Inspection on 08/10/06 for Monks Haven Residential Home

This inspection was carried out on 8th October 2006.

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

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

Other inspections for this house

Monks Haven Residential Home 04/12/09

Monks Haven Residential Home 02/06/09

Monks Haven Residential Home 01/12/08

Monks Haven Residential Home 10/12/07

Monks Haven Residential Home 17/06/07

Monks Haven Residential Home 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 8,9&10 October & 7,8 & 9 November 2006 14:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000032467.V303039.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. DS0000032467.V303039.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 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 DS0000032467.V303039.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2006 Brief Description of the Service: Monkshaven is situated on the sea front at Cullercoats and is a larger older style adapted building. The metro and other transport links are close by. The Home provides residential care for 33 older people, of whom up to 10 may have dementia care needs. Nursing care is not offered. Bedroom accommodation is spread over three main and two mezzanine floors. There are 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. DS0000032467.V303039.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, took place over 12 hours and involved one inspector. A range of evidence has been used to support the judgements reached in this report, including interviews conducted with the Home’s Manager, members of his staff team and residents, as well as findings from a recent protection of vulnerable adult investigation carried out around the time of the inspection. The premises were also inspected, as was a sample of care records, policies, and procedures. What the service does well: Staff pay £1.00 for each meal they take at the Home. The proceeds collected are then paid into the Home’s Amenity Fund and used to pay for entertainment and trips out. During the inspection, residents were provided with an opportunity to join in an afternoon entertainment event where a video of a famous Northumbrian tourist spot was shown and a musical session held. This seemed to be enjoyed by all who attended the event including staff. Dr George and his staff team provided every assistance during the inspection. The Home’s catering team had completed a daily record that provided evidence that consideration had been given to ensuring that residents received nutritionally balanced meals. Where appropriate, information about the varying types of dementia had been placed on residents’ care records. A detailed maintenance record had been completed and provided information about all refurbishment work and repairs carried out within the Home. The kitchen was clean, tidy and well organised. DS0000032467.V303039.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? The Manager had purchased a projector and video equipment that enabled the Home to provide residents with a weekly film night. The Manager had prepared teaching sessions on how to prevent potential outbreaks such Clostridium Difficile and MRSA. Staff will shortly be provided with training in these areas. 15 staff had completed eye care training. A new medication trolley had been purchased. The trolley had been chained to the wall. The Service User Guide had been updated to include the required information. The Home had purchased a new fax, printer and copier machine for the office. The Home had appointed a new head chef. The Home now has a team of three cooks. A set of new menus had been put in place. All staff had completed their mandatory training since the last inspection. All staff had either completed a Level 2 NVQ or were in the process of doing so. There was also evidence that: 1. The Home’s cleaning rota had been revised to ensure that domestic staff were clear about what tasks they were expected to undertake and at what frequency. Dr George had also specified what cleaning materials were to be used. A copy of the cleaning rota had been forwarded to the Commission as requested; 2. The carpet in bedroom 2 had been replaced. There was no longer an unpleasant odour; 3. The carpets in bedrooms 2, 6 and 13 had been replaced; 4. The chest of drawers in bedrooms 6 and 11 had been re-varnished and the veneer replaced; 5. The chest of drawers and bedside cabinet in bedroom 13 had been revarnished and the veneer replaced. The sink had been unblocked; 6. Hand drying facilities had been made available in toilet 7 – staff had been given further guidance on hand washing as a means of preventing the spread of infection; 7. The fire door near bedroom 41 had been re-adjusted to ensure that it closed properly; 8. The second floor cupboard containing confidential archived records had been locked; 9. The curtains in bedroom 7 had been refitted and cleaned. The dripping hot water tap had been repaired; DS0000032467.V303039.R01.S.doc Version 5.2 Page 7 10. Window restrictors had been fitted in all bedrooms; 11. The table in bedroom 8 had been replaced; 12. The worm armchairs in the small lounge had been replaced; 13. The roof had been repaired and the front of the building had been repainted; 14. The porch roof had been repaired; 15. Two new windows had been fitted at the front of the building; 16. All radiators had been flushed and cleaned; 17. A ground floor toilet had been replaced; 18. The bedroom of a resident with a sensory impairment had been fitted with a hearing fire alarm. The Home’s Service User Guide and Statement of Purpose contained information about how to obtain copies in alternative formats such as in large print or in other languages. What they could do better: The Home’s menus must be revised to include all of the required information. This should help demonstrate that residents are provided with meals that reflect their personal preferences and offer choice. Ensure that where a decision is reached to investigate a complaint, they are investigated in a thorough and comprehensive manner and complainants given detailed feedback. Ensure that detailed records are kept of any investigation conducted. This will help to ensure that residents and their relatives are clear that any concerns they raise will be listened to and treated seriously. Ensure that any adult protection concern arising within the Home is raised with the local safeguarding team and their advice sought. Ensure that staff are familiar with the Home’s Adult Protection Policy and the Local Authority’s safeguarding procedures. This will help ensure that residents’ well being is protected and that staff are clear about what action must be taken when allegations of abuse are raised. Ensure that the Commission is made aware of any events occurring within the Home that affect the well being of residents 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 residents. Ensure that the Home’s accident procedure is reviewed on a regular basis. This will help ensure that the Provider and his staff have access to clear and up to date policies and procedures that reflect best practice guidelines. DS0000032467.V303039.R01.S.doc Version 5.2 Page 8 Ensure that an ‘on-call’ policy and procedure is put in place. This will help ensure that staff working evening, nighttime and weekend shifts are clear about their own roles and that of the person providing ‘on-call’ support. Ensure that moving and handling risk assessments provide staff with clear guidance on the actual techniques to be used when assisting residents to mobilise and transfer. This will help ensure that staff are clear about their responsibilities and about how to transfer residents in a safe manner. Ensure that staff have the skills and guidance they need to accurately report events occurring within the Home concerning residents’ well being. This will help ensure that staff commencing their shift have clear information about residents’ needs and any concerns about their health. Ensure that the premises related concerns referred to within this report are addressed. This will help ensure that residents have a well-maintained and comfortable place in which to live. The Manager must obtain a relevant care qualification to ensure that staff are provided with clear leadership and direction. An Annual Development Plan should be prepared and implemented so that residents and their families can see that action is being taken to maintain their home in a safe and well-maintained condition. 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. DS0000032467.V303039.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 DS0000032467.V303039.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 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. The Home’s Service User Guide and Statement of Purpose contained sufficient information for potential residents to make an informed choice about whether to live at Monks Haven. This meant that potential residents would be given the information they needed to make an informed choice about whether to accept a placement at the Home. Suitable arrangements were in place to ensure that the needs of residents admitted into the Home had been assessed. This meant that residents could be sure that the staff at Monks Haven would be able to meet their needs. DS0000032467.V303039.R01.S.doc Version 5.2 Page 11 EVIDENCE: The Home’s Statement of Purpose and Service User Guide contained the required information. Both documents contained information advising potential residents and their families about how to obtain copies in alternative formats. Also, the Provider had just set up his own web site. The site included important information about how the Home operated and included photographs and comments made by residents accommodated at the Home. Senior staff knew where to find the Service User Guide and arrangements had been put in place to ensure that prospective residents and their families were able to obtain a copy. The care records of a recently admitted resident were examined. There was evidence that the Manager had obtained a copy of their Care Manager’s Assessment and Care Plan. The Manager had also tried to obtain Care Management information for existing residents where this information had not been forwarded to the Home. Although there were no ethnic minority elders living at the Home, a policy was available setting out the approach that would be adopted when considering how best to meet any identified needs in this area. DS0000032467.V303039.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ care plans did not adequately demonstrate how the Home intended to meet their health, personal and social needs. This meant that staff might not be sure about how best to meet residents’ needs and residents might not receive the care and support they needed. Generally, the arrangements in place for meeting residents’ health care needs were satisfactory. But, following an incident where a resident suffered a fall in her bedroom, staff failed to arrange appropriate medical care. This may have placed the resident at risk. The systems in place for the safe administration, storage and disposal of medication were generally considered satisfactory. This meant that residents were protected from potential serious harm and were able to live comfortable, healthy and pain free lives. Residents were treated with respect and dignity when receiving personal care and their right to privacy was protected. DS0000032467.V303039.R01.S.doc Version 5.2 Page 13 EVIDENCE: Concerns about the quality and accuracy of information recorded by staff in one resident’s care records had been identified. Further information about this concern is referred to in more detail under the Complaints and Protection section of this report. Other concerns were also noted. Information contained in the monthly evaluations completed by staff was limited and provided little insight into residents’ well being over each month. A care plan had not been prepared setting out how staff should meet the skin care needs of a resident with an open facial sore. But, it was noted that the matter had been referred to the resident’s GP and the community nursing service. It was also clear that the resident concerned refused any attempts by staff to treat the condition by pulling away any dressings that had been applied. (This concern was rectified by the Provider following the inspection.) A pressure area care assessment completed for the same individual indicated that two hourly positional changes and pressure relieving aids were required. None of this information was referred to in the resident’s care plans. Since the last inspection, care plans covering residents’ needs for support with the administration of their medication had been drawn up. Information about residents’ preferred routines had also been recorded. Although the Manager said that residents’ records were always securely stored, on the first day of the inspection, this was found not to be the case. Generally, residents had access to health care services both within the Home and in the community. But, a complaint made by a family member about her mother’s care, when investigated, showed that although she had received initial first aid from the night staff on duty, and she had been monitored on a regular basis throughout the night, action had not been taken to obtain medical intervention and treatment immediately. Dental health assessments had been carried out by the Home, but in one resident’s care records, there was no evidence of when they had last seen a dentist. Also, contact details for her dentist had not been entered onto her care record. The Home’s Medication Policy contained the required information. Drug alert notifications and a medication reference book were available in the office for staff to refer to. All medication was securely stored. Staff were observed giving medication in a safe manner. The controlled drugs cupboard had been cleared of all non-medication items. Identification photos were included in the medication records examined. A sample of medication records was checked and found to be satisfactory. DS0000032467.V303039.R01.S.doc Version 5.2 Page 14 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. DS0000032467.V303039.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements to provide specialist activities for residents with dementia were inadequate. This meant that residents had not been given the opportunity to take part in a variety of social activities that had been planned in advance and arranged to meet their individual needs. The quality of contact between some care staff and residents was unsatisfactory. This meant that some of the more dependent residents were not given enough opportunities to benefit from social contact with staff. Residents were given appropriate support to maintain contact with their families and friends and visitors were made to feel welcome. Improvements had been made to the Home’s menus. But, they were not fully adequate. This meant that residents did not have access to all of the information they needed to make choices about the meals offered by the Home. DS0000032467.V303039.R01.S.doc Version 5.2 Page 16 EVIDENCE: The Manager had recently provided opportunities for residents and their families to comment on the Home’s weekly activities programme. Details of the programme were displayed on the notice board in the dining room. Two sessions of activities were offered daily. These included drawing and colouring, reminiscence, music and sherry, bingo, chair exercise, dominoes, cards, ball games, board games, and arts and crafts. But, on the first day of the inspection, the activities listed for the afternoon session were not provided. And, for some residents, their contact with staff was very limited. Some staff were observed sitting in one of the lounge areas making little attempt to talk to and socialise with residents. Staff recorded which residents had participated in what activities. Monthly entertainment sessions were held. For example: • • • October 2006: There was a film and musical session. An outside entertainer had also been brought in; September 2006: There was a Country and Western Show. A film was also shown; August 2006: There was a Karaoke event where residents were encouraged to sing and dance. Residents had been provided with access to communion services on a regular basis. Arrangements had also been put in place to provide residents with opportunities to join in Christmas activities such as a concert given by local school children and gift sale held within the Home. There was little evidence of activities being arranged that were tailored to the needs of residents with dementia. There was no forward planning of entertainment and outings. A mobile library visited the Home on a regular basis and provided residents with access to a range of titles in large print. A hairdresser visited fortnightly and a local pastor every other week to offer communion. Residents spoken with said that the Manager and his staff team always made families and friends feel welcome. Visitors could be seen in private or join residents in the lounge and dining areas. There was a policy outlining the Home’s approach to enabling residents to maintain contact with family and friends. The Home had a policy on managing residents’ financial affairs. There was an expectation that residents will manage their own affairs wherever possible. In practice, residents’ relatives were said to advocate on their behalf where the person lacked capacity. A local advocacy service had also been used in the past. A policy on advocacy was in place and included contact details for North Tyneside Advocacy Service. DS0000032467.V303039.R01.S.doc Version 5.2 Page 17 Since the last inspection the Manager had devised a new set of menus which offered choice and variety.. The new head chef said that the required supplies would be purchased to allow the cooks to deliver the menu for each day. The previous inspection had identified that the cooks had been unable to follow the menus, as they did not have the necessary supplies. Despite the menus having been recently prepared, they did not contain all of the required information such as the approximate timings of meals and details of the second choice available at the lunch and teatime meals. Although a nutritional policy had been devised, it did not cover all the areas recommended by the Commission. The kitchen was hygienic, clean, tidy and well organised. The lunchtime meal was nicely presented and looked nutritious. Staff interviewed said that a food processor and new foodstuff containers would be a great aid to the kitchen. DS0000032467.V303039.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements had not been made to ensure that a resident received the immediate medical care she needed following a fall in her bedroom. This meant that the resident’s needs were not adequately met and that her health and well being could have been put at risk. Satisfactory arrangements had not been made to ensure that a complaint raised about the care a resident received at the Home was properly investigated under the local authority’s safeguarding procedures and Monks Haven’s protection of vulnerable adults policy. This meant that the resident’s family felt that their concerns were not properly addressed and dealt with in a professional manner. EVIDENCE: DS0000032467.V303039.R01.S.doc Version 5.2 Page 19 The Home’s Complaints Procedure included details of how to refer a complaint to the Commission. There was a copy in each resident’s bedroom. A summary of the procedure was also included within the Service User Guide. The Home’s Adult Protection Policy complied with the relevant guidance and legislation. Staff had received training in the protection of vulnerable adults. The Commission had received one complaint since the last inspection. This was immediately referred onto the local safeguarding team. The complainant was dissatisfied with the care and treatment that her mother received after falling (or slipping) to her bedroom floor. The complainant was unhappy that she had been unable to obtain an accurate account of what had happened to her mother during this time. The complainant was concerned that her mother had been left on her bedroom floor for almost five hours before an ambulance was called at the beginning of the day shift. The complainant was also dissatisfied with the provider because she felt that he had not undertaken a proper investigation into the concerns that she had raised, and he had not informed her of the outcome of his investigation. Following an investigation conducted under the guidance of the local safeguarding team, the following conclusions were reached: 1. The Home had committed an act of neglect of care, albeit unintentionally. The night duty and on-call seniors failed to put in motion the Home’s policies and procedures covering such a situation and in doing so, failed to ensure that a resident received the medical treatment and care they required. The on-call senior acted outside of her remit when she provided advice to the night duty senior. The absence of a night call policy may have added to the lack of clarity about roles and responsibilities; 2. Following the resident’s fall, the night staff on duty took immediate action to try and make her comfortable and then carried out checks of her condition approximately every 20 to 30 minutes. Advice was taken from the on-call senior and a decision was reached to leave the resident on the floor due to her reluctance to be hoisted and difficulties around using the hoist to raise her from the floor and back onto her bed; 3. The Manager had failed to inform the relevant agencies including the Commission for Social Care Inspection of the incident that had taken place; 4. Although the complaint should have been investigated by the local Safeguarding team, having made a decision to investigate the complaint, the Manager failed to conduct a robust enough investigation into how the incident was handled by his staff; 5. Having carried out an investigation, the Manager failed to ensure that the complainant was provided with clear information about his findings; 6. Staff failed to keep comprehensive and detailed records of the events leading up to and after the incident; DS0000032467.V303039.R01.S.doc Version 5.2 Page 20 7. The Manager failed to ensure that there was a safe system of work in place to provide his staff with guidance on how to move and handle the resident concerned. Although a manual handling risk assessment had been completed, and information about how to use the hoist included, there was no guidance about how to lift the resident from the floor even though all staff were aware that this person would not allow them to use lifting equipment; 8. The Home’s accident policy had not been reviewed in over 12 months and failed to provide staff with information about how to seek advice from other relevant professionals such as NHS Direct or the Paramedic Service. DS0000032467.V303039.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Provider had taken steps to improve the standard of decoration, furniture and fittings provided within the Home. But, some of the corridor and bedroom carpets were grimy and of a poor quality. This meant that some carpets detracted from the efforts that the provider had made to improve the overall appearance and quality of the Home’s furnishings, fittings and decoration. Generally, residents’ bedrooms were adequate and met their needs. This meant that they had access to private space where they could relax and feel comfortable. DS0000032467.V303039.R01.S.doc Version 5.2 Page 22 EVIDENCE: The Home was warm, generally clean and free of offensive odours, tidy and well lit. Bedroom furniture that had been identified as being in poor condition had been refurbished. There was evidence that most of the concerns identified in previous inspection reports about the quality of accommodation provided had been addressed. But, it was also identified that the following matters had not been attended to: • Bedroom 7: there was a very strong and unpleasant odour. The carpet remained in a poor condition despite having been cleaned. The Provider said that a new carpet would be fitted before the bedroom was reoccupied; Bedroom 17: the carpets remained in a poor condition despite having been cleaned. The Provider said that a new carpet would be fitted before the bedroom was re-occupied; Bedroom 29: the floorboard ridges were showing through the carpet possibly due to poor underlay. The provider advised that although the room was occupied, the resident concerned was immobile and did not actually use the carpet; Red corridor carpet: the carpets on the ground, first and second floors were both grimy and stained. The carpet remained in a poor condition despite having been cleaned. • • • Concerns were also identified during this inspection as follows: • • • Bedroom 5: there was an unpleasant odour; new carpet fitted Bedroooms 6, 8 and 13: the carpets were very stained and grimy. The carpets were replaced following the inspection; Bedroom 8 and the top floor bathroom: the radiators had not been guarded. The Manager confirmed that a large wardrobe and a bedside table had been placed in front of the unguarded radiator in bedroom 8 and a risk assessment had been completed. It was also confirmed that a guard had been made to cover the bathroom radiator, but that it had not yet been fitted. A check was made of the Home’s toilet and bathroom areas. They were clean, hygienic and hand-drying facilities had been made available in those checked. Communal emollient creams such as Sudacrem had been removed from residents’ bathing areas. Continence pads and plastic gloves had been appropriately disposed of. DS0000032467.V303039.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were enough care staff rostered on duty to meet the assessed needs of the residents accommodated. This meant that staff had the time required to ensure that residents were well cared for. Over 50 of the staff team had completed a qualification in care. Satisfactory arrangements were in place ensuring that staff regularly updated their mandatory training in key areas. This meant that staff had the skills and knowledge required to care for residents in a competent and safe manner. EVIDENCE: On the day of the inspection the required staffing levels were in place. It had previously been agreed with Dr George that the following levels of staffing would be provided depending upon the numbers of residents accommodated: Number of residents 20 to 22 23 Numbers of care staff 3 3 Management cover RM supernumerary RM DS0000032467.V303039.R01.S.doc Version 5.2 Page 24 24 25 3 3 or 4 supernumerary RM supernumerary RM supernumerary 4 staff to be provided at key times where one or more residents require two care staff to assist with personal care. Key times – am to 1pm and 5pm to 8pm RM supernumerary 4th member of staff to be provided during key times RM supernumerary 26 3 or 4 27 4 It had also been agreed that: • • The Manager’s hours would be extra to the care staff scheduled on duty for each shift; The above staffing levels would be reviewed and increased where necessary and that this might mean providing extra staff to those numbers set out in the above. A review of the provision of training within the Home showed that staff had either completed a qualification in care or were in the process of doing so. A minimum ratio of 50 trained members of staff had been achieved. The majority of staff had recently updated their training in key areas. At the time of the inspection, the provider was in the process of obtaining copies of certificates confirming that a recently appointed member of staff had completed their mandatory training. DS0000032467.V303039.R01.S.doc Version 5.2 Page 25 The Manager said that all staff had received a copy of the General Social Care Council’s Code of Conduct for Employees. DS0000032467.V303039.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for regularly monitoring the Home were not satisfactory. This meant that the service at Monks Haven was not being regularly reviewed to ensure that it continued to meet the needs of the people who lived there. There were suitable arrangements in place for consulting with residents about the care and support provided at Monks Haven. But, a suitable plan with attached timescales for developing the service at Monks Haven had not been prepared. This meant that residents and their families might be unclear about what action the Manager intended to take to improve the services offered at the Home. DS0000032467.V303039.R01.S.doc Version 5.2 Page 27 EVIDENCE: Since the last inspection of Monks Haven, Dr George had been appointed as Manager. He had recently completed the Skills for Care induction training covering such areas as moving and handling, basic food hygiene and health and safety. He had over two years experience managing a care home and had also worked as a medical doctor in the field of geriatric care. Although Dr George had obtained a relevant management qualification, he did not have a care-based qualification relating to the care of older people. Dr George was in the process of completing a relevant qualification. The Manager had completed an initial quality audit earlier in the year and subsequently prepared an Annual Development Plan to reflect his findings and to address requirements arising out of the last inspection. But, there were no timescales attached to the plan and a copy had not been forwarded to the Commission as requested. The views of the staff team, and other professionals involved with the Home had only been sought informally. Finanical records were in place for each resident. The money held on behalf of three residents was checked and found to match the balance detailed on their financial records. There was no evidence that regular audits had been carried out to ensure that accurate financial records were kept. The Manager had put arrangements in place which allowed residents to access their money when he was absent from the building. Large amounts of money, with one exception, were not being held on behalf of the residents whose records were checked. Reports of the visits carried out by the Provider to monitor the standard of care provided within the Home had not been prepared and forwarded to the Commission as requested. All staff had completed their moving and handling training. New equipment had been purchased following the training. Moving and handling risk assessments had been completed. The assessments did not include clear and specific guidance about the techniques to be used by staff when assisting individual residents to mobilise in a safe and competent manner. But, during the inspection, staff were observed assisting residents to mobilise in a safe and competent manner. A check was made of the Home’s wheelchairs. Since the last inspection, all of the Home’s wheelchairs had been serviced. They were appropriately stored, clean and had had their footplates attached. Windows throughout the building had been fitted with various types of window restrictors. Some of the window restrictors fitted were chains. Assessments to protect residents considered being at risk of falling from first and second floor windows had not been completed. There was no maintenance programme to ensure that the restrictors fitted were kept in good working order. DS0000032467.V303039.R01.S.doc Version 5.2 Page 28 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 3 X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X 2 2 DS0000032467.V303039.R01.S.doc Version 5.2 Page 29 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 The Manager must ensure that: 1. A care plan is put in place that provides staff with clear guidance on how to care for a resident with skin care needs resulting from an open facial sore; 2. Care plans are put in place where pressure area care risk assessments have identified that positional changes and pressure relieving aids are required. 2. OP7 12 & 15 The Manager must ensure that: 1. Residents’ care records are kept in a secure place; 2. Staff are provided with guidance on how to ensure that monthly evaluations provide a clear picture of how successful care plans have been in meeting residents’ assessed needs; 3. Care records identify the name of the dentist responsible for providing DS0000032467.V303039.R01.S.doc Version 5.2 Page 30 Timescale for action 01/02/07 01/04/07 dental care. Where it has not been possible to obtain dental care for a resident, this must be clearly identified in their care record and advice taken from the Community Dental Service. 3. OP8 12 Ensure that residents’ care 01/02/07 records contain details of the last date on which dental treatment was received. (Previous timescale 01/08/06 not met.) 4. OP12 16(2) The Manager must ensure that: 1. A varied daily programme of social activities is provided that reflects residents’ individual needs and preferences; (Previous timescale 01/11/06 not met.) of of 01/04/07 2. Staff have received basic training in the provision of social activities; 3. At least one person has completed more specialist training in the provision of activities; 4. Staff have access to all of the resources and equipment needed to develop a more specialist activity programme; 5. A Person Centered Activity Plan is prepared for each resident with dementia. The Provider must ensure that the provision of activities at Monks Haven is reviewed during DS0000032467.V303039.R01.S.doc Version 5.2 Page 31 their monthly unannounced monitoring visits to the Home. 5. OP15 16(2) The Manager must ensure that 01/04/07 the Home’s newly revised menus contain the following information: 1. The approximate timings of meals; 2. A specified second meal option at the lunch and tea-time meals; 3. Choices available at the supper time meal; 4. The range of beverages available throughout the day; 5. The availability of fresh fruit; 6. Information about vegetarian options and special dietary requirements. 6. OP16 22 The Registered Manager must 01/02/07 ensure that: • Where any complaint or concern is received, a detailed record is kept of: - Any complaint received; - The name and contact details of the person making a complaint; - What actions have been taken to investigate the complaint; - Statements taken from staff, or other persons interviewed, as part of the investigation process; - Conclusions reached Version 5.2 Page 32 DS0000032467.V303039.R01.S.doc • • • following completion of the investigation; A letter is forwarded to the complainant advising them of the outcome of any investigation conducted; A record is kept of the complainant’s response to the outcome of the investigation and whether they are satisfied with the conclusions reached; The complainant is advised about what to do in the event they are unhappy with how the investigation has been conducted and/or its findings. The Registered Manager must ensure that any complaint concerning the protection of a vulnerable resident is immediately referred to the local safeguarding team so that it can be investigated under their procedures. (Failure to implement this requirement will result in the Commission taking legal advice about how to ensure compliance with the above requirement.) 7. OP18 13(6) The Registered Manager must 01/02/07 ensure that any concern involving the protection of a vulnerable resident 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. (Failure to implement this Version 5.2 Page 33 DS0000032467.V303039.R01.S.doc requirement will result in the Commission taking legal advice about how to ensure compliance with the above requirement.) 8. OP19 16(2) The Manager must ensure that: • • • Bedroom 5: action is taken to eliminate the unpleasant odour; Bedrooms 6, 8 and 13: the carpets are cleaned or replaced; Bedroom 8 and the top floor bathroom: the radiators are guarded. Where a decision is made not to guard the radiator in bedroom 8, a risk assessment must be completed and updated on a six monthly basis or where circumstances change. The resident’s care manager must be advised of the action taken by the Home and their opinion sought and included on the Home’s risk assessment. 01/04/07 9. OP24 16(2) The Manager must ensure that 01/06/07 new underlay is fitted in bedroom 29. The Manager must ensure that 01/04/07 the red corridor carpet is replaced. (The timescale for implementing this requirement had not expired at the time of the inspection.) 10. OP24 16(2) 11. OP31 9 The Manager must relevant care qualification. obtain a 01/04/07 related DS0000032467.V303039.R01.S.doc Version 5.2 Page 34 12. OP33 24 The Manager must ensure that: • The views of staff and professional visitors to the Home are sought and used to inform the quality review process; An Annual Development Plan is prepared and a copy forwarded to the Commission. of 01/04/07 • (Previous timescale 01/08/06 not met.) 13. OP37 12 The Manager must ensure that: • • A written ‘On-call’ Policy is prepared and forwarded to the Commission; The Home’s ‘On-call’ Policy clearly states: - Who must be called and in what situations. Guidance should also be given on the role of NHS Direct, the Emergency GP and Ambulance Services; - The role and responsibilities of staff contacting the ‘on-call’ person; - The role and responsibilities of staff providing guidance to care staff needing advice and support ‘out of hours’; All staff are asked to sign the ‘On-call’ Policy to confirm that they have read and understood it. 01/02/07 • 14. OP37 12 & 17 DS0000032467.V303039.R01.S.doc 01/02/07 Version 5.2 Page 35 The Registered Manager must ensure that clear and detailed records are kept of: • The outcome of any GP visit, including any difficulties experienced by the GP examining the resident; Any important events that have occurred during a shift; All care and support provided to residents throughout the night time period including extra monitoring visits. • • 15. OP37 37 The Registered Manager must ensure that arrangements are in place for relevant information to be exchanged between shifts. The Registered Manager must 01/02/07 ensure that: • The Commission is informed, without delay, of any event in the Home that adversely affects the well-being or safety of any resident accommodated at Monks Haven; The Regulation 37 notification forms issued by the Commission are used to make the required notifications under this regulation. 01/04/07 The Registered Provider must ensure that he, or his representative, visits the Home at least once a month unannounced to: • Interview residents, their representatives and staff working at the Home to Version 5.2 Page 36 • 16. OP37 26 DS0000032467.V303039.R01.S.doc • form an opinion of the standard of care being provided; Inspect the premises and its records, including the complaints record. The Registered Provider must prepare a written report on the conduct of the care home and supply the Commission with a copy. (Failure to comply with this requirement led to the Commission taking enforcement action in December 2005 to ensure compliance. Legal advice about failure to comply with Regulation 26 will now be taken by the Commission.) 17. OP38 13(4) The Registered Manager must 01/02/07 review and update the Home’s Accident Policy. The Registered Manager must 01/02/07 ensure that moving and handling risk assessments and care plans: • Clearly describe the techniques to be used by care staff when assisting residents to mobilise; Provide staff with a safe system of work in those situations where residents refuse to allow them to use the identified moving and handling equipment. 01/04/07 18. OP38 13(4) • 19. OP38 13(2) Ensure that: • Individual risk assessments are carried out which consider the action that needs to be DS0000032467.V303039.R01.S.doc Version 5.2 Page 37 • taken to minimise the likelihood of vulnerable residents harming themselves by falling from, or jumping out of, any window 2 metres above ground level; A programme of maintenance is put in place that ensures that any window restrictor fitted in the Home is maintained in a safe condition. A record must be kept of any maintenance carried out. Information about the Registered Persons’ responsibilities in this area can be found on the Health and Safety Executive Website: www.hse.gov.uk The relevant guidance is: SIM 07/2001/39 The local Health and Safety Inspector can be contacted for advice. Details are available at the above web address. (Previous timescale 01/08/06 not met.) 20. OP38 13(2) of The Manager must ensure that 01/04/07 windows cannot be opened more than 100mm by using robust restrictors of the type specified in the latest guidance issued by the Health and Safety Executive. The use of chains to restrict window openings is not considered suitable for use in a residential care home environment. (Previous timescale 01/11/06 not met.) DS0000032467.V303039.R01.S.doc of Version 5.2 Page 38 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The Manager should ensure that the Home’s Service User Guide is made available in alternative formats and other languages. The Manager should review the Home’s Nutritional Care Policy to ensure that it covers the following information: • • • • • • • 3. OP15 The Manager should purchase a food processor and more appropriate storage containers for foodstuffs. 4. OP15 The Manager should ensure that there is written evidence confirming that residents have been provided with opportunities to comment on the Home’s menus. 5. OP30 The Registered Manager must ensure that a programme of training is put in place that provides all grades of staff with clear advice and guidance about what is expected of them when completing different types of records. The Registered Manager should ensure that there is DS0000032467.V303039.R01.S.doc Version 5.2 Page 39 2. OP15 The importance of hydration; Indicators of poor nutritional health; The need for dietary supplements for residents suffering from poor nutritional intake; The use of ‘finger food’ to improve dietary intake; Information about the nutritional risk screening tool that will be used in the Home; Information about how care plans will be used to aid better nutrition; The best ways to cook food to maximise nutrition. 6. OP38 written evidence that each member of staff has been trained to use the Home’s hoisting equipment. DS0000032467.V303039.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: 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. 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