Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 04/08/05 for Monks Haven Residential Home

Also see our care home review for Monks Haven Residential Home for more information

This inspection was carried out on 4th August 2005.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff on duty at the time of the inspection were kind and appeared to have developed caring relationships with the people in their care. Residents were generally satisfied with the care and support provided at the Home. Meals are varied and nicely presented. The Inspector joined the residents for their lunch-time meal and found it to be tasty with good portions served. The Proprietor and Manager were willing to take part in a positive discussion about the findings of the inspection. Both were happy to agree a way forward as part of their response to requirements and recommendations arising out of the inspection. Staff shop for residents to ensure that they have all of the toiletries, food and clothes they require. Staff help residents to look nice by assisting them to choose the clothes they wish to wear for the day ahead.

What has improved since the last inspection?

A new shower has been fitted to the middle landing. A number of bedrooms have been redecorated. Items of new furniture have been purchased for the lounges and dining areas. The kitchen has been re-painted and new items of equipment have been purchased. The external yard walls have been rendered, cleaned and then painted. Corridors throughout the Home have been repainted. Sit-on weighing scales have been purchased. The Manager has made improvements to the Home`s medication arrangements and residents` care plans. Senior staff accompany doctors and nurses visiting the Home to ensure that health care advice is followed through and the outcome recorded in residents` care plans. All senior staff have received Oxygen Therapy training. All staff have received training in the Protection of Vulnerable Adults, Dementia Care and Infection Control.

What the care home could do better:

Provide prospective residents with all of the information they need to make an informed choice about whether they wish to live at the Home. Ensure that a copy of the Care Management Assessment is obtained prior to each new resident`s admission into the Home. Further develop residents` care plans to ensure that they cover all aspects of health, personal and social care. Develop the Home`s Medication Policy to ensure that it includes the required information. Some changes to medication practices are required to ensure that residents are properly protected and kept safe. The Cook should be provided with information about residents` food preferences and dietary needs. A policy needs to be put in place outlining the Home`s approach to dietary assessment and nutritional care. Ensure that the levels of staffing agreed with the Commission are provided. Ensure that staff are provided with refresher training in key areas. Staff records must contain the required information and documentation. Ensure that the required pre-employment checks are carried out before staff commence work at the Home. Ensure that domestic staff have enough time to complete their duties. Submit an application Commission.Monks Haven Residential HomeforthecurrentmanagertoregisterwiththeB53-B03 S32467 Monks Haven V232109 040805 Stage 4.docVersion 1.30Page 7Ensure that staff receive certificated fire training on a yearly basis. Ensure that the Home, its fixtures and fittings are well maintained. Review the quality of care provided in the Home and produce an Annual Development Plan.

CARE HOMES FOR OLDER PEOPLE Monks Haven Residential Home 55-57 Beverley Terrace Cullercoats Tyne & Wear NE30 4NX Lead Inspector Glynis Gaffney Announced 04, 05 and 13 August 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Monks Haven Residential Home Address 55-57 Beverley Terrace Cullercoats Tyne & Wear NE30 4NX 0191 252 1957 N/A geoshineltd@aol.com Geoshine Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Vacant CRH 33 Category(ies) of DE(E) Dementia over 65 (10) registration, with number OP Old Age (23) of places Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Miss Bowmaker must submit an application to register as the Homes Manager by the 23 September 2005. Should Miss Bowmaker decide not to register, a Registered Manager must be recruited and an application for registration submitted to the Commission by the 04 November 2005. Date of last inspection 19 October 2004 Brief Description of the Service: Monkshaven is situated on the sea front at Cullercoats and is a larger older style adapted building. The Home provides residential care for 33 older people, for whom up to 10 may have dementia care needs. Nursing care is not offered. Bedroom accommodation is spread over three floors. There are 26 single bedrooms of which three have en-suites. Three double bedrooms are also available. There is a passenger lift to the main floors. Some bedrooms, bathrooms and toilets on the mezazzine floors can only be accessed 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 room. The Home has a small paved area to the front which was attractively presented. There was also a yard area to the rear of the building. Street parking was available. Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced, took place over 17 hours and involved two inspectors. The premises were inspected, as were a sample of care records and a selection of other records, policies, and procedures. Due to time constraints, the following requirements and recommendations set out in the October 2004 Announced Inspection Report were not checked: Requirements 16, 17, 21, 23, 26 and 27; Recommendations 1, 3, 4, 5 and 6. Four of the staff on duty and three residents were interviewed. Five other residents were also spoken to. Three relative and five resident questionnaires were returned. The people who completed them all said that they were happy with the quality of care provided at Monkshaven. One relative said that ‘all the staff look after mum very well. They are very attentive to all mum’s needs, are very friendly and look after the residents in a compassionate way. A job well done.’ What the service does well: What has improved since the last inspection? A new shower has been fitted to the middle landing. A number of bedrooms have been redecorated. Items of new furniture have been purchased for the lounges and dining areas. The kitchen has been re-painted and new items of Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 6 equipment have been purchased. The external yard walls have been rendered, cleaned and then painted. Corridors throughout the Home have been repainted. Sit-on weighing scales have been purchased. The Manager has made improvements to the Home’s medication arrangements and residents’ care plans. Senior staff accompany doctors and nurses visiting the Home to ensure that health care advice is followed through and the outcome recorded in residents’ care plans. All senior staff have received Oxygen Therapy training. All staff have received training in the Protection of Vulnerable Adults, Dementia Care and Infection Control. What they could do better: Provide prospective residents with all of the information they need to make an informed choice about whether they wish to live at the Home. Ensure that a copy of the Care Management Assessment is obtained prior to each new resident’s admission into the Home. Further develop residents’ care plans to ensure that they cover all aspects of health, personal and social care. Develop the Home’s Medication Policy to ensure that it includes the required information. Some changes to medication practices are required to ensure that residents are properly protected and kept safe. The Cook should be provided with information about residents’ food preferences and dietary needs. A policy needs to be put in place outlining the Home’s approach to dietary assessment and nutritional care. Ensure that the levels of staffing agreed with the Commission are provided. Ensure that staff are provided with refresher training in key areas. Staff records must contain the required information and documentation. Ensure that the required pre-employment checks are carried out before staff commence work at the Home. Ensure that domestic staff have enough time to complete their duties. Submit an application Commission. Monks Haven Residential Home for the current manager to register with the B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 7 Ensure that staff receive certificated fire training on a yearly basis. Ensure that the Home, its fixtures and fittings are well maintained. Review the quality of care provided in the Home and produce an Annual Development Plan. 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 B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 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 standard(s) 1, 2 and 3. The Home’s Statement of Purpose and Service User Guide did not provide prospective residents with sufficient information to enable them to make an informed decision about whether to live at the Home. Satisfactory arrangements were in place to ensure that every resident had been provided with an opportunity to read and sign a Statement of the Home’s Terms and Conditions. This provided residents with useful information about their rights and responsibilities whilst living at the Home. The arrangements for ensuring that a copy of each resident’s Care Management Assessment had been obtained were not satisfactory. This could result in staff not having access to all of the information needed to safely meet residents’ needs. EVIDENCE: Although the Provider had revised the Home’s Statement of Purpose following requirements set in previous inspections, it still did not include all of the required information. The Home’s Service User Guide also did not include all of the necessary details. Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 10 The care records of three residents were examined. A signed and dated Statement of Terms and Conditions was available in two of those checked. However, a signed Statement was not in place for a privately funded resident. Dr George agreed to rectify this matter immediately. Care Management information was not in place for one person. However, a reasonable explanation was given as to why this information was unavailable. In another care record, only a Care Management Care Plan was in place. The third care record checked was found to contain the required documentation. There was evidence in two of the care records that the Home had carried out its own preadmission assessment to ensure that it was able to provide the necessary care. Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10. Although progress has been made in developing residents’ care plans to cover all aspects of health, personal and social care, further development is still required to ensure that staff are clear about how they are to meet residents’ needs. The arrangements in place for involving residents in drawing up their own care plans were not satisfactory. The health care needs of residents were generally well met. However, some records did not clearly set out how, and by whom, residents’ health care needs had been met. The systems in place to support the safe administration, storage and disposal of medication were generally considered satisfactory and promoted good health. However, the Home’s Medication Policy was not adequate and may not ensure that residents are properly protected. Staff were seen to provide personal support in such a way as to promote and protect residents’ privacy, dignity and independence. Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 12 EVIDENCE: Three residents’ case records were examined. Care plans were in place for each resident and it was evident that the new Manager had made improvements to residents’ care records following the last inspection. However, they were still considered to be limited and did not cover all of the recommended areas. For example, none of the care plans examined covered residents’ needs for assistance with medication. In another resident’s care record, a nutritional risk assessment and care plan did not include sufficient detail as to how their nutritional care needs were to be met. None of the care plans examined had been signed by the resident, or their representative, to confirm their agreement with the contents. However, since the inspection, the Manager has made arrangements for all residents, and/or their representatives, to be consulted about the contents of their care plans. There was no evidence that the Manager had undertaken regular checks of the quality of information held in residents’ care records. Six monthly reviews of residents’ placements had not been undertaken. Residents’ records were securely stored. Residents had received recent nursing, medical, optical and chiropody input. Checks of residents’ weights had been carried out on a monthly basis. However, the recommended preventative risk assessments had not been completed for each resident. For example, a nutritional risk assessment had not been completed for one person. Preventative pressure area care risk assessments had not been completed for two persons. Continence care risk assessments had not been completed in any of the records checked. A care plan concerning the needs of a resident requiring Oxygen Therapy did not cover all of the recommended good practice areas. Although a resident was having her leg dressed by community nursing staff between May and July 2005, her care plan contained limited information regarding this matter. Care notes had not been made in a resident’s care record for a number of weeks, despite their discharge from hospital following a bout of Pneumonia. Neither had their care plan been reviewed in the light of the hospital admission. There was also no evidence in any of the records checked that residents had been visited by a dentist. However, it was confirmed that one of these residents independently makes their own dental and optical care appointments. Ms Bowmaker said that records of previous dental appointments for the other two individuals may have been taken out of their main care file and stored. The Home’s Medication Policy had been revised following requirements made in previous inspection reports. However, it still does not include all of the required details. Drug alert notifications were filed and available to staff. The Home’s medication reference book was three years out of date. Although residents taking four or more medicines had been referred to their GP for Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 13 review, there was no written information to support this. Medication records were generally well completed. Hand wash facilities were available in the main office area. Staff were not undertaking simple nursing tasks with the exception of supporting a resident with their Oxygen Therapy. Identification photos were in place for each resident with one exception. The systems in place for the storage, administration and disposal of medication were generally considered safe and appeared to be followed by senior staff. However, the drugs trolley was not secured to the wall, and temperature checks of the area within which the drugs trolley was kept, were not being undertaken. 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 B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 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 standard(s) 12 The meals at Monkshaven are of a good standard, nicely presented and offerd choice. However, the same menu cycle is repeated throughout the year and does not reflect seasonal changes. Arrangements for recording residents’ opinions regarding the content of the menus were inadequate. EVIDENCE: A four-week menu cycle was in use. Two choices are offered at each main meal time. However, a hot choice was not always available at the tea time meal and some menu choices had not been recorded in sufficient detail. The Manager said that residents had recently been consulted about the content of the Home’s menus. However, there was no evidence to support this and none of the residents interviewed, could recall being consulted. Details of the lunch and tea-time meals were displayed on the noticeboard in the dining room. Food stocks were checked and appeared adequate. The quality of the lunchtime meal was good and appeared to be enjoyed by all residents who participated in the meal. The dining room is a pleasant area and the tables were nicely dressed. Arrangements have been made for the Cook to receive training in the nutritional care needs of older people. A list of residents’ food likes and dislikes, and whether they were considered to be at risk because of poor dietary intake, was not available in the kitchen. The care plan of a resident identified as having poor dietary intake did not contain sufficient detail Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 15 about how their needs should be met. The Home did not have a nutritional care policy. Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18. A satisfactory Adult Protection Policy was in place and, if implemented in practice, should ensure that residents are properly protected. EVIDENCE: The Home’s Adult Protection Policy complied with the relevant guidance and legislation. There has been one adult protection concern raised with the Commission since the last inspection visit to the Home. This matter is subject to investigation. Personnel records contained evidence that staff had received training in the protection of vulnerable adults. Staff were able to satisfactorily describe the action that they would take to deal with allegations of abuse. Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20. Although the Provider has made a number of improvements to the premises over the last 12 months, the overall quality of décor, furnishings and fittings need further attention to ensure that residents are provided with a well maintained home within which to live. EVIDENCE: Over the last 12 months, the Proprietor has made a number of improvements to the premises, both internally and externally. For example, certain areas of the building have been redecorated and new lounge seating has been purchased. However, action had not been taken to address all of the concerns raised in previous inspection reports. The following matters remain unresolved: • • • • There were no privacy curtains to the windows in two of the toilets and bathrooms; The fireplace mantelpiece was chipped and the varnish was in a poor condition; The floor covering in one of the downstairs toilets (9) needs replacing; Bedroom 26: The carpet was very worn; B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 18 Monks Haven Residential Home • The external paintwork on a number of window frames was in a poor condition. (Dr George has since re-painted some of these window frames); Further concerns were also identified during this inspection as follows: • Lift machinery situated in the ceiling space on the top floor was heard making a very loud noise. An Immediate Requirement was issued requiring the Provider to investigate and remedy the cause of this noise. (Dr George has since resolved this problem); The red corridor carpet is badly stained by bleach marks in certain areas of the building. This makes the carpet look very unsightly; The emergency light near to bathroom 8 was flickering. (In his response to the draft report, Dr George commented that this matter had been attended to); Some of the external window frames to the rear of the building had rotted in places. (Dr George has since repaired the most rotten window frames); The coverings to two armchairs in the small lounge had a worn and grimey appearance. (Dr George has since removed these items of furniture.) • • • • Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 The Home did not have sufficient numbers of staff on duty to cater for the number of residents accommodated and their assessed needs. Nor were there sufficient numbers of qualified staff employed at the Home which could result in staff not having the skills, qualities and knowledge needed to deliver a good quality of care. Information held in staff personnel records is not adequate and arrangements for vetting staff are unsatisfactory potentially placing residents at risk of harm. EVIDENCE: The announced inspection report issued in October 2004, and a subsequent letter issued in May 2005, said that the following levels of staff must be provided at all times: 8am to 10pm 3 carers and one senior carer 10pm to 8am 2 carers including a senior carer It was also stated that the Manager’s hours should be extra to the care staff scheduled on duty and kitchen/domestic staff should be provided each day of the week to ensure that the required domestic tasks could be carried out. It was confirmed during the inspection that staffing levels had been decreased to take account of reduced occupancy levels. At the time of the visit there Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 20 were only 23 residents accommodated. The levels of staff provided were in line with those recommended by the Residential Forum for the Provision of Staffing in Homes for Older People. However, a number of concerns were identified during the inspection as follows: • A member of the domestic team told the Inspector that more cleaning hours were needed. This person also said that they were unable to complete all the required tasks in the time allowed and that because of this, it was ‘difficult to bottom the Home’; A senior carer said that now there were only three staff scheduled on duty, including a senior, it was very difficult for the carer allocated the ‘job of bedroom duties’ to get everything done. This person also felt that staff were very stressed trying to ‘get everything done’ and that extra staff were required at busier times of the day such as between 8am and 6pm. • The provision of the staffing levels was discussed in detail with the Registered Manager and Provider. Mrs Bowmaker said that now occupancy levels had begun ‘to edge up, the current levels of staffing were insufficient.’ She also felt that ‘providing support to care staff was making it very difficult to perform her management duties.’ Dr George acknowledged that now the numbers of residents had risen, staffing levels would need to increase to reflect this. It was also agreed that: • • The Manager’s hours would be extra to the care staff scheduled on duty for each shift; Until permanent staff could be recruited to fill shortfalls in the rota, agency staff would be used to provide the above staffing levels, as following a number of admissions, the total number of residents was now 27. Mrs Bowmaker said she thought this would be manageable and that new staff would be started as soon as the required pre-employment checks had been completed; Mrs Bowmaker would identify the busiest times of the day indicating when care staff faced the greatest demands on their time. This information will then be used to inform discussions held with the Provider regarding staffing levels. • Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 21 Following a further visit to the Home to discuss the draft announced inspection report, it was agreed with the Provider, Dr George, and the Manager, Ms D Bowmaker, that the following staffing levels would be provided throughout the working day from 8am to 10pm: Number of residents 23 24 25 Numbers of care staff 3 3 3 or 4 Management cover RM supernumary RM supernumary RM supernumary Points of information 26 3 or 4 27 4 4 staff to be 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 supernumary of staff to be provided during key times. RM supernumary Dr George agreed that the above staffing levels would be reviewed and increased where necessary. The Inspector confirmed that this might mean providing extra staff to those numbers set out in the above staffing agreement. Only 40 of the care team have obtained a relevant care based qualification. In the sample of staff personnel records examined, the following concerns were identified: • The files for two overseas staff, who mainly work at Monkshaven, were held at the Provider’s other care home. (Lead Inspector will seek advice B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 22 Monks Haven Residential Home • • • • • • about whether the personnel records of staff working at both his Homes can be kept in a central location; Gaps in employment had not been explored with one applicant who was then employed at the Home; It appeared that Testimonials provided by a prospective applicant had been accepted in place of references; The Home’s application form indicated that ‘Spent Convictions’ did not need to be declared. At the time of the inspection, the application form was changed following advice received from the Home’s Employment Adviser; There was no evidence confirming that staff had received a copy of their job description; Some staff files did not contain an identity photo or confirmation of identity; Information about one applicant’s education history had not been detailed on her application form. Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33 and 38. Residents live in a home which is run and managed by a person who is fit to be in charge, is of good character and able to discharge her responsibilities fully. The Manager provides consistent leadership, guidance and direction to staff and ensures that residents are properly cared for. Staff have not received training in key areas which has the potential to place them and residents at risk of potential harm. EVIDENCE: A Registered Manager was not in post. An application to register the current Manager has not yet been received. Ms Bowman has completed a relevant management qualification and is experienced in providing care to older people. She has now managed the Home for over six months and regularly updates her training. Staff were clear about who they reported to on their shift. Staff Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 24 interviewed said that they were clear about the standard of care they were expected to work to. Staff felt that they knew what was going on within the Home and felt able to raise any matters of concern with the Manager. Personnel records did not contain evidence that all staff had been issued with a copy of the General Social Care Council Code of Conduct. Arrangements are not in place to assess the quality of care and services provided at the Home. However, a ‘Continuous Quality Improvement Programme was submitted to the Commission and the Provider has devised a Residents’ Questionnaire. A review of staff training records revealed that not all staff had received refresher training in the following areas: First Aid; Basic Food Hygiene; Fire Prevention. Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 2 2 x x x x x STAFFING Standard No Score 27 2 28 2 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 x 2 x x 2 x 2 Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 26 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 Requirement Timescale for action 01/12/05 2. 2 5 Ensure that the Homes Statement of Purpose includes the following information: * The name and address of the Provider and his Manager; * The number and type of staff employed; * Details of staffs experience; * The age range and sex of residents catered for; * Details of the specialist care and activities provided to people with dementia care needs; * Details of the arrangements in place to meet residents religious needs; * Details of the Homes Complaints Procedure; * Details of the sizes of residents bedrooms. (This requirement was first issued following an inspection in May 2003.) Ensure that the Homes Service 01/12/05 User Guide contains the following information: * A more detailed description of the accommodation and services provided; * The relevant qualifications and experience of the Registered B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Monks Haven Residential Home Page 27 3. 3 14 4. 7 15 5. 8 12 Provider, Manager and the care team; * Details of the number of places provided and special needs and interests catered for; * Details of how to obtain a copy of the most recent inspection report; * A copy of the Homes Complaints Procedure; * Service Users views of the Home; * The name and address of the Commission for Social Care Inspection; * Details of the Homes Terms and Conditions of Residency. (This requirement was first issued following an inspection in May 2003.) Ensure that a summary of the Care Management Assessment is obtained before a resident moves into the Home. Ensure that residents care records contain a copy of the Homes own pre-admission assessment. Ensure that each residents care plan sets out in detail the action to be taken by care staff to ensure that all aspects of health, personal and social care needs are met. (This requirement was first issued following an inspection in October 2003) Ensure that residents, or their representatives, are consulted about the contents of their care plans. (This requirement was first issued following an inspection in October 2003) 121. Ensure that risk assessments are completed for all residents in the following areas: * Pressure area care (this requirement was first issued following an inspection B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc 01/12/05 01/12/05 01/12/05 Monks Haven Residential Home Version 1.30 Page 28 6. 9 13 conducted in October 2003); * Nutrition (this requirement was first issued following an inspection conducted in October 2004); 2. Ensure that each Oxygen Therapy care plan covers the recommended areas; 4. Ensure that care plans are put in place for residents assessed as being at risk of developing pressure area problems (this requirement was first issued following an inspection conducted in October 2004;) 5. Ensure that residents are provided with an opportunity to access dental health care on an annual basis; 6. Ensure that an upto date record of dental care received is available in residents current care records; 7. Where residents have been identified as having continence care needs, their care plans must confirm that a continence care assessment has been completed by the Community Nursing Team. 1. Ensure that the Homes 01/12/05 Medication Policy includes the following information: guidance on assessing a residents ability to safely self-medicate; guidance on the safe use of Oxygen; guidance on managing Drug Alerts. (This requirement was first issued following an inspection conducted in October 2004;) 2. Ensure that an identification photo is available in each residents medication record; 3. Ensure that records are kept of when the Home requests a medication review for residents on four or more medicines; B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 29 Monks Haven Residential Home 7. 15 16 8. 15 18 9. 19/20/21 23(2)(b)( o) 23(4) 4. Ensure that weekly checks of the air tempeature of the room in which the drugs trolley is stored are undertaken. 1. Ensure that the following written information is made available to staff working in the kitchen: details of residents considered to be at nutritional risk; details of residents’ dietary likes and dislikes. 2. Ensure that nutritional care plans clearly set out how residents needs in this area are to be met. 3. Prepare a policy which sets out the Homes approach to dietary assessment and nutritional care. Ensure that the Homes Cook is provided with training in the nutritional care needs of older people (this requirement was first issued following an inspection conducted in October 2004.) Ensure that: 1. Privacy curtains, or equivalent, are provided to the windows in all toilets and bathrooms; 2. The dining room mantle piece is re-varnished; 3. Replace the flooring in toilet (9); 4. The carpet in bedroom 26 must be replaced (Points 1 to 4 were first issued as part of a requirement following an inspection conducted in October 2004); 5. The emergency light close to bathroom 8 is repaired; 6. The red corridor carpet is replaced or repaired; 7. The cause of the noise coming from the lift machinery situated in the loft space is investigated 01/12/05 01/12/05 02/01/06 Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 30 10. 27 18 11. 28 18 and action taken to resolve any problems identified. (An Immediate Requirement was issued during the inspection.) 8. The external yard must not be used by residents as long as the concrete surface remains uneven. Ensure that the following staffing levels are provided as set out below: 1. 23 residents - 3 staff throughout the working day between 8am and 10pm; 2. 24 residents - 3 staff; 3. 25 residents - 3 staff. However, where one or more residents require two staff to meet their personal care needs, then a fourth carer must be provided at key times - between 8am and 1pm and 5pm and 8pm; 4. 26 residents - 3 staff. A fourth member of staff to be provided during key times; 5. 27 residents - 4 staff to be provided at all times; The Managers hours must not be included as part of the care hours needed to cover the rota. The permission of the Commission must be sought before any reductions in staffing take place outside of the staffing agreement set out above. In addition, staffing levels may need to be increased if resident dependency levels grow. Any shortfall in staffing against the agreed levels must be immediately notified to the Commissions Cramlington Office. Ensure that 50 of the care team have obtained qualifying training by the 31st December 2005. B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc 04/11/05 31/12/05 Monks Haven Residential Home Version 1.30 Page 31 12. 29 Schedule 2 13. 27 16(2) & 23(2) 14. 27 18 Ensure that the following 01/12/05 information is held on staff files: 1. Evidence that gaps in a prospective employees history have been explored (this requirement was first issued following an inspection conducted in February 2003); 2. An identification photo (this requirement was first issued following an inspection conducted in February 2003); 3. A fully completed application form; 4. Evidence that the Homes Induction Programme has been provided to newly employed staff; 5. Evidence that staff have been provided with a written job description; 6. Two written references requested by the Home (this requirement was first issued in May 2004); In addition, the personnel records for staff who work at Monkshaven must be kept at the Home. Provide a cleaning rota which 01/12/05 includes the following details: * What cleaning tasks are to be done each day, to what standard and by whom; * An indication of the time that should be taken to complete each task. If it is found that there are not enough staff hours allocated to complete the identified tasks, then additional hours must be allocated. The Homes rota must include 04/11/05 the following details: staffs full names and the name of the post they hold; the Managers hours. The Homes rota should be completed by the Manager rather Version 1.30 Page 32 Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc 15. 31 8 16. 33 24 17. 38 13(4) 18. 38 23(4) than the Provider. Ensure that a staff name is attached to each shift that needs covering. Ensure that the rota is updated to reflect any changes. Avoid using Monkshaven staff at the Providers other home to enable the care team to develop its own sense of identity; Forward a copy of the Homes rotas each month. An application to register the Homes Manager must be forwarded to the Commission without delay. A review of the quality of care provided at the Home must be undertaken at regular intervals. The review must seek the views of professional visitors to the Home. A copy of the report must be available to residents and the Commission. (This requirement was first issued following an inspection in October 2003.) Ensure that all staff have received refresher training in the following key areas: First Aid; Basic Food Hygiene. An Action Plan must be submitted to the Commission indicating when this requirement will be met for all staff. (This requirement was first issued following an inspection in October 2004.) Ensure that all staff receive certificated Fire Prevention Training on a yearly basis. An Action Plan must be submitted to the Commission indicating when this requirement will be met for all staff. 04/11/05 01/01/06 01/01/06 01/12/05 Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 33 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 7 7 Good Practice Recommendations Residents, or their representatives, should be encouraged to read and sign their care plans. Ensure that periodic checks of the quality of information held in residents care records are undertaken. Arrangements should be made to ensure that residents placements are reviewed on a six monthly basis. Purchase an up to date drug reference book. Ensure that the drugs trolley is secured to the cupboard wall when not in use. Ensure that handwritten medication administration records are signed by two staff to ensure that they are accurately recorded. 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. 3. 9 4. 15 5. Monks Haven Residential Home B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 34 Commission for Social Care Inspection 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 B53-B03 S32467 Monks Haven V232109 040805 Stage 4.doc Version 1.30 Page 35 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!