Inspection on 10/12/07 for Monks Haven Residential Home

This inspection was carried out on 10th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Monks Haven Residential Home 04/12/09

Monks Haven Residential Home 02/06/09

Monks Haven Residential Home 01/12/08

Monks Haven Residential Home 17/06/07

Monks Haven Residential Home 08/10/06

Monks Haven Residential Home 10/05/06

Monks Haven Residential Home 24/02/06

Monks Haven Residential Home 04/08/05

Monks Haven Residential Home 19/10/04

Monks Haven Residential Home 21/05/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Monks Haven Residential Home 55-57 Beverley Terrace Cullercoats Tyne & Wear NE30 4NX Lead Inspector Glynis Gaffney Key Unannounced Inspection 10,11,14,16 December 2007 & 08 January 09:30 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 Monks Haven Residential Home DS0000032467.V354500.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. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Monks Haven Residential Home Address 55-57 Beverley Terrace Cullercoats Tyne & Wear NE30 4NX 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) 0191 252 1957 geoshineltd@aol.com www.monkshaven.co.uk Geoshine Limited Dr Raju Jacob George Care Home 33 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (23) of places Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: The Home may admit up to one person, 55 years of age and above within the SI category of registration, (not exceeding total number of places registered) Date of last key 17 June 2007 inspection: Brief Description of the Service: Monks Haven is situated on the sea front at Cullercoats and is a larger older style adapted building. The metro and other transport links are close by. The home provides residential care for 33 older people, of whom up to 10 may have dementia care needs. Nursing care is not offered. Bedroom accommodation is spread over three main and two mezzanine floors. There are 27 single bedrooms of which three have en-suites. There are also three double bedrooms. There is a passenger lift to the three main floors and a stair lift has been installed between the top floor and the second mezzanine floor. Access to some bedrooms, bathrooms, and toilets is via a small number of steps. The following communal facilities are also provided: two lounges and a dining room; two bathrooms and one shower; nine toilets; a kitchen and adjoining utility rooms. The home has a small attractive paved area to the front and a yard area to the rear of the building. Street parking is available to the front and rear of the home. Information about how to access a copy of the home’s inspection reports is on the notice board in the dining room. The current scale of charges is £361 to £411. Information about fee charges is included in the home’s service user guide and statement of purpose. Additional charges are made for hairdressing, chiropody, newspapers, and taxis. 1. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. How the inspection was carried out: Before the visit: We looked at: • • • • • Information we have received since the last key inspection visit on the 17 June 2007 How the service dealt with any complaints and concerns since the last visit; Any changes to how the home is run; The manager’s view of how well they care for people; The views of people who use the service and their relatives, staff and other professionals. The Visit: An unannounced visit was made on the 10 December 2007. An ‘Expert by Experience’ also visited the home. An ‘Expert by Experience’ is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. Their comments have been included throughout this report. During the visit we: • • • • • • Talked with people who use the service, some of the staff and the manager; Looked at information about the people who use the service and how well their needs are met; Looked at other records which must be kept; Checked that staff had the knowledge, skills and training to meet the needs of the people they care for; Looked around the building to make sure it was clean, safe and comfortable; Checked what improvements had been made since the last visit. We told the manager what we found. The reader should note that compliance with Requirement 15, which had been included in the last key inspection report, is not required. It had been included by error. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Notifications required under Regulation 37 of the Care Home’s Regulations are now being made to the Commission within the required timescale. Safeguarding concerns are now being referred to the local authority within 24 hours. The body maps supplied by North Tyneside Safeguarding Team are now being used to log bruises that appear on peoples’ bodies. The manager has devised care plans for each person covering the following areas: 1. Diet; 2. Sight, hearing and communication; 3. Oral health; 4. Footcare; 5. Mobility; 6. Continence. In line with the Mental Capacity Act and guidance issued by the Commission on achieving better outcomes for people using services, the manager has considered what individual freedoms, choices and decisions each person is able to exercise. A pressure care risk assessment has been completed for each person. The manager has devised a care plan to provide staff with guidance on how to manage the agitated behaviour of a person living at the home. Following advice from the Commission, the manager consulted relevant professionals about how to better manage this individual’s challenging behaviours. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 7 Staff now complete the medication administration record after each person receives their medication. Information publicising activities and events occurring within the home are now available in large print. The posters are attractively presented. The provider has devised an annual development plan. Appropriate action has been taken to try to eliminate the unpleasant odour in one of the home’s bedrooms. The wall tiles in one of the ground floor toilets have been repaired and a radiator guard has been fitted. The stairwell ceiling damaged by a flood has been repaired and redecorated. New carpet underlay has been fitted in bedroom 29. The external window frame opposite bedroom 30 has been replaced. The armchair, wardrobe and chest of drawers in bedroom 2 have been replaced. The wall tiles have been repaired. The furniture in bedrooms 6, 10 and 11 has been refurbished. A new armchair has been provided in bedroom 6. One of the armchairs in bedroom 16 has been replaced. Privacy screening has been provided. The armchair in bedroom 18 has been replaced. The kitchen is being maintained in a clean and hygienic condition. A cleaning schedule has been put in place. The rear stairwell and corridor carpets have been replaced. A stair lift has been fitted to allow one of the mezzanine floors to be accessed by people with a physical disability. The provider has been awarded a grant that will allow another assisted bathroom to be fitted. The bathroom has been cleared of the disused equipment that had been stored there. The carpets in bedrooms 2, 10 and 26, and in the en-suite bathroom in bedroom 41, have been replaced. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 8 The home is now being kept in a clean and hygienic condition. Extra domestic hours have been provided. The Department of Health self-assessment infection control checklist has been completed. A stock of new towels has been provided. Quality surveys have been sent to peoples’ families. Criminal Records Bureau disclosure certificates have been obtained for new staff that have commenced working at the home since the last inspection. The staff concerned had all signed a statement to confirm that they were mentally and physically fit to do the job. Two written references had been obtained. Verification has been obtained about why each person left their last period of employment. 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. The summary of this inspection report can be made available in other formats on request. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 9 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 Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements are in place for assessing the needs of people before they are admitted into the home. This information provides staff with the information they need to safely care for the people living at Monks Haven. EVIDENCE: Admissions do not take place until a full needs assessment has been undertaken. Where the assessment has been undertaken through Care Management arrangements, the provider insists on receiving a summary of the assessment and a copy of the care plan. The home also carries out its own pre-admission assessment to ensure that it is in a position to meet each individual’s needs. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 11 For people who are self-funding and there is no social services involvement, the home carries out its own assessment. A qualified and experienced member of staff always undertakes the assessment. The care records of two people were examined. A copy of each person’s social services assessment and care plan had been obtained before they moved into the home. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Some peoples’ care plans are not fully satisfactory. This might mean that staff are not clear about how they should meet the assessed needs of people using the service. EVIDENCE: Each person has a range of care plans that cover such areas as continence, personal hygiene, and social care needs. One person using the service said that they had been involved in drawing up their care plans. The majority of care plans have been reviewed on a monthly basis. However, some of those checked had not been reviewed in either October or November 2007. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 13 The manager has recently completed training in how to implement the Mental Capacity Act. Following this training, the senior team have looked at what choices and decisions each person with dementia is able to make for themselves. However, people’s records do not show how staff have reached ‘best interest’ decisions on behalf of the people in their care. For example, on one day at approximately 5.30pm, staff made a decision to take two people to bed. Both individuals were in bed at approximately 5.45pm. The manager said that staff had done this because it was in their ‘best interests’. He said that they had been tired and regularly wake at 6am in the morning. The records of the people concerned contain no evidence of how decisions had been reached about their bedtime and early morning routines. A care plan has been devised for a person with facial cancer. However, it does not adequately describe how their needs in this area should be met. For example, the care plan does not provide guidance on pain management or the arrangements that have been put in place for cleansing the wound area. However, the home had obtained medical advice and treatment from the individual’s GP and the community nursing service. A nurse inspector was asked to visit the home and examine the person’s care records. The nurse inspector also met with the individual concerned and assessed their condition. The manager was provided with advice about how to strengthen the arrangements that are already in place to provide this person with suitable care. Dr George agreed to act upon the advice immediately but stressed that the person concerned resists any attempt to provide wound care. The nurse inspector also identified that the individual’s care records contained references to the person ‘screaming’ and ‘yelling’ when they have a bath. However, specific information about strategies to be used to handle their behaviour has not been drawn up. In addition, the information recorded by staff detailing what had led up to this behaviour and what actually happened during and after each episode, is limited. Also, their continence care plan does not clearly describe the steps to be taken by staff to meet the person’s needs. In the last key inspection report, the Inspector looked at a care plan for a person at risk of developing pressure sores. It was recorded that there were three different plans of care detailing what staff needed to do to prevent the person developing pressure sores. Details of some of the actions to be carried out by staff were different in two of the care plans. Only one of the care plans had been signed, and only one had been dated. It was not clear which of the plans was the current care plan. This matter still remains unresolved. The manager accepted that keeping historical care plans in people’s day to day care records is likely to cause confusion and could result in staff not being clear about what guidance they should follow. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 14 Some of the care records examined were disorganised and do not have a set structure. The manager was provided with advice about how this matter could be resolved. People’s needs are not always clearly identified in their care plans. None of the care plans checked describe what outcomes the home hopes to achieve by their intervention. People living at the home have access to health care services both within the home and in the local community. For example, in the care records checked, there is evidence that each person had seen: A chiropodist during the last two months; An optician and a dentist within the last 12 months; A community nurse and GP as and when required. Arrangements are made for relevant health care professionals to visit the home where people are unable to attend outside appointments. A member of staff always accompanies people attending casualty following an accident. A range of preventative health care risk assessments have been devised for each person. For example, in one person’s care records, risk assessments covering the following areas are in place – skin care, prevention of falls, continence and nutrition. People’s weight is monitored on a monthly basis. Following concerns expressed in previous inspection reports: • Medical advice is now sought wherever staff have concerns about an individual’s well being. For example, during the inspection, staff immediately attended a person who presented as having a mini-stroke. The condition of the person was assessed and the ‘out of hours’ on-call doctor consulted for advice; Staff are keeping more detailed records following GP visits to the home; The provider has devised a useful guide to the information that staff must include when completing daily care records. Some of the records examined contain evidence that staffs’ performance in this area has improved. Dr George said that further work is required in this area. • • The home has a medication policy that is available for all staff to read in the main office. All medication is stored in a locked trolley and cabinet to which only senior staff have access. The medicines trolley is kept clean, tidy and it is easy to identify which medication belongs to which people. Photos to identify each person are in their medication records. Records covering the administration and disposal of medication are kept. The records examined are generally satisfactory. All staff administering medication have received accredited training. However, these staff have not been assessed by the manager as being competent to administer medication within the home. The Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 15 Commission has received one notification concerning the mis-administration of medication since the last inspection. This involved a senior member of staff giving a person an inhaler that belonged to another individual as they were preparing to leave the home. The Commission established that although the medication had belonged to another person, it was the same medication. The mistake was immediately recognised and no harm came to the person concerned. Following the incident, the manager has updated the home’s medication policy to include guidance on handing over medication to family members. No requirements have been set following a recent pharmacy inspection of the home. Staff are polite, respectful, kind and courteous to the people in their care. However, a care practice was observed which calls into question staffs’ understanding of treating people with dignity. After the evening meal was finished, a person was left sitting at the dinner table for just under 20 minutes. During this time, they had no contact with staff. The person eventually asked the inspector if they would take them to the toilet. A member of staff was informed and immediately collected the person and wheeled them to a toilet. The inspector checked ten minutes later to find the person still sat in their wheelchair waiting to use the toilet. It was noted that one person was already using the toilet and another person was sat on a chair waiting to use the toilet. There were other toilets in the home that were not in use at the time. It took almost another 15 minutes before the person concerned was able to use the toilet she had been placed outside. A person who returned a survey said that they ‘usually’ receive the medical support they need. Of the five relatives who returned surveys, three said that staff ‘always’ gave their relative the care and support they needed. Two people said that this ‘usually’ happens. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Although there are satisfactory arrangements for providing people with opportunities to participate in a range of stimulating social activities, access to external events and trips out is limited. EVIDENCE: Staff are aware of the need to support people to maintain their independent living skills where they are able to do so. For example, two people were observed participating in household chores following main meal times. One person told the inspector that ‘I really value this little piece of independence, it keeps me going. It helps the staff.’ People using the service are given the opportunity to take part in a variety of activities. For example, in December 2007, the following activities were held in the home: Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 17 • • • • • 04/12/07 06/12/07 10/12/07 16/12/07 18/12/07 – – – – – making Christmas decorations; helping to put up Christmas decorations; Christmas party with entertainment and a raffle; entertainment from a live brass band; Christmas carol service provided by a local school. The ‘Expert by Experience’ said: ‘The home was steeped in Christmas trees and decorations all ready for the Christmas season. A sing-song was in progress in the lounge and several residents were taking part and singing along to many of the old songs.’ The manager has completed specialist training in providing activities to people with dementia. Members of his staff team have completed training in working with people with dementia. This covered the provision of activities. Information about peoples’ leisure interests and pursuits is obtained at the point of admission into the home. Information from the social needs assessment is then used to devise a care plan. There is a social needs assessment in each set of care records. However, none of them have been updated in the last 12 months. In one of the records examined, a person centred activity plan is in place. The home’s standard care plan format has not been used to record the information gathered. This has the potential to lead to inconsistent care plans which could result in staff confusion. It is clear that the manager and his staff have attempted to improve the provision of activities within the home. During the inspection, staff were observed encouraging people to join in the afternoon activity sessions. The inspector saw people participating in making Christmas decorations and engaging in an arts activity session. A copy of the home’s activity programme had been displayed in the dining area. This, and individual posters publicising events occurring in the home, has been produced in large print for people with visual problems. A movie evening and a flower arrangement session are held every fortnight. A regular weekly exercise class is held to keep people fit and healthy. There is a monthly church service that people can choose to attend if they wish. Birthdays and festive events are celebrated. A small number of people attend a local-tea dance arranged by the Alzheimer’s Society. The activity programme specifies that activities should be provided during the morning and afternoon periods. However, no activities were provided during the morning of the inspection. In addition, there is no programme of external social events and outings. A person who returned a survey said that the home ‘usually’ provides suitable activities. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 18 The ‘Expert by Experience’ said ‘I was shown the activities register where various activities were listed. Some residents had been making Christmas cards which were on display. Entertainers come in from time to time and I saw a record of their ratings. The residents have the opportunity to attend tea-dances organised by outside agencies, but sometimes when the day arrives, they are reluctant to go.’ People who use the service are supported to maintain important personal and family relationships. Visitors can be seen in private or meet with their relatives in the lounge and dining areas. Nobody spoken with could recall the home placing any restrictions upon their visitors. There are no care plans providing staff with guidance on how to support people to maintain personal relationships. The home has a varied menu that offers choice. Each day the cook consults with people to find out if they have enjoyed the food served. A record is not kept of people’s responses. Although the menu for the day is clearly displayed in the dining room, the writing is small and difficult to read. People have access to snacks and drinks in-between meal times. The inspector participated in the lunchtime meal. The meal was tasty, nutritious, and appetising. Staff respond to people’s needs in a caring and sensitive manner and provide them with the assistance they needed to eat their meal. The atmosphere is relaxed and unhurried. Each person has a nutritional risk assessment. The home’s standard format for recording nutritional risk assessment information has not always been used to record the outcome. Currently, there are no people with a different ethnic or cultural background using the service. A person who returned a survey said that they ‘always’ like the food served at the home. The ‘Expert by Experience’ joined people for their tea-time meal. She said that she ‘… accepted soup and fruit and jelly. The soup was quite tasty and warm. I was very pleased to watch the way in which the care worker was feeding a resident in their wheelchair. She was sitting at the same level and spoke gently to her and didn’t hurry her in any way. When the resident had finished her jelly and fruit she was offered more which she eagerly accepted.’ Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Safeguarding concerns are now being handled in a satisfactory manner. Satisfactory systems are in place to ensure that the required notifications are being made. This will help to ensure that people’s well-being is protected and that staff are clear about what actions they need to take to keep people safe. EVIDENCE: The home has a complaints procedure that meets the National Minimum Standards. The procedure has recently been reviewed and a copy has been placed in each person’s bedroom. The procedure can be made available in alternative formats on request. The manager said that a written record would be kept of any complaint received by the home. However, the complaints book did not include details of complaints made to Care Management and the Commission about the home. The manager and his staff team have adopted a more professional attitude to complaints management and have improved the way in which complaints are handled. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 20 In the last key inspection report, reference was made to an anonymous complaint having been received. A representative from the local authority’s safeguarding team has carried out an investigation and the findings have been shared with the manager. In summary, the complainant alleged that: • Some people had been moved from their own bedroom to make way for new people being admitted into the home. The local authority’s safeguarding team found this allegation to be unfounded. The family member of a person who had recently changed bedrooms said that the manager had involved them fully and consulted them about the proposed change. They also said that the manager had consulted their relative. They said that they did not have any concerns about the home’s conduct; • The manager had interfered with people’s medication and the home’s pharmacist was unhappy with this. The local authority’s safeguarding team found this complaint to be unfounded. The Commission carried out a full inspection of the home’s medication systems and practices and made one requirement and one recommendation. These were unrelated to the general concern raised by the complainant. The home’s pharmacist was consulted and they said that they had no concerns about the manager’s conduct; • A person who had been burned had had Sudacreme applied to the affected area. The local authority’s safeguarding team found this complaint to be unfounded. A representative from the primary health care team was consulted about this matter. They said that this was an accepted practice and did not see anything inappropriate about the treatment given; • The home failed to obtain medical advice following substantial bruising noted on one person’s body. The local authority’s safeguarding team substantiated this allegation. • The manager had told a visiting health care professional that nursing care was provided at Monks Haven. The local authority’s safeguarding team found this complaint to be unfounded. The healthcare professional concerned was consulted and supported Dr George’s assertion that this had not occurred; • New staff had commenced work at the home without an induction. DS0000032467.V354500.R01.S.doc Version 5.2 Page 21 Monks Haven Residential Home The local authority’s safeguarding team substantiated this allegation. The key inspection that took place shortly after the complaint was received found that there was no written evidence that a newly appointed member of staff had received an induction covering the ‘Skills for Care’ induction standards. In addition, there was no written evidence that they had received an in-house induction. One requirement was set and has been reviewed in this report; • That following a person’s admission into hospital, the manager had led hospital staff to believe that he was their GP. The local authority’s safeguarding team found this complaint to be unfounded. Inquiries were made of the ward team who oversaw the admission and they provided no evidence to support this allegation; • That a concern was raised in relation to a previous investigation that had taken place. The safeguarding team reached a decision not to investigate this concern any further following advice supplied by the Commission; The manager asked a community nurse visiting the home to assist with an illegal lift. This concern has been addressed under the primary health care team’s internal procedures. During the key inspection that followed receipt of this complaint, the inspector spent time observing staff assisting people to move and transfer. No concerns were identified; A person with pressure sores had been left lying in bed until late morning. The local authority’s safeguarding team found this concern unresolved. During the key inspection that followed receipt of this complaint, a decision was made to check that a preventative pressure care risk assessment had been completed for each person. Also, that where needs had been identified, that appropriate care plans had been put in place to provide staff with guidance on how to manage people’s pressure area and continence care needs. Two requirements were set and have been reviewed in this report. The home has a safeguarding adults policy that provides staff with clear guidance on how to handle adult protection concerns. The local safeguarding team has checked the policy to ensure it is compliant with best practice guidance and advice. • • Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 22 Since the last inspection: • The Commission has taken enforcement action against the registered person following a failure to notify the North Tyneside Adult Safeguarding Team and the Commission about an issue relating to a person living at the home; The Commission has taken enforcement action against the registered person following a failure to notify the North Tyneside Safeguarding Team within the stipulated 24 hours about an incident that affected a resident living at the home. The registered person also failed to notify the Commission at the earliest possible opportunity; The Commission took enforcement action against the registered person following a failure to notify the North Tyneside Adult Safeguarding Team and the Commission of an incident involving a person living at the home; • • Following the serving of an enforcement notice, the manager was required to ensure that: • The North Tyneside Adult Safeguarding Team is notified of any incidents affecting the health and welfare of, or of potential harm or abuse to, people living at the home; All senior staff are familiar with North Tyneside Council’s Adult Safeguarding protocols and the home’s own safeguarding policies and procedures; The home’s management team are: 1. Clear about and comply with the responsibilities and duties placed upon them by Regulation 37 of the Care Homes Regulations 2001. The Notice also stated that senior staff should be provided with relevant training and that a record of this should be kept in their individual training record; 2. Able to access copies of the standard forms issued by the Commission for Social Care Inspection for recording Regulation 37 notifications; The Commission is notified without delay of all notifiable incidents occurring within Monks Haven. Since the Commission took enforcement action in August 2007, the manager has taken action to ensure that both the Commission, and the North Tyneside Safeguarding Team, are notified of all relevant incidents affecting the wellbeing of people living at the home. Notifications made have been timely and recorded using the Commission’s recommended format. The manager has also Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 23 • adopted a positive attitude to implementing the requirements stipulated in the enforcement notice and has worked in partnership with North Tyneside Council’s Safeguarding Team and the Commission to do this. When safeguarding meetings have been held, the home’s manager has always attended. In addition, the manager has implemented more robust ways of working such as: ‘Body Maps’ are now completed whenever an individual injures themselves in any way; Staff are now clearer about their responsibilities under the Care Homes Regulations 2001. The two senior staff interviewed said that it was an expectation that they would immediately inform the manager of any concerns arising within the home. They also said that the manager had explained what records needed to be kept to comply with the legislation. All staff employed at the home on a permanent basis have received training in safeguarding vulnerable adults. Of the five relatives who returned surveys, all said that they had been told how to make a complaint. Four said that the home responds appropriately whenever they raise concerns. One person said that this ‘usually’ happens. One person who returned a survey said that they had been told how to make complaint. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 25, and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements are in place to maintain and improve the home’s decoration, furnishings, and fittings. This means that people living at Monks Haven had been provided with accommodation that is decorated and furnished to an adequate standard. EVIDENCE: The home provides a physical environment that meets the specific needs of people living at Monks Haven. There is an annual development plan that sets out what improvements will be made to the home’s decoration, fixtures and fittings during 2008. A copy of the plan has been made available to the Commission. The home’s maintenance worker maintains a detailed repairs and Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 25 maintenance record. All the premises related requirements stipulated in the last key inspection report have been complied with. People are able to bring their own furniture and possessions with them when they move into the home. In some of the bedrooms visited people had chosen to personalise their rooms. A small number of people have their own en-suite facilities. Although the furniture in bedrooms 6, 10, and 11 has been refurbished following the last inspection, it still has a worn appearance. A person living at Monks Haven said that the home is clean, tidy, warm, well lit, and comfortable. This person mentioned that they have a hearing impairment. They said that the manager had installed a fire-warning bell for people with hearing impairments in her bedroom. There have been no outbreaks of infection and the kitchen was generally clean and hygienic. The manager had completed the Department of Health infection control selfassessment checklist. The ‘Expert by Experience’ said: ‘It is a very old building and has a lovely appearance, beautiful old doors and a very impressive staircase and banister…the hall, staircases and passageways were newly decorated. I was shown all the bedrooms, which appeared to be relatively clean but slightly shabby. Unfortunately there was a strong smell of stale urine in several rooms…the manager explained that the residents in these rooms have severe incontinence problems.’ Plans are being made to add a small conservatory to the rear of the building to provide people with more communal space. The only premises related concern identified is the poor condition of the remaining red corridor carpet. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for ensuring that new staff complete the ‘Skills for Care’ induction training workbook are not fully satisfactory. This might mean that staff do not have all of the required skills and competencies needed to provide people with person centred care delivered in a safe environment. EVIDENCE: There are enough qualified and experienced staff rostered on duty to meet the health and welfare of the nineteen people using the service. There is a rota which sets out what shifts are being worked and by which staff. The following numbers of staff are provided throughout each 24-hour period: • • Two care staff, including a senior carer, cover the night time shift from 10pm to 8am; Three care staff, including a senior carer, cover the daytime period from 8am to 10pm. DS0000032467.V354500.R01.S.doc Version 5.2 Page 27 Monks Haven Residential Home Domestic and catering staff are also available each day. The manager is supernumerary to the care rota. The rotas contain the necessary information with the following exceptions: staffs’ full names; the hours worked by the manager; shift times for night staff, and the domestic and catering staff. Staffing rotas take into account the needs and routines of the people using the service. One person using the service who returned a survey said that: • • They ‘always’ receive the care and support they require; Staff are ‘always’ around to help them when they need it. The ‘Expert by Experience’ said that a relative told her that they were very satisfied with the care provided to their spouse. This person said ‘…she likes to help downstairs and is allowed to help in the dining room laying tables and so on…she has a double room with beautiful sea views and seems quite content.’ Another person told the ‘Expert by Experience’ that she was ‘…quite satisfied with her care.’ She said that ‘…she has a breakfast and her evening meal in her room, but chooses to go down to the dining room for her lunch.’ The home does not have a formal training plan that identifies which staff need to do what training over the next 12 months. However, the manager is aware of gaps in the training programme and is taking action to address these. On commencing work at the home, staff are expected to complete the ‘Skills for Care’ induction. However, a member of staff who had completed the statutory training component of the induction training was unable to provide a completed ‘Skills for Care’ workbook. Over 70 of the staff team have obtained a relevant qualification in care. Seven staff have obtained a National Vocational Qualification (NVQ) in Care at Level 2. Two staff have obtained a NVQ 3 in Care and one other person is in the process of doing so. One of the domestics has obtained a NVQ at Level 2 in Housekeeping. The manger has recently arranged for his domestic staff to commence training leading to a relevant qualification in care. Ten staff are due to undergo ‘Skills for Care’ induction training early in the New Year to ensure that they are up to date with current best practice. Some staff have previously completed this training but were unable to demonstrate to the manager that they had completed the Skills for Care’ workbook. Arrangements have also been made for staff to access more specialist training. For example, a senior member of staff has completed training in supporting people with dementia care needs, caring for those with poor vision and using oxygen safely. However, it is the view of the Commission that all care staff would benefit from completing training in dementia care, person centred Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 28 planning and carrying out risk assessments. A member of staff appointed within the last 12 months has updated their statutory training. Of the five relatives who returned surveys: • • Three said that staff ‘always’ have the right skills and experience to look after people properly; Two said that they ‘usually’ did. Following the last inspection, the manager has taken action to ensure that all the required pre-employment checks are carried out before permanent staff commence working at the home. However, the manager said that the agency that supplies the home with staff do not provide confirmation that the individuals sent to work at Monks Haven have received appropriate training and undergone the required pre-employment checks. The home has an up to date recruitment and selection policy supplied by its employment adviser. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 29 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although improvements have been made to the ways in which the home complies with the management and administration standards, further work in these areas is still required. EVIDENCE: The manager is a qualified medical doctor and has obtained the Registered Manager’s Award. He has managed the home for over three years. Dr George ensures that his statutory training is kept up to date. Although staff are not yet receiving formal supervision at the frequency required by the National Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 30 Minimum Standards, arrangements have been made to address this shortfall. The manager has prepared a plan setting out which staff will receive supervision and on what dates. In addition, all staff have been issued with self-assessment questionnaires which they must complete before undergoing their first appraisal. The timescale for complying with a requirement from the previous inspection concerning staff supervision and appraisals has not yet expired. The manager has taken a positive approach to implementing requirements made following the previous two inspections. Most of the people living at Monks Haven have their money managed on a dayto-day basis by the home. Each person has their own separate purse in which their money is kept. Peoples’ money is kept secure. Two staff signatures and receipts are obtained for any money spent on people’s behalf. Generally, balances matched with the amounts of money recorded on people’s financial records. Where this was not the case, a reasonable explanation was provided. There has been an improvement in the standard of financial record keeping and the records show evidence of being regularly audited. However, a considerable amount of money was being held on behalf of one person. This matter was resolved following the inspection. The manager has put systems in place to monitor the quality of care provided at the home. For example: • • • An annual development plan has been devised; Visits to monitor the quality of services and care provided at the home are taking place on a regular basis; All people living at Monks Haven, and their relatives, have recently been issued with surveys to obtain their views about the performance of the home. All staff have received training in how to mobilise and transfer people safely. During the inspection, two care staff were observed supporting a person to mobilise using techniques that are not referred to in their moving and handling risk assessment and care plan. The manager immediately addressed this matter with the two staff concerned, and for the remainder of the inspection, all staff were observed moving and handling people in a safe manner. Following a requirement set in the last inspection, the manager has obtained a copy of a letter confirming that the home’s portable appliances have been tested and found safe. A tour of the building revealed no health and safety concerns. Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 31 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 2 8 2 9 2 10 X 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 3 17 X 18 3 2 3 X X X 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 3 X 3 2 2 Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 32 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 OP7 Regulation 15 Requirement Ensure that: • • • • Each person’s needs are clearly outlined in their care plans; Each person’s care plans contain desired outcomes; People’s care plans are reviewed monthly; Each person’s preferred routines for personal care are included in their care records – especially in relation to: getting ready for and going to bed; getting up in the morning; use of preferred toilets. Timescale for action 01/06/08 Compliance with this requirement will help staff to be clear about what help and support people require and how this is to be done. 2. OP8 15 In relation to the care provided 01/02/08 for one person, ensure that the community nursing service is contacted and asked to provide advice regarding: DS0000032467.V354500.R01.S.doc Version 5.2 Page 33 Monks Haven Residential Home • • • • A detailed pain assessment; A detailed wound assessment; A referral to the tissue viability nurse and McMillan nursing service; The need to provide an ‘end of life’ care pathway. Amend the care plan to include the following details: • • • Care of wound and how to encourage co-operation; Guidance on preventing or minimising deterioration of skin integrity; More information about nutritional assessment and interventions to prevent weight loss; A weight monitoring strategy. • Compliance with this requirement will help ensure that the person concerned receives better person centred care delivered in collaboration with the relevant primary and specialist health care services. 3. OP19 16(2) Replace the remaining corridor carpet. ‘red’ 01/06/08 Compliance with this requirement will help to ensure that people are provided with good quality communal facilities. 4. OP27 18 Ensure that the home’s rotas 01/02/08 contain the following information: • • Staffs’ full names; The hours worked by the registered manager; Version 5.2 Page 34 Monks Haven Residential Home DS0000032467.V354500.R01.S.doc • The hours worked by night carers, domestic and catering staff. Compliance with this requirement will help the Commission to establish that the required numbers of staff are scheduled on duty throughout each 24-hour period. 5. OP30 18 Ensure that staff complete the 01/06/08 ‘Skills for Care’ workbook to provide evidence of their learning and development. Ensure that staff receive: • • Formal structured supervision at least six times a year; An annual appraisal. 01/06/08 6. OP36 18 Ensure that a training needs analysis is completed for all staff and a written record kept. 7. OP37 15 Ensure that a finance care plan is 01/02/08 prepared for each person that details the level of support they require with the management of their money. The plan must clearly outline the roles and responsibilities of each party that is involved with the person’s money. Compliance with this requirement will help to ensure that people receive the support they require and their financial interests’ are safeguarded. (The timescale for complying with this requirement expired on 01/12/07) Ensure that staff comply with the 01/01/08 guidance contained in people’s DS0000032467.V354500.R01.S.doc Version 5.2 Page 35 8. OP38 13(4) Monks Haven Residential Home moving and handling risk assessments and care plans. 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 OP7 Good Practice Recommendations Purchase a copy of the Mental Capacity Act Code of Practice. Ensure that all staff are aware of the above Code and how it affects their day-to-day work as carers. Update your assessment and care planning policy to include guidance on how your service will consider people’s capacity to take decisions. Devise documentation, which will enable you to record how you have reached a ‘best interest’ decision on someone’s behalf. In respect of each ‘best interest’ decision you need to make, you should include the following trigger points in your documentation: • • • • • Have you considered the two stage test of capacity and recorded the outcome; Can the person understand information relevant to the decision that needs to be made; Can the person remember that information long enough to make the decision; Can the person weigh up information relevant to the decision; Can the person communicate their decision by talking, using sign language, or by any other means. 2. OP7 Ensure that: • Each person’s care records contain details of their DS0000032467.V354500.R01.S.doc Version 5.2 Page 36 Monks Haven Residential Home • • • • 3. OP7 preferred style of communication; A standard format is used to record care plans; Each service user’s care record contains only their current risk assessments and care plans. Historical risk assessments should be archived to avoid staff becoming confused over which are the current risk assessments and care plans; People living at the home, or their representatives, are given the opportunity to read and sign their care plans to confirm their agreement with the contents; A recognised ‘falls’ risk assessment tool is used to record risk assessment findings. When completing risk assessments: • • • • • • • • Use a standardised format; Clearly define the risk present; Assess the level of risk present before control measures are put in place; Clearly define the actions to be taken by staff to minimise the risk present; Assess how well the risk has been managed by the home’s intervention; Ask each member of staff to read and sign the risk assessment; Record the date on which the risk assessment is to be reviewed; Ensure that they have been signed and dated by the person completing the documentation. 4. OP9 Review the home’s medication policy in the light of the latest guidance issued by the British Royal Pharmaceutical Society. Assess the competency of staff to administer medication and keep a written record of this assessment and the outcome. 5. 6. OP12 OP15 Prepare a programme of external social activities and outings. Ensure that there is written evidence confirming that people have been provided with opportunities to comment on the home’s menus. Ensure that the following details are recorded in Monks Haven’s complaints book when a complaint about the home is received by Care Management or the Commission: DS0000032467.V354500.R01.S.doc Version 5.2 Page 37 7. OP16 Monks Haven Residential Home • • • • 8. 9. 10. 11. OP21 OP24 OP30 OP30 The date on which the complaint was received; The complaint details; The method of investigation used; The investigation outcomes and details of the action plan put in place to address any shortfalls identified. Provide en-suite facilities in more bedrooms. Consider upgrading the furniture provided in bedrooms 6, 10, and 11. Ensure that the agency supplying staff to work at the home provide details of the training they have completed. All care staff should complete specialist training in working with people with dementia, carrying out risk assessments and person centred planning. Ensure that: • • Where appropriate people are supported to open a bank account; Only a limited amount of cash is held on the premises on behalf of people who live at Monks Haven; Assess whether a person is able to manage their own finances and manage any risks. Use the single test set out in the Mental Capacity Act 2005 when assessing people’s capacity to take a particular decision and adopt ‘best interest’ principles where a decision has to be made on a person’s behalf; There is an appointed person to manage each individual’s financial affairs. 12. OP37 • • Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Monks Haven Residential Home DS0000032467.V354500.R01.S.doc Version 5.2 Page 39 - 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. 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