Inspection on 10/05/06 for Monks Haven Residential Home

This inspection was carried out on 10th May 2006.

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

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

Other inspections for this house

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 10/12/07

Monks Haven Residential Home 17/06/07

Monks Haven Residential Home 08/10/06

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Monks Haven Residential Home 55-57 Beverley Terrace Cullercoats Tyne & Wear NE30 4NX Lead Inspector Glynis Gaffney Unannounced Inspection 10, 11, 12 and 16 May 2006 10:00 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.V290252.R01.S.doc Version 5.1 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.V290252.R01.S.doc Version 5.1 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 Geoshine Limited 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.V290252.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Not applicable. Date of last inspection 24/02/06 Brief Description of the Service: Monkshaven 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 26 single bedrooms of which three have en-suites. There are also three double bedrooms are also available. There is a passenger lift to the three main floors. 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 the current scale of charges was not available. Additional charges are made for hairdressing, chiropody, newspapers and taxis. Copies of the Commission’s Inspection reports were not available to visitors, staff and residents. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, took place over 18 hours and involved four inspectors. Each Inspector examined the Home’s performance against a small group of National Minimum Standards. A range of evidence has been used to support the judgements reached in this report, including interviews conducted with the Home’s Acting Manager, members of his staff team and residents. Residents with dementia care needs were also interviewed. The premises were also inspected, as were a sample of care records, policies, and procedures. What the service does well: What has improved since the last inspection? Since the last inspection, the following improvements had been made to the premises: • • • • • • • • • • Toilet 1: a new light and window covering had been fitted; Toilet 4: the window frame had been cleaned and a new floor covering fitted; Toilet 6: a new floor covering had been fitted; Bedroom 7: the room had been re-decorated; The red corridor carpet had been cleaned; Bedroom 17: the carpet had been cleaned; Bedroom 15: the carpet had been cleaned; Bedroom 24: the window frame had been cleaned and re-painted; Bedroom 29: the bedside cabinet had been re-varnished. The carpet had been cleaned and the wardrobe handle had been refitted; Small lounge: one of the armchairs had been replaced. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 6 What they could do better: Prospective residents should be provided with a copy of the Home’s Service User Guide so that they can make an informed choice about whether to live at the Home. Consideration should be given to making the Service User Guide available in other formats suitable for residents with sight problems. The Home should ensure that they have collected sufficient information prior to a resident’s admission to enable them to make a decision about whether to offer a placement. Prospective residents should be informed in writing that the Home is able to meet their needs. Prospective residents should be visited by staff in their current accommodation so that a better understanding of their needs can be obtained. The Home’s rota should include the information that the Commission needs to have in order to check that the Home is properly staffed. Satisfactory numbers of staff should be on duty so that residents’ needs can be properly met. The Provider has been served with a Warning Letter to ensure that this requirement is met. Sufficient numbers of qualified staff should be employed so that residents know that they will be cared for by professional staff who know how to meet their needs. The Home’s cooks should work to a set of menus. This will help ensure that residents receive a balanced and nutritional diet, which offers sufficient choice. A nutritional policy must be prepared to ensure that catering staff are clear about their responsibilities and duties ensuring that in the absence of the Acting Manager, residents continue to receive the same quality of food provision. The Acting Manager needs to ensure that the Home’s Activity Programme reflects residents’ assessed needs and interests, including those persons with dementia. The Acting Manager must obtain a relevant care qualification and undertake refresher training in key areas to ensure that staff are provided with clear leadership and direction. Further improvements must be made to the condition of the premises and its furniture, fittings and fixtures so that residents are provided with a wellmaintained place in which to live. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 7 Staff must transfer residents safely and in line with their training so as to minimise the potential for injury and serious harm. Residents’ care records should include all of the information required by care staff so that they know how to safely and properly care for residents. The Home’s cleaning rota should clearly identify the tasks that need to be undertaken by domestic staff to ensure that the building is maintained in a clean and hygienic condition. An Annual Development Plan should be prepared and implemented so that residents and their families can see that action is being taken to maintain their home in a safe and comfortable condition. Staff must seek immediate advice from the local Safeguarding Team where residents are subject to potential harm. Senior staff need to be clear about the location of the Home’s Complaints Record. This will help ensure that any complaints are properly recorded. 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. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 8 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.V290252.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this Service. Prospective residents were not provided with the information they needed to make an informed choice about whether to live at the Home. Suitable arrangements had not been made to ensure that residents’ needs had been assessed prior to their accepting a place at the Home. EVIDENCE: The Home had developed a Statement of Purpose and Service User Guide that contained information about the services provided at Monkshaven. The Service User Guide was available in a standard format only. A resident recently admitted into the Home said that she had not been provided with a copy of the Home’s Guide. The Deputy Manager was unable to locate any spare copies of the Guide. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 10 The needs of a prospective resident had been assessed prior to their moving into the Home. Although a copy of the Care Management Assessment was not available in this person’s care records, a copy of the Care Manager’s Care Plan had been obtained. The prospective resident’s needs had been assessed by staff to ensure that the Home was in a position to properly care for them. The person concerned was provided with an opportunity to visit the Home prior to admission, and to meet with residents and staff. However, staff had not visited the person in their current accommodation prior to admission. A written record of the Home’s assessment was available, but the Home’s standard documentation had not been used to record the information collected. Although it was clear that efforts had been made to inform staff of the new resident’s care needs, a member of staff felt that more background information could have been provided. The new resident’s care records did not include a ‘Life History’. Although there were no ethnic minority elders living at the Home, a policy was available setting out the approach that would be adopted when considering how best to meet their needs. All of the residents interviewed felt that staff knew what their needs were and how to meet them. Residents commented in surveys that they either always, or usually, received the care and support they needed from staff. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ care plans did not adequately demonstrate how the Home intended to meet their health, personal and social needs. Residents’ health care needs were satisfactorily met. Although residents received their medication on time, some of the Home’s medication practices did not adequately protect residents from potential harm. Residents were treated with respect and dignity when receiving personal care and their right to privacy was protected. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 12 EVIDENCE: The care plan of a newly admitted resident was examined and it was found that: • Although care plans covering personal hygiene, social isolation and mobility had been prepared, these did not cover all of the recommended areas had been covered such as those needs associated with nutrition, chiropody, management of personal money and medication; The care plans had not been drawn up until approximately four weeks after admission. The resident confirmed that she had not been involved in the development of her care plans; Information about the resident’s preferred routines was in place; A Nutritional Risk Assessment had been completed. The assessment contained no mention of the chewing difficulties that the resident was experiencing due to very loose dentures; The Home had received important advice from the Community Nursing Service about how to meet the resident’s physical care needs. Although the advice received had been recorded, it had not been used to update the resident’s care plan. • • • • None of the other care plans examined covered residents’ needs for support with medication and finance. Although there was evidence that some residents had signed their care plans, other residents commented that they had not heard of, or seen, their care plans. Residents had access to health care services both within the Home and in the community. For example, residents were supported to access medical, optical and chiropody care as required. Dental health care assessments had been completed. But, it was not possible to confirm when residents had last received dental health care as such information was not readily available in their care records. Records of interventions carried out by health care professionals visiting the Home were satisfactorily recorded. The Home’s Medication Policy contained the required information. Drug alert notifications were filed and kept in the office. A medication reference book was available for staff to refer to. However, a member of staff commented that she had little background knowledge of the drugs that were being administered within the Home. The medication records were generally well completed. During the lunchtime meal it was noted that the medication trolley was left open whilst the senior member of staff crossed to the other side of the room to administer an item of medication. This was a potential hazard. The Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 13 medication trolley lock was broken. Items of medication (Adrenaline and antibiotics) had been left unsecured in the main office. Money belonging to residents had been placed for safekeeping in the Controlled Drugs cabinet because senior staff were unable to access the Home’s safe. This is considered an unsafe practice. Hand wash facilities were available in the main office area. Detailed care plans were in place for two residents requiring Oxygen Therapy. Identification photos were not in place for all residents. Staff were observed providing personal care to residents in a kind, considerate and helpful manner. Residents interviewed confirmed that staff respected their privacy and treated them in a dignified manner. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents were only provided with opportunities to join in a limited range of social activities. Arrangements to provide specialist activities for residents with dementia were inadequate. Residents received the assistance they needed from staff to eat their meals and suitable nutritional assessments and care plans were in place. But the arrangements in place for menu planning were not satisfactory and there was a lack of choice at both the lunch and teatime meals. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 15 EVIDENCE: Residents had assessments of their social needs. However, care plans for social care had core interventions that were not specific to individuals’ interests. Evaluations of the plans had been recorded monthly and these demonstrated some evidence of activities enjoyed by residents. A weekly activities programme was displayed on the notice board. This depicted two sessions of activities daily including drawing and colouring, reminiscence, music and sherry, bingo, chair exercise, dominoes, cards, ball games, board games, and arts and crafts. A senior member of staff said the activities changed from week to week depending on what residents wished to do. Staff had been recording a Daily Activities Attendance Sheet with codes for the type of activity undertaken by each resident. The last completed sheet was from the end of April 2006. The Inspector was told the records were not up to date as further pre-printed sheets were not available. Some evidence of participation in activities was recorded in resident daily reports. The sheets did not show provision of a variety of activities, and in many instances, only passive activity such as music or television was indicated. There was also no evidence of activities being arranged that were tailored to the needs of residents with dementia. There was no forward planning of entertainment and outings. An entertainer had visited the Home at Easter. Outings had only taken place in the local area when the weather was fine. The Home has a policy on maintaining contact with family and friends. This incorporated the visiting policy, including the residents right to refuse visitors and offering hospitality. Relatives were said to be routinely invited to reviews of individuals care. One resident attended a local day centre. Some use is made of local amenities. Local clergy visit monthly to provide Communion. There was no other involvement of community groups. The Home has a policy on managing residents’ financial affairs. This covered the expectation that residents will manage their own affairs where possible. It also contained details of receiving assistance from relatives/friends/advisors, cash held for safekeeping, benefit books, fees, agency arrangements, and records. In practice, residents’ relatives were said to advocate on their behalf where the person lacked capacity. A local advocacy service had also been used in the past. A policy on advocacy was in place. This included a definition, how advocacy works and contacts for North Tyneside Advocacy Service. Improvements required and recommended at the previous inspection concerning meals and menus had not been actioned. Policies on dietary assessment, nutritional care and revision of menus had not been devised. A hot meal choice at teatime and provision of recommended portions of fruit and dairy products had not been fully introduced. Menus and nutritional needs of Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 16 residents were discussed with the cook who had recently taken up his post. The cook was keen to learn about nutrition for older people and fortification of meals. Kitchen staff had not been working to a planned menu and had been catering according to available food stocks. The implications of this were discussed with the cook. Residents who take a vegetarian diet were not always being provided with suitable meals. An example of this was the teatime meal served on the day of the inspection, which was corned beef pie. A three-week menu was available. The cook believed this was to be introduced in the near future. He was not certain whether residents had been consulted. This menu showed choice of meals with the alternative at lunch and tea being a vegetarian option. Records of meals provided from the beginning of this month were examined. There was no choice of meals at lunch or tea. Nutrition charts indicating recommended portions of starchy foods, fruit, vegetables, protein, dairy products, nourishing snack supper and milky drinks had been completed daily. However, these did not always demonstrate recommended portions had been provided. It was also noted that whilst full fat milk was used, margarine was routinely used instead of butter. The care records of two residents identified as being nutritionally at risk were examined. Nutritional assessments and care plans were recorded and weights were monitored monthly. Care plans included interventions for encouraging food and fluids, and weighing, though did not specify provision of fortified foods or high calorific snacks/drinks. The use of food and fluid charts had ceased. One resident was said to require feeding. A member of staff provided this person with assistance at each meal though independent eating, for example finger food was encouraged. It was also of concern that: • • • Numerous items of crockery were chipped and stained; There did not appear to be a full set of matching crockery; Tablemats and napkins were in a poor condition. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the Home had a robust complaints procedure, which was known to residents, there were some individuals who felt that the concerns they had raised had not been taken seriously by staff. Staff had received suitable training in safeguarding vulnerable adults. There was one case where staff had failed to take appropriate action to adequately safeguard one resident. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 18 EVIDENCE: A Complaints Procedure was available and included details of how to refer a complaint to the Commission. A copy of the procedure was located in each resident’s bedroom. A summary of the Complaints Procedure was also included within the Home’s Service User Guide. The Commission had not received any complaints since the Home’s last inspection. The Home had received one complaint, which was under investigation. Neither of the senior staff that assisted with the inspection were able to locate the Home’s Complaints Book. A resident interviewed told the Inspector that she had complained several times about having to go to bed early. She also said that she had raised this numerous times with staff but had just given up trying. Two other residents said that they had told staff they were dissatisfied with the quality of food served but that nothing had been done about it. The Home’s Adult Protection Policy complied with the relevant guidance and legislation. There had been no adult protection concerns raised with the Commission since the last inspection visit to the Home. There was evidence that staff had received training in the protection of vulnerable adults. However, an adult protection concern was identified following the examination of one resident’s care records. The concerns identified by the Inspector had not been discussed with the local Safeguarding Team. Immediate action was taken by the Deputy Manager to rectify this concern. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 and 26. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Steps had been taken to make the premises safe. was not fully adequate. The standard of hygiene Overall, the standard of decoration was acceptable. Some of the furniture and fittings within the Home were inadequate. EVIDENCE: Over the last 12 months, the Proprietor had made a number of improvements to the premises, both internally and externally. For example, certain areas of the building had been redecorated. The following matters had not been attended to since the February 2006 Unannounced Inspection Report was issued. However, the timescale set for compliance with the requirement had not expired at the time of the inspection. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 20 • • • • • • • • Bedroom 2: the carpet remained in a poor condition despite having been cleaned. The room contained an unpleasant odour; Bedroom 6: the carpet remained in a poor condition despite having been cleaned. The chest of drawers was in a poor condition; Bedroom 7: there was a very strong and unpleasant odour. The carpet remained in a poor condition despite having been cleaned; Bedroom 11: the veneer on both chests of drawers had come away in places; Bedroom 13: the carpet remained in a poor condition despite having been cleaned. The bedside cabinet and chest of drawers had a worn appearance; Bedrooms 17, 23 and 29: the carpets remained in a poor condition despite having been cleaned; Small lounge: one of the armchairs was very worn. Two others had a soiled appearance; Red corridor carpet: the red corridor carpet on the ground, first and second floors was both grimy and stained. The carpet remained in a poor condition despite having been cleaned. Further concerns were also identified during this inspection as follows: • • • • • Toilet 7: there were no hand drying facilities present; First floor bathroom: a tub of Sudacrem left in the bathroom appeared to be available for general use. Used incontinence pads had been left in a waste paper bin; Bedroom 41: the fire door adjacent to this room was not closing properly; Second floor cupboard: the cupboard was unlocked and contained old resident care records; Bathroom 5 (second floor): used plastic gloves had been left out on a washbasin. There were used incontinence pads in a waste paper bin. There was a dirty soap dish containing a number of old soaps which should not have been there; Second floor corridor: the carpet looked grimy; Bedroom 7: the curtains had come away in places from the curtain rail. There were faecal type stains on the curtains. The hot water tap was dripping and would not turn off; Bedroom 13: there was no window restrictor. The plug hole was partially blocked; Bedroom 15: a used commode had not been removed from the bedroom and cleaned; Bedroom 17: the room contained a chipped and worn table; Bedroom 27: there was no seat cover to the commode; The front porch: the ceiling was water damaged and the wallpaper had lifted in places. • • • • • • • Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There were not always enough care staff rostered on duty to meet the assessed needs of residents. New staff had been employed at the Home only after robust pre-employment checks had been completed. This protected residents from being cared for by unsuitable people. Staff had not received appropriate training to equip them with the necessary skills to meet the assessed needs of residents who lived at the Home. EVIDENCE: It had been agreed with the Provider during a meeting held in October 2005 that the following levels of staffing would be provided: Number of residents 20 to 22 23 Numbers of care staff 3 3 Management Points of cover information RM supernumerary RM supernumerary DS0000032467.V290252.R01.S.doc Version 5.1 Page 22 Monks Haven Residential Home 24 25 3 3 or 4 26 3 or 4 27 4 RM supernumerary RM 4 staff to be supernumerary provided at key times where one or more residents require two care staff to assist with personal care. Key times – 8am to 1pm and 5pm to 8.pm. RM 4th member supernumerary of staff to be provided during key times. RM supernumerary It was also agreed that: • • The Acting Manager’s hours would be extra to the care staff scheduled on duty for each shift; The above staffing levels would be reviewed and increased where necessary and that this might mean providing extra staff to those numbers set out in the above. However, on the day of the inspection, only two staff were rostered on duty to care for 20 residents of whom: • • • • 10 had dementia care needs; 6 had continence care needs; 9 required assistance to wash and dress; 11 required assistance with personal hygiene and bathing. Information was given to the Inspectors that the same situation had occurred on the morning shift of the previous day (09 May 2006). It was noted that the domestic worker scheduled on duty for the same day was not present and that there were no plans in place to cover her absence. A selection of rotas was examined covering the periods 2 April to the 8 April 2006; 17 April to the 22 April 2006 and the 30 April to the 6 May 2006. It was found that there were Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 23 26 occasions where the level of staffing provided fell below that set out in the August 2005 and February 2006 Inspection Reports. Some of the rotas examined did not include staffs’ full names. One week’s rota was almost illegible. Residents interviewed during the inspection commented that there were always staffing problems. One resident said that ‘…although I still receive the same standard of care, I have to wait much longer for help. It is not good enough…’. Another resident said ‘…the staff are kind, but there are not enough of them to care for everybody…’. In one of the service user surveys returned the following comment was made ‘shortages in staffing has led to bedrooms not always being properly cleaned as they should be.’ Although 50 of the care team had not obtained a relevant care qualification, arrangements had been made for four more staff to undertake the required qualifying training. Following the last inspection, the Provider had introduced a simple system that provided him with an overview of what training staff had had, and what training required updating. Four senior staff had nearly completed a 12-week Medicine Awareness training course. A further three staff were undertaking a 12 week Dementia Care training package and five staff had recently received continence care training. A sample of staff personnel records examined were found to be satisfactorily maintained with one exception. There was no evidence that staff had received a copy of their job description or the General Social Council’s Code of Conduct for Employees. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff had not received adequate training in key areas, which had the potential to place them and residents at risk. Satisfactory steps had not been taken to promote the health and well being of residents and to protect them from potential hazards. The records of residents’ money did not adequately protect them against potential financial abuse. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 25 EVIDENCE: In October 2005, Dr George took on the full time role of Acting Manager and has applied for registration with the Commission. Over the last 20 months, he has gained experience in managing a care home and had, on an occasional basis, worked as a carer as part of the shift compliment. However, he had not worked in any other position within a care home. Dr George had not undertaken recent training in key areas, such as manual handling, basic food hygiene and health and safety. His First Aid certificate was out of date. Although Dr George had not undertaken recent dementia care training, he attends regular workshops arranged by the Dementia Care Network. Dr George had also worked as a medical doctor in the field of geriatric care and had obtained a relevant management qualification. But he does not have a care-based qualification relating to the care of older people. However, Dr George had recently taken steps to commence the required training. The Acting Manager had recently completed an initial quality audit and prepared an Annual Development Plan. But, arrangements had not been put in place to seek the views of the staff team and other professionals involved with the Home. Insurance certificates were in place and provided appropriate cover. Finanical records were in place for each resident. But, the money held on behalf of one resident was less than the total balance detailed on their financial record. It was noted that the financial balance sheets used within the Home did not have a separate debit column. There was no evidence that regular audits had been carried out to ensure that accurate financial records were kept. Two signatures had not been obtained each time money was taken from, or put into, residents’ financial accounts. Receipts were often not attached to the records and had not been cross referenced with entries made. Large sums of money were being held on behalf of some residents. In the absence of the Acting Manager, senior staff were not able to directly access residents’ money. Arrangements had been made for staff to receive certificated fire training. But first aid and basic food hygiene training had yet to be arranged for those staff requiring an update. Staff had received infection control training. Two recently appointed nurse trained staff had not yet received manual handling training. The Deputy Manager’s manual handling training was out of date. This was of particular concern as two care staff were seen employing a banned ‘underarm lift’ to transfer a resident from an armchair to a wheelchair. The senior member of staff on duty admitted that she realised residents were not being transferred using the recommended techniques as had been demonstrated on her manual handling training. Senior staff were not clear Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 26 about what manual handling equipment was available for use within the Home. Although a risk assessment had been conducted in respect of one residents mobility needs, the person completing the assessment had not assessed all of the possible environmental risks present. Staff were transporting residents in wheelchairs that did not have footplates fitted. Some of the Home’s wheelchairs were checked and found to be grimy. The Deputy Manager was unable to confirm what arrangements were in place to service the wheelchairs or to whom each of the wheelchairs stored in the reception area belonged to. Checks of the hot water supplied to residents’ bathing facilities were not being checked on a regular basis. Windows throughout the building had been fitted with various types of window restrictors, including some with chains. There was no window restrictor in bedroom 13. The absence of robust window restrictors, or in one bedroom the lack of any window restrictor, has the potential to result in serious harm to vulnerable residents. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 27 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 ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score 2 X 2 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 X X X X 2 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 3 2 2 x 2 Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 Ensure that prospective 01/08/06 residents, and their families, are provided with a copy of the Home’s Service User Guide. 2. OP3 14 Ensure that a summary of the 01/08/06 Care Management Assessment is obtained before a resident moves into the Home. Take action to obtain the above information in respect of existing residents where this is reasonably practicable. (Previous timescales of 01/12/05 and 30/04/06 not met.) 3. OP7 15 Ensure that each resident’s care 01/08/06 record is updated to include all the following details: 1. Written evidence that they have received a copy of the Home’s Statement of Purpose and Service User Guide; Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 29 Requirement Timescale for action 2. A signed contract of terms and conditions of residency; 3. A copy of their Care Management Assessment; 4. Care plans addressing needs in the following areas: medication; management of money; chiropody; hearing and eye care; challenging behaviours such as aggression (where appropriate); 5. A copy of their most recent Care Management Review report; (Previous timescale 30/04/06 not met) • of An initial plan of care is put in place within 72 hours of a new resident’s admission into the Home; When drawing up the Nutritional Risk Assessment, careful consideration must be given to the condition of teeth/dentures and their impact on a resident’s ability to chew and swallow; It is clear which staff have been delegated the responsibility of updating residents’ care plans following changes in their care needs and circumstances. 01/08/06 • • 4. OP7 15 Ensure that: • A policy is prepared which Version 5.1 Page 30 Monks Haven Residential Home DS0000032467.V290252.R01.S.doc sets out the Homes approach to dietary assessment and nutritional care. A copy of the policy should be forwarded to the Commission for comment; (Previous timescales of 01/12/05 and 30/04/06 not met) 5. OP8 12 Ensure that residents’ care 01/08/06 records contain details of the last date on which dental treatment was received. 6. OP9 13(2) Ensure that: • • • The medication trolley lock 01/08/06 is repaired; Medication is stored securely; The current system for administering medication is risk assessed and any concerns identified are acted upon; The Controlled Drugs cupboard is not used to store residents’ money or any non-medication items; An up to date photo of each resident is kept in the medication administration file to aid identification. • • 7. OP12 16(2) The Home must provide varied 01/11/06 daily social activities that reflect residents’ individual needs and preferences, including those persons with dementia. 01/11/06 Ensure that the Home’s cooks work to a set of menus which offer choice at all main meal times. A vegetarian option must be included as part of the DS0000032467.V290252.R01.S.doc Version 5.1 Page 31 8 OP15 16(2) Monks Haven Residential Home choices offered appropriate. where Ensure that the Home’s cooks are clear about their responsibilities in relation to: • • • Menu planning; Consulting residents about the quality of food served at main meal-times; Consulting with residents about the content of the Home’s menus. Ensure that the Home’s cooks have a good understanding of: • The nutritional needs of older people, particularly those who may suffer from poor nutrition and hydration problems; What would be expected of them should the Home admit a resident with a different cultural background. • Prepare a nutritional policy for use within the Home that covers: • • • The importance of nutrition and hydration; Indicators of poor nutritional health; The need for dietary supplements for residents suffering from poor nutritional intake; The use of ‘finger food’ to improve dietary intake; Use of nutritional risk screening tools and care plans to aid better nutrition; The best ways to cook food to maximise nutrition. Version 5.1 Page 32 • • • Monks Haven Residential Home DS0000032467.V290252.R01.S.doc 9. OP15 16(2) Ensure that the chipped and 01/08/06 stained crockery, table mats and napkins are replaced. 01/08/06 Ensure that senior staff are clear about the location of the Home’s Complaints Book. 10. OP16 22 11. OP18 13(6) Ensure that: • Senior staff are clear about circumstances arising in the Home that might necessitate a referral to the Safeguarding Team to protect the well being of a resident; Senior staff have read and understood the local agreements that have been put in place to safeguard residents. 01/08/06 • 12. OP19 23(2) Ensure that the Home’s cleaning 01/08/06 rota covers the following areas: • • • • • • • The lounge areas and the furniture contained within them; The hairdressing room; The laundry; The utility area to the front of the kitchen; The office; Regular shampooing of the Home’s carpets and curtains; Window cleaning. Ensure that the Home’s cleaning rota states what products are to be used for specific cleaning tasks. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 33 A copy of the revised cleaning rota must be forwarded to the Commission. (Previous timescale 01/05/06 not met) 13. OP24 16(2) Ensure that the carpets in 01/06/06 bedrooms 2, 7, 17 and 29 are replaced. (The timescale for meeting this requirement, as set out in the last inspection report, had not expired at the time of this visit) 14. OP24 16(2) Ensure that: • The carpets in bedrooms 6 and 13 are replaced. of 01/08/06 of (Previous timescale 01/05/06 not met) 15. OP24 16(2) Ensure that the red carpet is replaced. 16. OP19 16(2) & 23(2) Ensure that: • corridor 01/12/06 • • • • • Bedroom 7: the curtains 01/08/06 are re-fitted and cleaned. The dripping tap is repaired; Bedroom 13: the plug hole is cleaned and unblocked; Bedroom 27: the commode is provided with a seat cover; Bedroom 17: the table is re-varnished or replaced; Repair and re-decorate the front porch area; Bedrooms 6 and 11: the chest of drawers are either Version 5.1 Page 34 Monks Haven Residential Home DS0000032467.V290252.R01.S.doc • • refurbished or replaced; Bedroom 13: the bedside cabinet and chest of drawers are either refurbished or replaced; Small lounge: the armchairs are either refurbished or replaced. 17. OP26 16(2) Ensure that: • • Action is taken to eliminate 01/08/06 the unpleasant odours in bedrooms 2 and 7; The ‘Continence Care’ trigger checklist provided by the Commission is completed in respect of residents occupying the above bedrooms. of 01/07/06 (Previous timescale 01/05/06 not met) 18. OP26 16(2) Ensure that: • • • Used continence pads and plastic gloves are properly disposed of; Hand drying facilities are made available in all toilets; Emollient creams such as Sudacrem are for individual use only. 19. OP28 18 Ensure that 50 of the care 31/12/06 team have a relevant qualification in care. 01/08/06 Provide written evidence that staff have been provided with copies of their job description and the General Social Care Council Code of Conduct. 20. OP29 7, 9 and 19 Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 35 21. 22. OP31 OP33 9 24 The Acting Manager must obtain a relevant care related 04/04/07 qualification. Ensure that: • The views of staff and 01/08/06 professional visitors to the Home are sought and used to inform the quality review process; An Annual Development Plan is prepared and a copy forwarded to the Commission. 01/07/06 • 23. OP35 17(2) Ensure that: • Money held on behalf of residents is audited regularly and where errors are identified, action is taken to rectify these; Residents, and their families (where appropriate) have immediate access to money they have deposited for safekeeping at the Home; Large amounts of money are not held on behalf of residents. • • 24. OP38 13(4) Undertake refresher training in 01/07/06 the following key areas: Moving and Handling; First Aid; Basic Food Hygiene; Health and Safety; Dementia Care. (Previous timescales of 31/01/05 and 01/01/06 not met) Ensure that: 1. Newly appointed staff 01/08/06 have up to date training in 25. OP38 13(4) 18 Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 36 moving and handling; 2. All staff involved in assisting residents to transfer and mobilise are aware of how to apply their training when implementing the guidance contained in manual handling risk assessments; 3. Each resident’s manual handling risk assessment clearly specifies the techniques and equipment to be used by staff when assisting with movement and transfer; 4. Completed manual handling risk assessments cover all of the possible risks associated with mobilising. 26. OP38 13(2) Ensure that: • Individual risk 01/08/06 assessments are carried out which consider the action that needs to be taken to minimise the likelihood of vulnerable residents harming themselves by falling from, or jumping out of, a window 2 metres above ground level; A programme of maintenance is put in place, which ensures that any window restrictor fitted in the Home is maintained in a safe condition. A record must be kept of any maintenance carried out. about your Version 5.1 Page 37 • Information Monks Haven Residential Home DS0000032467.V290252.R01.S.doc responsibilities in this area can be found on the Health and Safety Executive Website: www.hse.gov.uk The relevant guidance is: SIM 07/2001/39 Your local Health and Safety Inspector can be contacted for advice. Details are available at the above web address. 27. OP38 13(2) All windows in the Home that: • • • Are accessible to vulnerable residents Are two metres or more above ground level Can be opened sufficiently wide enough to enable a resident to fall or jump out 01/11/06 Must be fitted with restrictors that prevent the window from being opened no wider than 100mm. Windows fitted with chain-style window restrictors are not considered suitable for use in a residential care home environment. 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 OP1 Ensure that: Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 38 Good Practice Recommendations • • 2. OP3 Staff are able to provide prospective residents, and their families, with a copy of the Home’s Service User Guide; The Home’s Service User Guide is made available in alternative formats. The Home’s pre-admission assessment document should be used to record the outcome of the assessment of a prospective resident’s care needs. A ‘Life History’ should be obtained before each prospective resident is admitted into the Home. 3. OP5 Ensure that a representative from the Home visits prospective residents in their current accommodation prior to admission. 4. OP9 Contact the Home’s pharmacist and request drug information leaflets on all medication being administered within Monkshaven. This information should be placed in a file and made available to all staff. 5. OP12 Ensure that: • Actitivities are organised and provided that are appropriate for residents with dementia care needs. Staff should be trained and supported to provide such specialist activities; A yearly programme of outings and events is drawn up. • 6. OP15 Prepare a policy outlining how frequently the menus are to be updated, how this should be undertaken and who should be involved. Ensure that the menus provide residents with an opportunity to have two portions of fruit and dairy products each day. Ensure that a hot meal choice is available at the tea-time meal. 7. OP35 Ensure that two signatures are obtained for each entry made on residents’ financial records. Preferably, one of the signatures should be that of the resident concerned. Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 39 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Monks Haven Residential Home DS0000032467.V290252.R01.S.doc Version 5.1 Page 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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