care staff provided, however their conflicting roles and responsibilities of the care staff have a negative impact on the staffing. Carers have the skills and knowledge to fulfil there role and responsibilities. EVIDENCE: There is a Registered Nurse on duty at all times. Also there are 6-7 carers on duty in the morning and 3-5 in the evenings. At night there is one registered nurse and 3 carers. Agency staff are employed to cover any shortfalls in the duty rotas. The home also employs a team of ancillary staff for catering, domestic duties and laundry. Care staff are required to undertake a number of roles that are not care duties and this is having an impact on the care provided. A high proportion of service users to take their meals in their bedrooms, at present the care staff distribute the meals. Care staff also serve the hot drinks. Service user and relative comment cards stated that there can be a long delay in answering the call bell, especially around meal times. Three service users comment cards stated that they believe there is a shortage of staff and this is impacting on their needs being met. A new call bell system has been installed which records the time the bell was rung and answered. Overall the recruitment process is thorough with CRB’s and POVA checks being conducted before new staff start work. However a couple of staff have been started with POVA first checks whilst awaiting the full check being completed. These staff need to be supervised at all times. It was identified that a work permit was not for this place of work. There are 24 permanent carers plus 5 Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 16 flexi, 13 of the care staff have the NVQ qualification and a further 10 are currently studying for it. There is a yearly training programme. Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34,37,38 The manager has the skills and knowledge to continue to bring the home forward. Overall the health & safety practices are good but there remains some areas of improvement needed. EVIDENCE: The registered manager is well qualified for the position but is leaving within the next few weeks. The home has been well managed with the homes ethos being maintained. The registered manager is supported by a deputy manager who has had a number of responsibilities delegated to them will be acting as manager until a new manager is found. The environmental health & safety certificates were up to date although it was found that when the maintenance person was on leave that fire checks were not conducted. Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 4 4 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 2 3 2 x 3 x x 2 2 Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 19 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 OP3 Regulation 14,15 Requirement More information/ details must be gathered during the preadmission assessment and recorded, avoiding inappropriate admissions. The registered person must make an application for a variation to the homes registration for those service users admitted outside of the current registration. No service user is to be admitted that does not meet the homes current registration. To provide staff with the knowledge and skills to produce care plans and daily reports that are detailed and informative. To liase with appropriate parties regarding the problems being experienced relating to the equipment provided for the disposal of medicines. The controlled drug cupboards must be mounted to the wall with the required fittings. Written confirmation of the administration dosages of medication must be obtained. Staff must not accept medication with Give as directed by doctor Timescale for action 30/01/06 2. OP4 12,14,18 30/01/06 3. OP7,8 12,13,14, 15,16,17 12,13,14, 16,17,23, schedule 3 31/03/06 4. OP9 31/03/06 Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 20 instructions. 5. OP9,18 12,13,14, 16,17,20, 23, schedule 3 12,16,18 The adult protection and medication policy must be updated to provide details of current practices. Proper reviews must be conducted of the policies and procedures. The registered persons must review the circumstances and find a solution for the delays in answering the call bells. The registered person must review staff working practices and procedures - relating to non care duties performed and numbers of staff performing these at anyone time. For all staff to be given reasonable notice of their duty rotas and informed of changes made to planned shifts. The registered persons to ensure work permits are for the place of work and correct. To contact the Home Office for clarification if needed. Staff working with only a POVA first check awaiting the CRB must have a nomintaed supervizor at all times. For a person to be nominated to conducted fire safety checks in the appointed person absence annual leave, sickness. (Previous timescale 14.03.05, 31.09.04) The Service Users terms and 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) to update the statement of purpose to show the changes to 31/03/06 6. OP10,27 31/03/06 7. OP27,32 8. OP29 5,10,12, 17,18,21, 24 schedule 4 7,9,12,19 schedule 2 30/01/06 30/01/06 9. OP38 12,13,16, 17,23,37 30/01/06 10. OP2 5 31/03/06 11. OP1 4,5 schedule 31/03/06 Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 21 1 the organisational structure. 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 Good Practice Recommendations Maurice House H56-H05 S37465 Maurice House V246430 171005 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU 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. 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