Inspection on 24/07/09 for Mon Choisy

This inspection was carried out on 24th July 2009.

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

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.

Other inspections for this house

Mon Choisy 24/07/07

Mon Choisy 16/07/07

Mon Choisy 22/06/06

Mon Choisy 21/02/06

Mon Choisy 09/08/05

Mon Choisy 23/11/04

Mon Choisy 29/06/04

Mon Choisy 12/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Mon Choisy 128 Kennington Road Kennington Oxford OX1 5PE Lead Inspector Ruth Lough Key Unannounced Inspection 24th July 2009 10:10 DS0000013112.V377012.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mon Choisy Address 128 Kennington Road Kennington Oxford OX1 5PE 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) 01865 739223 enquiries@auditcare.com Mrs Ellen Audit Mrs Ellen Audit Care Home 28 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only (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 (OP) 2. Dementia (DE) The maximum number of service users to be accommodated is 28 Date of last inspection 24th July 2007 Brief Description of the Service: The home is located near Oxford in the village of Kennington, close to shops and public transport facilities. The home is privately owned and managed, and provides 24-hour support for a maximum of 28 residents; it does not provide nursing care but accesses external medical and nursing services to maintain the health of the residents living there. Mon Choisy is the larger of two homes owned by Mr & Mrs Audit in Kennington and shares a management structure and policies and procedures with its sister home, Kirlena House. It was opened in 1985 and extended in 2001. There are 22 single rooms and three double bedrooms with a wash hand basin in each. There are two assisted baths, four showers, and ten toilets. The house itself is detached, with a patio area and sloped courtyard garden at the rear that can be accessed via pathways with handrails. Resident’s rooms are on two floors with stairs and lift access to the first floor. The rear ground floor sun lounge overlooks the garden and there are further communal rooms including a separate dining room-cum-sitting room, a sitting room overlooking the front drive, and a small internal sitting room. The kitchen caters for the residents of both homes. There is a laundry and further utility rooms in outbuildings at the rear of the home. The fees for this home range from £491 to £562 per week. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 5 Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means that people who use the service experience Adequate quality outcomes. This was an unannounced key inspection process generated from the Adequate findings identified at the last assessment of the quality of the service by the commission in July 2008. This inspection process included reviewing information provided by the service in the Annual Quality Assurance Assessment and any returned surveys to the commission before a two day visit to the home. The second day visit was to review documents that were not available on the first day. An annual quality assurance assessment (AQAA) is a self assessment and a dataset that is filled in once a year by all providers whatever their quality rating. It is one of the main ways that we will get information from providers about how they are meeting outcomes for people using their service. The Annual Quality Assurance Assessment from this service was returned within the required timescales and had been completed satisfactorily although some of the information was quite brief. The registered manager was not present when we visited the service on both days, between 10:00 and 14:50 of the first day and 11:10 and 16:00 on 27th July, on the second day. During the time spent in the home the records for care planning, recruitment, and administration of the service were assessed. Three of the people using the service were involved with the inspection process. We met with six staff, one relative, and a visiting professional who were present in the home. The people who use the service and the staff who provide the support were also consulted about their opinion of what is provided, through surveys. Of the ten people who are in receipt of support that we contacted, we received five responses at the time of writing this report. Five staff were also contacted through surveys, of which two responded. Two professionals, who have been involved with visiting the services on a regular basis, were also contacted. From this visit it was found that the three requirements and some of the recommendations that were made to improve the service during the last Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 7 inspection process have been met. There were a few areas that will need to continue to improve to protect the people they support and one immediate requirement was made to ensure that staff adhere to safe working practices for the storage and handling of chemicals in the home. A number of good practice recommendations were given at the time of the inspection and can be found in the body of this report. What the service does well: From information obtained through this inspection the people who use the service can be confident that they will obtain a good standard of care and support. They can be also be certain that their concerns will be listened to and that they will be protected from possible abuse or harm by the systems in place. The service provides a homely, friendly environment that people appear to enjoy living in. Staff are friendly, welcoming, and supportive and have been provided with the training and knowledge to care for the people they support. An advocate commented in the survey that in their opinion that the home provided, “Excellent, all round, care of residents.” Other comments from relatives and visitors were: “All the staff are kind and caring” “Staff friendly and attentive. Visitors always welcomed with the offer of tea or coffee.” “All the staff are very caring” “Staff interact well with Mum.” Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 8 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 9 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 10 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 Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 People using the 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 people who use the service have their personal care and support needs assessed thoroughly before they are offered a place in the home. EVIDENCE: The records for four people were reviewed to see what information is obtained about their needs before they commenced living in the home. All four had been admitted during the last six months. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 12 From what could be seen the necessary information is obtained from the person concerned, their relatives, and any other social or health care professional involved in their care. Four of the five people who responded to the surveys confirmed that they had been provided with information about the service to make an informed choice to live there. They also confirmed that they had been given written information about what the service can provide in a contractual agreement. One person indicated that they did not. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the 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 personal and healthcare needs of individuals needs are planned for and met. Medication is administered safely. EVIDENCE: All respondents to the survey from the commission expressed that they thought the personal and health care needs of the people living in the home were being met. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 14 An advocate commented in the survey that in their opinion that the home provided, “Excellent, all round, care of residents.” Other relatives put, “Always makes sure my mother is clean and tidy. They worried when she was not eating well and have discussed this with me. Always let me know of any worries they have concerning my mother.” The records for five residents were used to assess if the care planning and delivery of support meets the identified needs of the people they care for. These included those records looked at in regard to the initial assessment process and an additional record for someone who had been supported in the home for over six years. From the sampled records it was apparent that there is a holistic look at individuals needs and that there were the necessary monitoring tools in place for ensuring their health and well being. The records were to be found held in three separate areas as staff were finding it difficult, through lack of space, in the homes care document system to manage this. In one record it was documented that one individual had lost a significant amount of weight over the last six months. From what could be seen staff had not taken sufficient action to seek medical assistance or advice. Once alerted to this, senior staff immediately passed the information to the District Nurse who was visiting the home. A recommendation was made to find an effective method of monitoring by staff to ensure that any significant needs are identified quickly and referred to the relevant health profession as soon as possible. The home has purchased and implemented a new controlled drugs cupboard that now meets the Misuse of Drugs (Safe Custody) Regulations 1973. They also have suitable storage facilities for the safekeeping of other medications they hold on resident’s behalf. Staff are given the necessary information about the medications individuals are prescribed and they are recording appropriately any administration on the MAR (Medication Administration Record) Charts. Staff are supplied in the medication records a recent photograph of the person concerned to assist the safety checks carried out before medications are administered. Staff are also provided with several copies of the homes medication policies and procedures and other documents with the MAR (Medication Administration Record) charts. However, some of these records may not be relevant to the current practices and senior staff should review these to ensure that they have the most up to date information available to them to avoid confusion. The care planning information only noted in the sampled records minimal detail of the individuals choices for the end of their life. The information obtained about personal preferences or choices to remain in the home should their health deteriorate had not been sought. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 people who live in the home do have the opportunity for choice over how they wish to conduct their lives and are able to maintain some of their interests. The activities provided by staff may not always meet their needs or wishes. Meals are usually enjoyed and meet individual’s health needs and personal choices. EVIDENCE: The care records have been improved since the last inspection process. The staff have been busy seeking information, where able, about the personal history and interests of the people they support. The sampled records show that there is a variable detail for some of the new residents as they are still waiting for further information from the next of kin or the individual themselves. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 16 They are now noting in brief the chosen daily routine which could be seen in greater detail in the reviews of care. They are also recording on a weekly basis the involvement with activities and evaluate the findings monthly. However, they does not appear to be a planned approach to providing activities for individuals, this would be very helpful to meeting the specific mental health needs and abilities of the person concerned. A visiting professional commented in a survey returned to the commission: “I would like to see more activities, especially ones relating to orientating them and also physical activities.” They also made additional comments about the residents sitting in the front lounge for long periods and the large rear lounge underused. An observation of the residents during both days of the inspection visit showed that the majority were sitting in the lounge in the front of the home; some in the dining room, only two were in their rooms. Nearly all of the residents that were in the front lounge did not have anything focus or interact with such as a newspaper, book or magazine to look at or have anything to do. There was very little conversation between residents and most were not engaged in watching the TV which was on, or looking at the others on the other side of the room. Staff were only present in the room to carry out a task such as escorting someone to the toilet or delivering a hot drink. The large well decorated and spacious lounge at the rear was not occupied and was not used by resident or staff during both days of the inspection. Comments in the surveys returned to the commission included; “Fed well and enjoys herself in the home.” “Food nice. Noticed that staff very patient when helping to feed those who can’t feed themselves.” The meals and menu planning are developed by the Registered Manager, Care Manager and catering staff. Information is sought about personal preferences when residents come to stay in the home and changes made when staff learn more about the individual and their likes and dislikes. Any dietary or nutritional needs are identified and alternatives to the planned meal for individuals are implemented. One resident expressed that at times staff forget to ask if they would like what is on offer, the majority of the time they just delivered the meal without checking that it was what they wanted. This comment was passed back to the Care Manager during the second day of the visit to the home. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 17 From information given by care staff, there were only two of the current eighteen residents that prefer to eat their meals in their rooms. The other residents are encouraged to eat their meals in the main dining room. The dining room is set out with tables for four, three or two residents to sit together. The midday meal was observed on the first day of inspection, and it was apparent that residents would have enjoyed a little light conversation and involvement with staff. One group of residents were keen to have conversation with staff and each other. Others repeatedly requested staff to join them for the meal. One member of staff was seen to be supporting a resident to eat their meal. The approach was kindly and supportive but was conducted with the member of staff standing over them therefore the resident concerned had to look raise her head to understand the member of staff, make eye contact and interact throughout the process. This observation was passed back to the Care Manager. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their relatives are confident that their concerns or complaints are listened to and acted upon. The service has systems in place to protect the people living in the home from possible abuse or harm. EVIDENCE: Residents and their relatives are provided with a copy of the homes complaints process in the Statement of Purpose and Service User Guide when a service commences. The complaints process is also put on display in the home for people to read. From information returned in the surveys residents and their relatives were confident that any comments, concerns, or complaints they may have, would be listened to and acted upon. Information in the Annual Quality Assurance Assessment showed that there had been one formal complaint made to the home since the last inspection process. This could be seen in the records for complaints. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 19 From looking at other records, including those for the employment of staff it was evident that another concern had been brought to light which was dealt with under a disciplinary procedure and not managed as a formal complaint. The staff do not use a method of recording minor concerns centrally that are dealt with almost immediately by the staff member who the comment is made to. Some of the minor concerns had been recorded in the individuals own care records. However, there is no method of drawing this information, such as a complaints log, for monitoring trends of concerns or comments that could be used for the overall quality assessment processes the service carries out on its performance. The information provided and knowledge of staff in regard to protection of the residents from possible abuse or harm was reviewed. Staff have available the homes policy and procedures to read and are provided with a copy of the local authority’s information and guidance to access readily on the office desk in the home. The information about training given to staff did support that staff had an introduction to the topic in their induction programme which is then revisited with formal training at a later date. A discussion with one member of staff revealed that they were not confident about what the process was, or how to manage a concern should it arise. The concerns about this individual member of staff were passed back to the Care Manager. Other members of staff appeared confident and knowledgeable. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service cannot be sure that the homes facilities and environment will meet their needs or is maintained in their best interests. EVIDENCE: The home is situated in a residential area on the main road through Kennington. The building was not purpose built but adapted over time to its current facilities. Resident’s accommodation is provided on the ground and first floor of the home, there is a second floor with offices that has storage space Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 21 and staff sleep-in accommodation. There are extensions to the rear of the original building with bedrooms, a large communal room and bathroom facilities. Overall residents are provided with three main areas of communal space to use. There is a forth small room in the centre of the ground floor accommodation that provides a quiet space for meetings with families or is used by the visiting hairdresser once a week. None of the bedrooms have en suite facilities and are variable in size and shape. Some of which can be used as shared accommodation, should it be required. Six of the bedrooms of the home are presently unoccupied as they are going through the process of being redecorated and re-carpeting. This is partially through planned refurbishment and the unexpected repairs following water damage to part of the central corridor in the ground floor area of the home. Since the last inspection process some changes have been implemented to improve the accommodation and facilities for the residents. A new shower and seat has been placed in the downstairs bathroom which provides greater flexibility for residents who prefer to use it. The shower or wet room on the first floor remains out of use, as identified during last inspection, as the plumbing for this was one of the causes of the problems with water damage. The home has a number of bathrooms/ shower rooms so this does not impact too much on the current needs of the people living in the home. As previously identified at the inspection of July 2008, some of the toilets on both the ground floor and first floor are poorly arranged and do not necessarily have the extra aids suitable for the needs of the people using them. The provider has informed us that there is a continual programme of renewal for the home generally and these are part of this process. However, we have strongly advised the provider to have an assessment of the premises by a suitably qualified Occupational Therapist to identify that they have the necessary adaptations and equipment for the needs of the people they support. The home provides the same number of assisted baths or showers that it had before 31st March 2002. Looking at the individual accommodation some of the mattresses, bed linen and commodes have been replaced, making the facilities more comfortable to the people living in the home. There are still a number or mattresses waiting to be replaced and there are still some vanity units in bedrooms that have damaged surfaces that may cause skin damaged to residents or compromise the control of infection in the home. Both these areas were identified as of concern at the last inspection and from what could be seen part of these concerns have been started to be rectified, but quite slowly. Again, although there has been some replacement of bedroom furniture, much of this looks tired and worn. In one bedroom the same damaged furnishings seen at the last inspection process are still in use and haven’t been replaced. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 22 Redundant kitchen equipment has been left externally to the home and can be viewed from a resident’s bedroom. There are other pieces of equipment such as washing machines, chairs and commodes distributed around the laundry and storage areas to the rear of the property that haven’t been disposed of when no longer required for use. This generally makes some of the areas of the home unattractive and untidy. The practices for hygiene and control of infection were looked at as this was an area that concerns were identified at the last inspection. From what could be seen liquid soap and paper towels had been made available for staff and residents to use in various areas of the home. The laundry did not have these in place and control of infection could be seriously compromised by not ensuring these are kept replenished. The general laundry area, which is in a separate building at the rear of the home and accessible from the garden, was not in a very clean condition. Several cupboards in this area were filled with odd items, not very tidy, and it did not look as if the was a strong cleaning regime in place in this part of the home. Areas of the floor had dust and soap powder spills left and surfaces were not clean and well maintained. There were some concerns over the Control of Substances Hazardous to Health Regulations (COSHH) 1988 practices in this area, and will be reviewed further in the report. This is particularly relevant because the laundry room cannot be locked and the doors were left open and was accessible to residents who could be using the garden. From what could be seen the Care Manager had implemented a risk assessment in regard to access to the laundry area. The document gave information about how staff were to reduce the risks for residents, which was to be escorted at all times in the garden area by a member of staff. This is possibly not the most practicable answer for all residents, restricts their opportunity to freely mobilise around the home and garden, and clearly not carried out as residents seen in the garden without support. These observations were passed back to the Care Manager during the second day of inspection. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment records for some of the staff employed in the home do not support that robust recruitment practices have been carried out which could put residents at risk from inappropriate people providing support to vulnerable individuals. EVIDENCE: Comments from professionals visiting the home were: “I always find the staff helpful and caring and have no issues with Mon Choisy.” “All the staff are kind and caring” Other comments from relatives and visitors were: “Staff friendly and attentive. Visitors always welcomed with the offer of tea or coffee.” Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 24 “All the staff are very caring” “Staff interact well with Mum.” The records for staffing the home and a sample of the recruitment practices were reviewed to see if there is a sufficient number of skilled and competent staff working in the home. A copy of the week’s duty rota was reviewed to see what roles and numbers of staff were available at different times of the day to support the people living there. From this rota it could be confirmed that the number of staff did appear to be sufficient for the current number of residents of which there were eighteen at the time of this inspection. According to the rota most staff are flexible to the work shifts and roles they carry out. They can take responsibility for leading the shift, cooking or laundry. The home does not employ dedicated staff for the provision of activities or laundry. It was not indicated on these documents when the Registered Manager was present in the home but this may be because at the time of the inspection visits to the home the manager had been called away for an undetermined time period for a family emergency. The home has a care manager working full time to ensure that care is delivered as planned and who appears to be managing the service day to day. Information was not given in detail in the Annual Quality Assurance Assessment about the numbers of staff with an NVQ. This was provided in a separate document completed in May which indicated that there was only one member of the eleven care staff had attained an NVQ 2 or above. From information in the training file and a discussion with staff present during the inspection visit, there is one further new member of staff with this and another who has achieved an NVQ 3. We were provided information that others were in the process of studying for an NVQ 3 and NVQ 4 in accordance to their student visa conditions. According to the records, some do not appear to be studying towards an NVQ. The overall numbers of care staff with NVQ qualifications is below the anticipated 50 . The recruitment files for four staff were reviewed to see what practices are in place and residents are protected from inappropriate staff being employed. There was an area of concern identified during the last inspection process, where incomplete information had been obtained about two individuals work history. From the records seen nine staff have been employed since the last inspection process. Of the eleven care staff employed in the home according to the information provided by the home, this is a significant number of staff changes that could effect continuity of care for the residents. The sampled records did show there are again some gaps in the information for full work history for two staff and there was no evidence that these had been explored in the interview process. The records did support that proof of the person’s identity is taken, usually their passport for the application of the Criminal Records Bureau and Protection Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 25 of Vulnerable Adults list checks. The records show that the necessary Criminal Records Bureau and Protection of Vulnerable Adults list checks are carried out before staff commence working in the home. For these same two staff there was not sufficient information about their work permit status. The detail of the transfer to the home of their work permit was not available with the records reviewed and we were informed that they may be held separately. However, the responsible person for this was not available and the Registered Manager was advised to contact the commission should further information be made available. At the time of writing this report no further information had been provided by the service. The training records for these staff were also reviewed and for two new staff they supported that they had been provided with their induction programme and had commenced and almost completed all the mandatory training they required. For one staff member the records had not been transferred to the home from the sister home, Kirlena, so they were not available at the time of the inspection. Additionally some of the staff have attended training for dementia, falls prevention, and chair exercises. For those staff with English as not a first language they have had, or are in the process of obtaining lessons, to improve their skills. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There continue to be some areas of weak management of the home that are not in the best interests of the people who live there. EVIDENCE: One relative made a comment in a returned survey; Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 27 “The service is of a uniformly high standard.” One visitor put forward information in regard to what they thought the service did well; “The Owner/ Manager visits each resident individually every day” The Registered Manager was not present throughout the two days of the inspection visits, as she was away at the time. The Care Manager who has responsibility for the delivery of care and support was present on the second day and was able to provide sufficient information for the inspection process. There was no information available to show that the manager has continued to develop her role such as training, since the last inspection visit. The Annual Quality Assurance Assessment was returned to the commission within the required timescales, although in parts did not give sufficient information about the service to be used within this inspection assessment. There are several areas they are developing for formal consultations with the people they support about their opinion of what the service provides. The results from the last survey process in November 2008 have been assessed and reports generated from them to give back to the participants and their relatives. From this last process it was apparent that the majority were happy with the support they were provided with, the food on offer, and the admission process. However, at least 20 of the respondents were not satisfied with the social activities on offer. There was no information available to show that the results of this process had been listened to or that there were actions in place to improve the service. A more recent event is the commencement of formal residents meeting, in the last few weeks which should assist with seeking resident’s opinions other than the Bi annual surveys and their reviews of care. The home manages small amounts of money on resident’s behalf for sundries such as newspapers, hairdressing, toiletries and chiropody. A small sample of records were reviewed which supported that this was being carried out safely. The records and information for safe working practices were reviewed to see if residents, staff and visitors are protected. The service has in place the necessary documented policies and procedures to sustain good practices and from the information about training, staff are provided with the required instruction to implement them. As previously identified in the section about the environment of the home, there were concerns about the management of the laundry area and the storage of items that should be kept under Control of Substances Hazardous to Health Regulations (COSHH) 1988 regulatory practices. In the laundry room which was left unsecured, there were bags of soda crystals, a container of carpet cleaner, and soap powder, left possibly accessible to residents living in Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 28 the home. The area was generally not very clean. An immediate requirement was made for these chemicals/ substances to be secured safely. Similar weak practices were seen at the last inspection visit in regard to chemical items being stored with food products in an external area of the home and items left unattended in communal areas. During this inspection it could be seen that this previous practice had been rectified. From information given the staff are given basic training in Control of Substances Hazardous to Health practices in their induction period and in the general health and safety training. A sample of the fire safety records, were reviewed to assess that the service meets its responsibilities to maintain safe practices in the home. The information available supported that regular fire safety drills and checks are carried out and that any requirements or advice given from the Fire Service after routine inspections is carried out appropriately. This inspection has shown that there has been slow progress to improve the environment and the facilities in the home since the last inspection process. The management of the recruitment practices appear to continue to have gaps that may not ensure that staff are fit for the purpose they are employed for. There are elements of poor practices for protecting the wellbeing and safety of the people who live and work in the home, by not securing toxic substances kept in the home and grounds. All these areas of concern are taken into consideration in regard to the judgement of the management and administration of the home. Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 29 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 x X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 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 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 OP38 Regulation 13.4 Requirement That suitable safety measures are put in place to ensure that items that should be stored and used that come under the legislation for Control of Substances Hazardous to Health Regulations (COSHH) Timescale for action 24/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mon Choisy DS0000013112.V377012.R01.S.doc Version 5.2 Page 31 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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