Inspection on 17/06/07 for Monks Haven Residential Home

This inspection was carried out on 17th June 2007.

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 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 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 Key Unannounced Inspection 17, 18, 19, 21 June and 12 July 2007 13:30 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.V335719.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.V335719.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.V335719.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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) 8th October 2006 Date of last 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. 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 was situated on a notice board in the dining room. The current scale of charges runs from £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. Monks Haven Residential Home DS0000032467.V335719.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 visit on the 8 October 2006; How the service dealt with any complaints & 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 & their relatives, staff & other professionals. The Visit: An unannounced visit was made on the 17 June 2007. 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 & how well their needs are met; Looked at other records which must be kept; Checked that staff had the knowledge, skills & training to meet the needs of the people they care for; Looked around the building to make sure it was clean, safe & comfortable; Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: A detailed maintenance record had been completed. This provided information about all refurbishment work and repairs carried out at the home. Staff had the opportunity to gain a qualification in care and update their statutory training in key areas. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? Peoples’ care records now contain details of the last date on which dental treatment was received. The manager had attended a course in how to provide activities for people with dementia. The front of the building had been renovated and repainted. been repaired. The roof had A number of external windows, which were in a poor condition, had been replaced. New and more robust window restrictors had been fitted to 13 bedroom windows. The home’s menus had been revised to include more information about the timing and content of meals and the availability of snacks and drinks. The provider had purchased a projector to enable a fortnightly film show to be held. Care plans providing staff with guidance on how to care for a person with facial cancer, and how to meet peoples’ pressure area care needs, had been prepared. A nutritional policy had been prepared. What they could do better: Peoples’ care plans must cover the areas set out in the National Minimum Standards. They should be updated to reflect peoples’ changing needs. They should be signed and dated. This will help people to receive more individualised support and a better quality of life and experience. There should be more opportunities for people to attend external social events and outings, including those individuals with dementia. This will help to ensure that people are able to lead a fulfilling and stimulating life that suits their needs and abilities. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 7 The registered person needs to prepare an annual development plan and improve the standard of the home’s decoration, furnishings and fittings. This will help people, and their families, to see that there is a written programme that sets out how the home’s furnishings, fittings and fabric of the building are to be renewed, repaired and improved. They will also be able to see how the provider intends to improve the care and services provided at the home. Sufficient domestic staff must be employed to keep the home clean. This will help ensure that people using the service live in a home that is clean and hygienic. Update the home’s recruitment policies and procedures. The staff records must contain the required information. Robust pre-employment checks must be carried out before staff are employed at the home. This will help protect people from individuals who are considered unsuitable to work with vulnerable adults. Staff should receive regular formal supervision and an annual appraisal. A training needs analysis should be completed for each member of staff. This will help ensure that staff are well supported, appropriately supervised and aware of their responsibilities in protecting the welfare of people living at the home. All care staff should complete specialist training in working with people with dementia care needs. This will help ensure that staff have the knowledge and skills to care for people with dementia. Ensure that the required health and safety records are in place. Ensure that staff have participated in fire drills at the frequency set down by the fire service. This will help protect people from harm and danger. Staff should be clear about the standards to which they are expected to work. Management systems should be in place to monitor staffs’ performance. This will help ensure that the home is run in the best interests of the people using the service. Ensure that the home’s ‘on-call’ policy and procedure covers the required areas. This will help ensure that staff working evening, night time and weekend shifts are clear about their own roles and that of the person providing ‘on-call’ support. Ensure that the Commission is made aware without delay of any events occurring within the home that affect peoples’ well being as required under Regulation 37 of the Care Homes Regulations. This is an important step in ensuring that the provider has access to all of the best practice professional guidance available to him helping to ensure that he takes every possible action to protect the well being of the people in his care. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 8 Ensure that any adult protection concern arising within the home is raised with the local safeguarding team and their advice sought. This will help ensure that people are protected from harm or abuse. 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.V335719.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.V335719.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): 3 Standard 6 was not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements were in place for assessing the needs of people before they are admitted into the home. The care records of people living at the home were satisfactory. They contained the required documentation and this provided staff with the information they needed to safely care for people living at Monks Haven. EVIDENCE: People had not been admitted into the home until their needs had been assessed by social services. The care records of two people were examined. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 11 A copy of the social services assessment and care plan had been obtained for the person most recently admitted into the home. There was also evidence that the home had obtained its own pre-admission assessment information before agreeing to the admission. In the second set of care records examined, there was a social services care plan. There was no evidence that the home had carried out its own pre-admission assessment. The manager said that this individual had transferred from one of his other homes and was already known to staff working at Monks Haven. Monks Haven Residential Home DS0000032467.V335719.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 and records were not fully satisfactory. Staff promoted the health of people living at the home by enabling and supporting them to access relevant health care professionals. This might mean that staff are not clear about how they should meet the needs of people using the service. The systems in place to support the safe administration, storage and disposal of medication were not fully satisfactory. Inadequate arrangements were in place to assess the competency of staff to administer medication. This might mean that people are placed at risk. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 13 EVIDENCE: Care plans covering peoples’ physical, social and personal hygiene care needs had been prepared. Care records contained important information such as life history details, an assessment of peoples’ levels of dependency and a record of the physical care provided to each person. Care plans did not cover all of the areas referred to in the National Minimum Standards. The care plans examined were written in plain language. In one of the care files examined, there was a care plan providing staff with guidance on how to support and care for a person with facial cancer. This provided staff with useful guidance on how to meet this person’s needs. The plans of care for a person who was at risk of developing pressure sores were also checked. 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. None of the care plans had been updated to take account of the changing needs of the person concerned. Although there had been some improvement to the quality of report writing, night staff were still failing to record relevant information about how they met peoples’ night time care needs. One person’s care plans had not been evaluated on a monthly basis. The home’s standard care plan format had not always been used to provide staff with guidance on how to meet peoples’ needs. A key worker system operated within the home and this allowed staff to offer more individualised care. Staff had a clear view of what being a key worker involved. Staff had arranged for people to receive access to relevant health care professionals, depending on their needs. People felt that their health care needs were well met. Peoples’ weights had been checked on a monthly basis. Staff had completed training in meeting peoples’ health care needs covering such areas as eye care and the use of oxygen. Health based risk assessments covering the following areas had been completed – prevention of falls and pressure sores, and nutritional care. It was noted that: • • The home’s standard ‘falls’ risk assessment format had not been used to record some of the assessments carried out. This may lead to the assessor failing to cover all of the necessary areas; A preventative pressure area care risk assessment had not been carried out for one of the people whose care records were checked. People spoken to say that staff treated them in a kind and considerate manner and respected their privacy. Staff were observed providing personal care in a kind and supportive manner. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 14 Peoples’ care records did not contain sufficient details of their preferences regarding the way in which they wanted staff to meet their personal care needs. During the inspection, one person said that the manager had not acted upon their preference regarding which bedroom they occupied. This was denied by Dr George who said that both the person and their family had been consulted. The manager acknowledged that no discussion had taken place with social services. There was no written record of the discussion held with the person. The home had a medication policy that was available in the main office. All medication was stored in a locked trolley and cabinet to which only senior staff had access. The medicines trolley was clean, tidy and it was easy to identify what medication belonged to which person. Photos to identify each person were in their medication records. There were records covering the ordering, administration and disposal of medication within the home. Although these records were generally satisfactory, on a small number of occasions, staff had omitted to sign the administration record after administering medication to people. The administration records contained examples of where staff had failed to sign to confirm that an item of medication had been given. All staff administering medication had received accredited training. A written assessment had not been carried out to ensure each member of staff was competent to handle, record and administer medication properly. No incidents concerning the mis-administration of medication had been reported to the Commission. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. 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. There has been an improvement to the way in which activities are provided which means that people are being given more opportunities to participate in stimulating social activities and events within the home. People had limited opportunities to participate in organised activities outside of Monks Haven. Suitable arrangements were in place to support people to maintain contact with their families and friends. Satisfactory menus which are nutritionally balanced and offer choices at main meal times are in place. EVIDENCE: The manager had completed specialist training in providing activities to people with dementia. A number of staff had also completed training in working with people with dementia. This covered the provision of activities. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 16 The manager said that information about peoples’ leisure interests and pursuits had been obtained at the point of their admission into the home. Two sets of care records were examined. The social assessment for a person recently admitted into the home had only been partially completed. It did however contain very useful information about the person’s needs. There was no social care assessment in the second file examined. Although each person had a social care plan, the objectives and interventions were not specific to the individual. During the inspection, staff were observed consulting and encouraging people to join in the afternoon activity sessions. The inspector saw people participating in cookery and arts activity sessions. Although a copy of the home’s activity programme had been displayed in the dining area, it was difficult to see it. The activity programme specified that activities would be provided during the morning and afternoon periods. Staff said that they were ‘always’ too busy to deliver the morning activity session. A programme of external social events and outings was not in place. 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. A monthly church service is held. Birthdays and festive events are celebrated. People who use the service had been supported to maintain important personal and family relationships. One person said that ‘visits from my niece are the most important thing in my life.’ People spoken with, including a relative, said that the manager and his staff always made families and friends feel welcome. 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. Since the last inspection, new menus had been introduced and a nutritional policy had been devised. Although the menu for the day was clearly displayed in the dining room, the writing was small and difficult to read. People had access to snacks and drinks in-between meal times. The inspector observed the teatime meal being served. Staff responded to peoples’ needs in a caring and sensitive manner. People were provided with the assistance they needed to eat their meal. The atmosphere was relaxed and unhurried. Nutritional risk assessments had been completed for all people. There were no people with a different cultural background using the service. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 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. 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. The written procedures for handling complaints were satisfactory. But, not all people were confident that their complaints or concerns would be listened to, taken seriously and acted upon. Suitable procedures were in place to protect people living at the home from harm or abuse. If these procedures are correctly followed it would help safeguard the welfare of people living at the home. EVIDENCE: The home had a complaints procedure that could be made available on request in other formats such as large print. People said that they had been given a copy of the home’s complaints procedure. They said that they knew how to make a complaint and were clear about what would happen if they did. Staff were clear about how they would handle complaints. The home had a safeguarding adults policy that provided staff with clear guidance on how to handle adult protection concerns. The local safeguarding team had checked the policy. Senior staff interviewed knew when incidents needed external input and who they should report any concerns to. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 18 Since the last inspection, a number of concerns about the home have been raised with the Commission. A relative of a person living at the home made one and the other was an anonymous complaint. The concerns raised by the relative were investigated by the local authority under its safeguarding adults procedures. The outcome of the investigation was to require the manager to implement more robust financial recording and accounting procedures. The manager had failed to follow the home’s own procedures for safeguarding adults when the relative raised the concern. The anonymous complainant raised their concerns about the home with the Commission after the inspection commenced. These concerns are being investigated by the local authority under its safeguarding adults procedures. The investigation is still ongoing. But, there was evidence to substantiate an allegation that one person living at the home had bruises on their body and medical advice had not been sought. There was no record of the reasons why the manager had not obtained medical advice and there was no record of how this person’s bruises were monitored or treated There was also a separate incident involving a different person living at the home who had been allegedly assaulted by another resident. The manager failed to notify the Commission at the earliest possible moment as required by the Care Homes Regulations. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 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. Satisfactory arrangements were not in place to maintain, replace and improve the home’s decoration, furnishings and fittings. This meant that people living at Monks Haven had not been provided with accommodation that was decorated and furnished to a satisfactory standard. Parts of the home were not clean and hygienic. This meant that people were living in a home that was not adequately cleaned and this could affect their health and well-being. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 20 EVIDENCE: The provider had submitted a detailed Annual Quality Assurance Assessment (AQAA). The completed AQAA set out what improvements the provider hoped to make to the service over the next 12 months. The manager said that he did not have a separate annual development plan. A full time maintenance man is employed at the home and detailed records of work carried out had been kept. Following requirements made in the last inspection report, the provider had: • • • Replaced the carpets on the first and second corridor floors; Fitted new carpets in several bedrooms; Carried out other general improvements to the fabric of the building. A number of concerns were identified: • Availability of bathroom facilities: the National Minimum Standards state that there must be a ratio of one bath to every eight people living at the home. At the time of the inspection, there were only two bathing facilities in use. Of the remaining two bathrooms available within the home, the provider said that one could not be used due to lack of level access, and the other on the ground floor was being used as a general storage area. Dr George said that he would arrange for this bathroom to be brought back into use; Bedroom 2: there was damage to the wall near the hand washbasin and the back of the door. The armchair was grimy. Handles were missing off the chest of drawers and the wardrobe. The carpet had a grimy appearance and had not been cleaned; Bedroom 3: the room’s occupant was in hospital at the time of the inspection. There was a single tablet of medication on the chest of drawers. An empty cup on the bedside cabinet had mould growing in the bottom. A blanket placed on the bed was grimy. The towels in the room were in a poor condition; Bedroom 5: there was an unpleasant odour. This matter remains unresolved since the last inspection. During the feedback session, the provider said that an industrial cleaner had since been hired to clean the carpet and this had removed the odour; Bedroom 6: The two bedside cabinets and the chest of drawers were in a poor condition. The cushion pad to one of the arms on the armchair was damaged; Bedroom 10: The carpet was very stained, grimy and had not been vacuumed. The bedroom furniture was in a poor condition; • • • • • Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 21 • • • • • • • • • • • • Bedroom 11 (double room being used as a single): the room contained two single beds. The occupant requested that the unused single bed should be removed to give her more space. Some of the bedroom furniture was in a poor condition; First floor mezzanine corridor bathroom and toilet: The bath was very stained. The toilet window was grimy and was covered in bird droppings. The provider said that this area of the home was not in use; Bedroom 16 (double): the armchair was in a poor condition. There was no screening to provide the room’s occupants with privacy when washing and dressing; First floor shower room: there was no anti-bacterial hand wash available. Two dressing gowns had been left in the shower room, as had various items of toiletries and two odd slippers; Ground floor toilet: the wall tiles behind the toilet cistern were in a poor condition. The radiator was not guarded; Bedroom 19 (unoccupied): the décor was in a poor condition. The bedside cabinet had a worn appearance. The carpet was grimy and stained; Stairwell ceiling damaged by flood: the wallpaper in the area of the flood damage had lifted; Bedroom 18: the room had not been vacuumed. The window sill and bedside cabinet top were grimy and in need of cleaning. The armchair was stained and grimy; Bedroom 26: the room’s occupant confirmed that staff had made his bed earlier in the day. But, the quilt cover was grimy and stained. The pillowcase contained a hole. The carpet was grimy; Bedroom 29: the carpet underlay had not been replaced as required in the last inspection report; Bedroom 41: the carpet in the en-suite bathroom was stained and looked grimy; External window frame opposite bedroom 30: the window frame was in a very poor condition. An inspection of the kitchen was undertaken. The teatime meal had been prepared before the cook finished his shift. The meal consisted of: assorted sandwiches, crisps, crumpets, salad and coleslaw, corned beef pie, fruit breads and cakes. The food had been left uncovered on a bench top. The cooker sides and the deep fat fryer, and the wall tiles surrounding them, were greasy and unhygienic. The dry stores cupboard shelves were grimy. Concerns about kitchen hygiene had been raised in a previous inspection report. A range of specialist equipment and adaptations was available within the home. For example: the top floor bathroom had a fixed hoist to help people get in and out of the bath. There was a sit down level access shower on the first floor. Grab rails had been fitted beside all toilets. There was a mobile hoist. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 22 Staff had access to a range of moving and handling aids. The bathing facilities were clean and hygienic. A thermometer was available in each bathroom to enable staff to test hot water temperatures. Not all parts of the home were accessible to people with physical disabilities. For example: bedrooms, toilet and bathing facilities located on the two mezzanine floors can only be accessed by people who are independently mobile. In the long corridors on the first and second floors, a homemade nonslip ramp had been fitted. A lift had been provided to the first and second floors. The home had an infection control policy. A self-assessment infection control checklist compiled by the Department of Health had not been completed. Staff had completed infection control training. The laundry was clean and tidy. Mostly single room accommodation was available. Some bedrooms situated on the mezzanine floors were not in use at the time of the inspection due to difficulties with access. These rooms were not decorated, furnished and equipped to a suitable standard. The provider said that if they were brought back into use, they would be furnished and decorated to a suitable standard. Some bedrooms had been personalised in line with the occupant’s preferences and contained furniture that people had brought in with them. People living at the home had access to a range of communal areas such as a variety of lounge areas and a dining room. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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. Domestic staffing levels were not sufficient to ensure that the home was kept to a satisfactory standard of cleanliness and hygiene. Staff had the skills and knowledge required to meet the needs of people living at the home in a safe and professional manner. Recruitment policies are not always followed which could result in somebody working at the home that was unsuitable to work with vulnerable adults. EVIDENCE: At the time of the inspection, there were 24 people living at the home. The following staffing levels were in place: • • Two care staff, including a senior carer, had covered the night time shift between from 10.00 pm to 8.00 am; Three care staff, including a senior carer, had been scheduled to work from 8.00 am and 10.00 pm. DS0000032467.V335719.R01.S.doc Version 5.2 Page 24 Monks Haven Residential Home Domestic and catering staff were also on duty. between 8.00 am and 10.00 pm each day. The manager usually works None of the people whose care was case tracked as part of the inspection were able to comment on whether staffing levels were sufficient to meet their needs. Staff felt that current staffing levels only allowed them to meet peoples’ basic needs. One person said that finding time to sit down and talk with people was very difficult and that the shifts they worked were ‘very busy and hectic.’ This person also said that on a morning shift, care staff spent as much time ‘making beds and cleaning bedrooms’ as they did ‘seeing to residents’ needs’. It was evident that there was not enough domestic cover to keep all parts of the home clean. During less busy times of the day, staff were observed writing up care records and providing social activities and opportunities for socialisation. There was no evidence that peoples’ physical care needs had not been met. Some areas of the home, such as peoples’ bedrooms, were not clean and hygienic. The manager and it was agreed that extra domestic hours would be provided to ensure that all areas of the home could be satisfactorily cleaned on a daily basis. Plans were underway to recruit a second domestic member of staff and agency staff were being used to cover the rota on a temporary basis. Over 50 of the staff team had obtained a relevant qualification in care. Four staff had obtained a National Vocational Qualification (NVQ) in Care at Level 2 and three others were in the process of doing so. Two staff had obtained a NVQ 3 in Care. One staff member had obtained a NVQ at Level 2 in Housekeeping. A senior staff member had completed training in such areas as supporting people with dementia care needs, caring for those with poor vision and using oxygen safely. The manager was able to clearly outline the benefits that a well-trained workforce brought to Monks Haven. All staff had recently updated their statutory training in the following key areas: moving and handling; first aid; food hygiene, infection control and fire safety. Staff felt that they had received sufficient training to enable them to meet the needs of people living at the home. With one exception, the required pre-employment checks had been carried out. The personnel file of a recently appointed senior carer was examined. Although the person concerned had updated their statutory training since starting work at the home, there was no written evidence that they 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; Completed an application form and provided a full employment history; Provided a statement about whether they had any convictions; Provided a statement about their physical and mental health. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 25 Also, a satisfactory Criminal Records Bureau (CRB) check and two references had not been obtained. The provider said that the person concerned had recently been employed at another of his homes. Dr George agreed to arrange for a provisional check to be carried out for this person until a full CRB check could be completed. He also agreed to remove this person from the senior rota and ensure that they were supervised at all times. The home had a recruitment and selection policy. This had not been updated since 1999 and did not cover the provider’s responsibilities and duties under the Care Homes Regulations. The home had used agency staff to cover 20 shifts in the previous three months. Only one member of staff had ceased their employment at the home during the last 12 months. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager was suitably qualified and experienced but had not taken appropriate action to meet all of the National Minimum Standards. This meant that the home was not run as effectively as it should be. The views of people living at the Monks Haven, staff and relevant professionals were not taken into account when planning the development of the home. Staff were not properly supervised and their performance regularly appraised which could mean that they are not caring for people in the best way possible. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager is a qualified medical doctor, has recently obtained the Registered Manager’s Award and has updated his statutory training in key areas. He has managed the home for over three years. Most of the requirements from the previous inspection had been met. But, the manager had not taken action to ensure that some of the key minimum standards were met. For example: staff were not being provided with regular supervision; systems for monitoring staff performance in areas such as maintaining a good standard of cleanliness and hygiene were not in place. The provider had put systems in place to monitor the quality of care provided in the home. For example: • • • A full quality assurance audit had been carried out in early 2006; The provider had completed the Commission’s Annual Quality Assurance Assessment as part of the inspection process; Visits to monitor the quality of services and care provided at the home had taken place on a regular basis. However, there had been no quality assurance review of services provided at the home during the last 12 months. There was no evidence that people living at the home, staff and other relevant professionals, had been consulted about the quality of the service. Most of the people living at Monks Haven had their money managed on a dayto-day basis by the home. Each person had their own separate purse in which their money was kept. Peoples’ money was securely stored. Two staff signatures had not always been obtained for money spent on behalf of people living at the home. Balances that were checked matched with the amount of money indicated on peoples’ financial records. Receipts had been obtained for money spent. Financial records did not show evidence of regular audits. The standard of records kept was variable. Staff had not received regular formal supervision six times a year as required by the National Minimum Standards. None of the staff whose files were checked had received an annual appraisal. Following a safeguarding issue that had occurred in the home in 2006, the provider had been required to prepare and implement an ‘on-call’ policy for the home. Although the provider had devised such a policy and made it available to the Commission, the revised policy did not cover all of the areas referred to in the requirement. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 28 A range of health and safety records was examined. Apart from the standard of cleanliness in some parts of the home, a tour of the building revealed no other obvious hazards. A current gas safety certificate was in place as was a current inspection report for the home’s electrical installations. The home’s fire equipment had been checked at the recommended frequencies. An up to date fire risk assessment was in place. The home’s accident record was generally well completed. Following a requirement set in the last inspection, there was evidence in one of the care records checked, that detailed guidance had been put in place setting out how staff were to help the person move and transfer. However, the following concerns were also identified: • • • Although the home’s electrical equipment had been checked in February 2007, a certificate was not available to confirm this; It was not possible to confirm which staff had taken part in fire drills held during the last 12 months; Following a concern raised during the inspection about the disposal of contaminated waste, the provider immediately contacted, and acted upon, the advice of the local communicable disease nurse. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 2 X 2 X X 2 2 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 2 X 2 2 2 Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 30 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 12 & 15 Requirement Ensure that peoples’ care plans: • Address their needs in the following areas: 1. Diet; 2. Sight, hearing and communication; 3. Oral health; 4. Footcare; 5. Mobility; 6. Continence; Reflect their individual preferences about how they want their care to be delivered; Are updated to reflect their changing needs; Are dated and signed. Timescale for action 01/09/07 • • • 2. OP8 15 Ensure that a pressure area care 01/09/07 risk assessment has been completed for each person living at the home. Ensure that staff complete the 01/08/07 medication administration record following the administration of each person’s medication. 3. OP9 13(2) Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 31 4. OP12 15 Ensure that: • • Each person has an up to date fully completed social needs assessment; A person centred activity plan is prepared for each person and contains individual objectives in line with their needs and wishes; The provision of activities at Monks Haven is reviewed during the provider’s monitoring visits. 01/09/07 • 5. OP18 13(6) Ensure that: • The Commission is informed, without delay, of any event in the Home that adversely affects the well-being or safety of any person accommodated at Monks Haven; The Regulation 37 notification forms issued by the Commission are used to make the required notifications under this regulation. 01/08/07 • (The timescale for complying with this requirement expired on the 01/02/07) 6. OP18 13(6) Ensure that any concern 01/08/07 involving the protection of a vulnerable person living at Monks Haven is referred to the local safeguarding team for advice in line with the home’s policies and procedures, and the local authority’s guidelines. (The timescale for complying with this requirement expired Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 32 on the 01/02/07) 7. OP18 12 Ensure that: • Proper provision is made for the health and welfare of people living at the home, including seeking prompt medical advice where this is necessary; Staff keep accurate records which provide clear details of the care provided to people living at the home. 01/08/07 • 8. OP19 23(2) Prepare an annual development 01/09/07 plan. (The previous timescales for complying with this requirement expired on the 01/08/06 and 01/04/07) 9. OP19 16(2) Immediate action must be taken 01/09/07 to eliminate the unpleasant odour in bedroom 5. (The timescale for complying with this requirement expired on the 01/04/7) Ensure that the following repairs 01/11/07 and improvements are made: • Bedroom 2: repair the damaged wall tiles located behind the hand wash basin; Ground floor toilet: repair the wall tiles located behind the toilet cistern. Provide a guard for the radiator; Stairwell ceiling damaged by flood: replace the wallpaper in this area; Bedroom 29: fit new carpet underlay. (The Version 5.2 Page 33 10. OP19 23(2) • • • Monks Haven Residential Home DS0000032467.V335719.R01.S.doc • previous timescale set for this requirement had expired on 01/04/07); Repair or replace the external window frame opposite bedroom 30. 11. OP19 23(2) Ensure that the following 01/11/07 improvements are made: • Bedroom 2: replace or refurbish the armchair. Replace the handles on the chest of drawers and wardrobe; Bedroom 6: replace or refurbish the bedside cabinets and chest of drawers. Repair the arm rest on one of the armchairs; Bedroom 10: replace or refurbish the bedroom furniture; Bedroom 11 (double): remove the unused single bed in line with the occupant’s wishes. Replace or refurbish the bedroom furniture; Bedroom 16 (double): replace or refurbish the armchair. Provide privacy screening; Bedroom 18: replace or refurbish the armchair. 01/08/07 • • • • • 12. OP19 16(2) 23(2) Ensure that: • The cooker, deep fat fryer, wall tiles and the dry store cupboard shelves are kept in a clean and hygienic condition; Robust monitoring arrangements are in place to ensure that the kitchen is cleaned to a satisfactory • Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 34 standard. 13. OP19 23(2) Ensure that the red corridor 01/11/07 carpet in the following areas is replaced: • • The carpet leading from the fire exit by bedroom 23 to toilet 4; The carpet on the ground floor corridor leading from the rear entrance door to the staircase. The stair carpet in this area must also be replaced. 14. OP21 23(2) Ensure that a ratio of one 01/08/07 bathing facility is provided to every eight people living at the home. Ensure that new carpet underlay 01/09/07 is fitted in bedroom 29. (The timescale for complying with this requirement expired on the 01/06/07) 15. OP24 16(2) 16. OP25 16(2) 23(2) Ensure that: • The carpets in bedrooms 2, 10 and 26, and the ensuite bathroom in bedroom 41, are cleaned. If the appearance of the carpets does not improve, they must be replaced; Mezzanine first floor bathroom and toilet: the bathroom window is cleaned; Bedroom 18: the windows and bedroom furniture are clean and hygienic; Bedrooms 3 and 26: people are provided with clean bed linen, which is in a good condition; 01/11/07 • • • Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 35 • Peoples’ bedroom carpets are hoovered on a daily basis. 17. 18. OP19 16(2) 16(2) Ensure that all people are 01/08/07 provided with suitable towels. Complete Health checklist. the Department of 01/09/07 Infection Control OP26 19. OP27 18 23(2) Ensure that sufficient domestic 01/11/07 hours are provided to enable: • • The home to be kept clean and hygienic; Care staff to have the time to meet peoples’ emotional and social needs. 20. OP29 Schedules 2&4 Ensure that the following 01/08/07 information has been obtained for all staff employed in the home after April 2002: • • An enhanced Criminal Records Bureau disclosure certificate; A signed statement confirming whether or not the applicant has any convictions; A signed statement that the applicant is physically and mentally fit to do their job; A full employment history; Copies of two written references, including one from their current or previous employer; Verification of why the applicant left their previous post where this involved working with vulnerable adults for a period longer than three months. Version 5.2 Page 36 • • • • Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Ensure that the home’s recruitment policies and procedures are updated to take account of relevant legislation such as the Care Homes Regulations 2001. 21. OP30 18 Ensure that: • All staff commencing work at the home complete induction training which covers the ‘Skills for Care’ common induction training standards; A written record is kept of the in-house induction training provided to new staff. 01/08/07 01/09/07 • 22. OP31 9 Ensure that: • • Staff are clear about the standards to which they are expected to work; Management systems are in place to monitor staffs’ performance. 23. OP33 24 Arrange to consult with people 01/09/07 living at the home, staff and relevant professionals, about their views regarding the conduct of the home and the quality of the service. (The previous timescales for complying with this requirement expired on the 01/08/06 and 01/04/07.) Review the quality of care, services and facilities provided at the home at least once a year. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 37 24. OP34 Schedule 4 Ensure that: • Two staff signatures are obtained for all financial transactions undertaken on behalf of people living at the home; Receipts are cross referenced with the relevant entry on a person’s financial balance record; Peoples’ financial records are audited on a regular basis. 01/08/07 • • 25. OP36 18 Ensure that staff receive: • • Formal structured supervision at least six times a year; An annual appraisal. 01/01/08 Ensure that a training needs analysis is completed for all staff and a written record kept. 26. OP37 12 & 17 Ensure that the home’s ‘on-call’ 01/09/07 policy includes guidance on the role of: • • • NHS Direct, the Emergency GP and Ambulance Services; Staff contacting the ‘oncall’ person; Staff providing guidance to care staff needing advice and support ‘out of hours’. Ensure that all care and support provided to residents throughout the night time period, including extra monitoring visits, is clearly recorded. (The timescale for complying with this requirement expired Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 38 on 01/01/07) 27. OP38 13(2) 23(2)(6) Ensure that: • Written evidence is obtained confirming that the home’s electrical equipment has been tested in line with the relevant regulations; Fire records detail the names of staff participating in fire drills. 01/09/07 • 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. 2. Refer to Standard OP3 OP7 Good Practice Recommendations The home should carry out its own pre-admission assessment before agreeing to a new admission. Use the home’s standard care plan format when preparing new plans of care. People living at the home, or their representatives, should be given the opportunity to read and sign their care plans to confirm their agreement with the contents. Use recognised ‘falls’ risk assessment documentation to record risk assessment findings. Prepare new preventative risk assessments for the people who transferred to Monks Haven following the closure of their previous home. Ensure that the home’s Change of Bedroom Accommodation policy is shared with the local council’s commissioning section and their advice acted upon. Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 39 3. OP9 Assess the competency of staff to administer medication and keep a written record of this assessment and the outcome. Whenever a person is consulted about changing their bedroom accommodation, ensure that: • • Their care manager is consulted; A written record is kept of any discussion held with the person concerned. 4. OP10 5. OP12 Ensure that there is written evidence confirming that people have been provided with opportunities to comment on the home’s menus. Prepare a programme of external social events and outings. Take advice from the local environmental health officer about how best to store foodstuffs, such as sandwiches, that have been prepared in advance. All staff at the home should be provided with a contract of employment that has been signed by both the member of staff and the employer. All care staff should complete specialist training in working with people with dementia. Use a standard financial ledger to record all transactions undertaken on behalf of people whose money is handled by the home. 6. 7. OP15 OP19 8. OP29 9. 10. OP30 OP34 Monks Haven Residential Home DS0000032467.V335719.R01.S.doc Version 5.2 Page 40 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 - 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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