Inspection on 19/06/07 for Monmouth Court Nursing Home

This inspection was carried out on 19th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Monmouth Court Nursing Home 10/01/06

Monmouth Court Nursing Home 07/06/05

Monmouth Court Nursing Home 27/10/04

Monmouth Court Nursing Home 02/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Monmouth Court Nursing Home Monmouth Close Off Montgomery Road Ipswich Suffolk IP2 8RS Lead Inspector Jill Clarke Unannounced Inspection 10:20 19 & 21st June 2007 th 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 Monmouth Court Nursing Home DS0000024449.V343611.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. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Monmouth Court Nursing Home Address Monmouth Close Off Montgomery Road Ipswich Suffolk IP2 8RS 01473 685594 01473 680785 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) www.bupa.com BUPA Care Homes (CFHCare) Limited Mrs Claudette Yvonne Lyons Care Home 120 Category(ies) of Old age, not falling within any other category registration, with number (120), Physical disability (3), Terminally ill (120) of places Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. General Medical Physically Disabled aged from 50 years Terminal Chronic Sick Palliative Care - 3 patients - Cilgerran House Date of last inspection 10th January 2006 Physically Disabled aged from 50 years Brief Description of the Service: Monmouth Court was built in 1993 and purchased by BUPA Care Homes in 1998. The home is situated next to a pleasant park in the residential Maidenhall area of Ipswich, about two miles from the town centre. It is on a local bus route to and from Ipswich town centre, and near a local parade of shops. There is ample parking to the front of the building. Monmouth Court is a modern purpose built care home and consists of four houses (Raglan, Powys , Cilgarren, and Harlech), each accommodating up to 30 residents. All bedrooms are of single occupancy, and although they are not en-suite, bedrooms have a wash hand basin, communal toilets and bathrooms located close by. Communal areas consist of large lounge/dining room, with small kitchenette and sitting room on each of the houses. All bedrooms have views of the landscaped gardens. Fees currently range form £506.92 to £765.00 per week. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection, due to the size of the home was undertaken over 2 days, and focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to, and during the inspection. Although the first day of the inspection was unannounced, the home was made aware during the first visit, when the inspector would be returning to complete the inspection. The first day was spent on the houses, observing the routines, talking with the people who use the service, and looking at their care records. The second day was split, between time on the houses, and reviewing records held in the main office. Records looked at during the inspection included, care plans, staff recruitment and training records, Statement of Purpsoe, Service Users guide, Staff rotas, medication records, and quality assurance feedback. The manager and staff were pleasant and helpful throughout, answering any questions and providing extra information as required. Commission for Social Care Inspection (CSCI) feedback cards and surveys were sent to the home to give residents, relatives, visitors and staff an opportunity to give feedback on how they thought the service was run. Relative feedback cards, which asked different questions, were also sent to the home in July 2006, as part of the CSCI on-going monitoring of the home. At the time of writing this report, 26 Resident, 8 staff, 51 relative (44 from 2006 and 7 from 2007) surveys have been received, comments from which have been included in this report. Discussions with the people living at Monmouth Court identified that they preferred to be known as residents, this report respects their wishes. What the service does well: The people using the service, when asked what they felt the home did well gave positive feedback. This included staff “are all wonderful, what ever job you ask them to do it – never complaining – get on with it”, “staff very helpful and caring”, “very happy and satisfied, girls very willing to help and enjoy a joke”. Relatives and visitors said they were made to feel welcome by approachable staff, and took advantage of the pleasant gardens to sit and chat. Visitors liked having the facilities to be able to make drinks when they visited, making it a more social activity – as you would in your own home. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 6 The home is well managed. New staff receive induction training to support them in having the skills and knowledge to care for the residents, which is updated as required. Residents receive nutritious meals, and staff are committed to ensuring that meals supplied meet their individual preferences. The introduction of a ‘nite bite’ menu, ensures that residents are able to choose from a selection of snacks, when ever they wish. The home is constantly looking at new ways to involve residents in giving feedback on the service, and using this information to improve/address any shortfalls. BUPA’s own incentive of rewarding staff through their ‘personal best’ scheme, promotes staff in looking at ways the service can be improved to benefit the people they are caring for. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assessed and given detailed information on the home, including fees payable, to support them in deciding if the home will meet their needs. EVIDENCE: Displayed in the entrance/reception area of Monmouth Court is an array of BUPA publications, which gives information on the company, their aims, and Monmouth Court. This includes a BUPA Care Homes ‘Residents and relatives information’ coloured booklet. The booklet gives information such as ‘what to bring in’, and housekeeping arrangements. Also supplied in each of the bedrooms, is a ‘useful information file’, which gives residents more localised information on the house there are living on. A file looked at, was informative and gave an insight on what the ‘house’ had to offer in a welcome newsletter, and separate information sheets. However, some of the information was out of date, and the size and type of font used varied, therefore some pages were Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 10 easier/clearer to read than others. When discussed with the manager, they said they would review the files, and look to addressing the points raised. When first contacted by prospective residents or their advocate, the home complete an ‘enquiry’ form. Staff will take brief details at this stage, on the person’s needs, so the home has an understanding of what they are looking for, and that the level of care required, falls within their registered category. Staff will then visit the person, and undertake their own pre-admission assessment, give information booklets, and answer any questions. On completion of the new pre-assessment form, the assessor has to confirmed that they feel the ‘resident is suitable for admission to the home’. The completed forms held on files, showed that the member of staff carrying out the assessment had replied ‘Yes’, and evidenced that the resident/relative had been fully consulted. Prospective residents and/or their relatives/advocates are welcome to visit the home, and house they will be living on. From residents surveyed, 15 out the 26 said that they had received enough information on the home, prior to moving in to support them in deciding if it was right for them. Comments made from the people who felt they did not receive sufficient information, identified that the move was made very quickly due to family circumstances, or the hospital needing to release their acute beds. Discussions with the administrator identified that moves can occur the same day as the ‘enquiry’ contact is made. However, staff would have still visited the hospital and undertaken their own assessment. In an emergency situation, if people need to move in straight away from their own home, staff would obtain details over the telephone, and assess on admission. Discussion with the manager identified that the home does offer ‘intermediate care’, which they refer to as ‘flexi beds’. People using these beds have normally been identified, as not ready to go back to their home, but no longer requiring hospital care. Prior to their discharge form hospital, the will manager liaise with hospital and social care staff, to identify what community support such as physio or occupational therapy, will be required as part of the residents rehabilitation. Whilst at the home, staff can continue to monitor the residents progress, with the aim of getting them fit to go home. During the inspection it was identified that the home had been admitting people with dementia, whose primary need is nursing. Current regulatory guidance, identifies, that whilst dementia is the secondary and not primary need, they do not need to hold a dementia registration category. However, the pre-admission assessment must be able to evidence this, and provide information on the current level of dementia, to support them in monitoring the residents on-going mental health needs. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 11 Where staff were aware that a residents needs had changed, and the dementia care had become their primary need, and were unable to give the level of support required, action was being taken to have the people reassessed, and a more suitable, specialist care setting sought. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are involved in decisions about their lives, and are consulted in the planning of their care. EVIDENCE: Since the last inspection BUPA have introduced a new care plan format to be used by all their care homes. Previously, the care plans were found to cover nursing needs, but did not fully reflect the resident’s preferences and wishes on how they wanted to be cared for. The new care plans have been developed to ensure that staff fully consults with the resident, or where unable, their family/advocate, to ensure the information held is individualised to them. Houses visited were in different stages of implementing the system, which they are looking to complete by the end of June 2007. Staff admitted that the introduction of the new care plans was “a lot of work to start with”. However, once they have made the change from the old to new care plan template for their current residents it “will be easier in the future” as Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 13 they will only have the new residents care plans to complete. Nurses using the new care plan format said it was “very good”. BUPA’s own audit team will be visiting, and looking at how staff have completed the individual personalised elements of the care plan, and give feedback on their findings. The 6 care plans looked at, included a cross section of old and new care plan formats. This enabled the inspector to assess where areas of information may be missing from the old format, the inspector would be able to make a judgement as to whether this would be covered, when the new system of recording information is fully introduced. The new care plans covered resident’s physical, mental, social, medical and nursing care needs. This included information on the residents’ mobility, mental state, lifestyle, nutrition, sleeping pattern, and ‘personal cleansing and dressing’. At the beginning of the care plan, a summary of each area of the person’s individualised needs has been assessed, with staff ticking to state what further action has been taken. This normally involved completing a ‘personal plan’, to give further individualised information on how the care was to be delivered, including any identified risks. This gave staff more detailed information, and positively demonstrated how residents’ preferences were being recorded, and how staff were encouraging residents to retain their independence. For example, (name of resident) ‘prefers a bath once/twice a week’, ‘throughout the procedure encourage’ resident to ‘do a bit’ themselves, and ‘carer always to involve (resident’s name) in decision making’. The personal plan for sleeping arrangements for 1 resident, also gave a good level of personalised information ‘likes windows to be closed, lights off and door kept open, give assistance on request, check regularly during the night’. Another resident’s personal plan informed staff that they liked ‘to go to bed 10-10.30 after a cup of tea’, and ‘likes to wake up 8.30’. Currently staff are keeping a separate ‘preference sheet’ for each resident, which gives information on their preferred daily routines. Staff find this information invaluable, and will use the sheets as reference until all the information has been fully incorporated into the new care plans. Where staff have used this information, and incorporated it into the new care format, it gave a good insight, linked with the activity information sheets, on residents preferred daily routine. The quality of the information on the different houses varied slightly, with the information on some care plans more informative then others. For example 1 new resident’s care plan, under personal care and nutrition, referred the reader to their nutritional risk assessment, however this was not seen to be on file. The daily report written by staff did not reflect the same level of verbal information given to the inspector, as to how the resident was settling in. The old care plan format used to include a separate sheet that monitored their first few days, which worked as a temporary care plan, whilst they got to know Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 14 the resident. This seems to have been replaced by the overall summary booklet at the front of the care plan, but did not reflect the same level of information during this important time. Instead, the system was reliant on staff including this information into the daily report, which had not fully happened. Concerns had been raised (see Complaints and Protection section of this report) over the monitoring of residents physical care. This included concerns over a resident who had dry, flaky skin. Medication Administration Records (MAR) showed residents who had been prescribed ‘white soft paraffin 50/50 for dry skin’. BUPA has recently recruited a specialist nurse to take the lead in ‘Tissue viability’ (monitoring people’s skin, to ensure appropriate action is taken to prevent it breaking down, or where it has, making sure the resident receives the appropriate treatment). The Nurse, although covering other homes, will be based at Monmouth Court, and involved in updating staff’s training. Residents completing the CSCI survey were asked if they received the medical support they needed, 24 replied’ always’, 1 ‘usually’, and 1 ‘never’. Where 1 resident had replied ‘usually’, they had further commented that ‘although Nurses are highly qualified, they cannot even give me an aspirin without the Doctors say so’. As they had not given their name, it could not be followed up to see why they had not been offered medication, as allowed under ‘homely remedies’. Another resident commented that the ‘Doctor is called when necessary’. Care records held information on Doctors visits, and action taken following the visit. Duirng the inspection, Doctors were seen visiting residents whilst on 2 of the houses. The records also showed where staff had liaised with external Health and Social Care professionals, to support individual residents behavioural needs. Each of the personal care plans identified any risk, and how they would be managed to ensure the safety of he resident. Residents spoken with during the inspection were all happy with the level of care and support the were receiving, with the only negative point, that at times they had to wait for staff to receive attention (see Staffing section of this report). From the 5 relatives/advocates who had completed the new style 2007 CSCI survey, all but 1 (who had replied ‘usually’) had said that the home gave the expected level of care, that had been agreed with the home. Comments included ‘very well cared for’, and ‘top class’. Monmouth Court own 2006 quality survey, showed out of the 22 completed surveys returned, 27 rated the quality of care they received as ‘excellent’, 64 as ‘good’, and 9 with no clear judgement as to whether the care was good or poor. Asked if the staff always showed respect towards them, all replies fell in the ‘excellent and good’ categories. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 15 There was detailed information on one resident who was receiving palliative care, which showed that staff had sensitively consulted with them, and their family on their ‘end of life arrangement’. A Nurse trained in Liverpool ‘Gold Standards Framework for Chronic Disease Management’ had completed this. During the inspection, the inspector watched the medication being given out on 2 of the 4 houses. This was undertaken in a safe manner, with medication being dispensed from its ‘blister’ pack (a card with see-through pockets, which holds the set dose of medication to be taken), for each resident in turn, then completing the MAR sheet, to confirm the medication had been given/taken. It was undertaken in a relaxed manner, with the nurses taking time, when required to remind the resident what the tablet was, and how it would help them. Although handled sensitively, and with patience, 1 resident could not be encouraged to take all their medication. The nurse said they would go back and try again later. Medication was given out during the meal time, care plans did not fully reflect if this was the residents preference/identified medical need, or part of the home’s set routine. MAR sheets looked at, had been fully completed, including the section to show when, and how much medication had been received from the pharmacist. Where medication was not supplied in ‘blister’ packs, a sample check of 2 resident’s drugs, against the homes records, identified that the correct amount of tablets were left. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered nutritious meals, and support by staff to access a range of activities. EVIDENCE: Residents surveyed were asked if the home arranged activities that they could take part in, 18 replied ‘always’, 2 ‘usually’, 2 ‘sometimes’ 1 was left blank, and another 3 said ‘never’. However, these 3 residents had also commented that they preferred to ‘stay in their room’ and were ‘not interested in trips out’. This reflected 1 resident’s comments during the inspection, who said they had a “glorious day” at the weekend, however further discussion identified it was not because they had gone out – but had enjoyed the peace and quite when the other residents had gone out. The home benefits from each house having their own dedicated part-time activities organiser. Time spent talking to the organisers, showed that they were very motivated and enjoyed their work. Residents, through activities have a chance to socialise with residents from the different houses, as well as having 1 to 1 time. Residents said they had recently enjoyed a visit to Christchurch Park. One relative asked about outings out, said they were going Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 17 to Eastern Park Farm next week, but external outings were difficult to arrange, as they needed “to find enough helpers” to push the wheelchairs, and support residents. The manager said they were trying to move away from large organised outings, and arrange them in smaller, more personalised groups, and 1 to 1 outings. Time spent talking to residents identified that they enjoyed the bingo and quiz sessions. 1 resident had accompanied the activities organise, using the local Dial- a-ride service to help select bingo prizes. New specialised bingo cards had been purchased which were easier for residents to use. Staff on the houses, fund raise to pay for activities and outings, which supplements the £250 each house receives from BUPA. Residents spoke of the other activities/social events they had joined in with, which includes ‘gentlemen’s’ club, craft sessions, and during the inspection 1 house was having a “ladies day”, to coincide with ladies day at Ascot, which they were watching. Activity co-ordinators keep a record for each resident to monitor what they join in with, and if they enjoyed it, and also to monitor that each resident has a chance to join in with 1 to 1 or group activities. Care plans held copies of the residents monthly ‘activity reports’, and a useful ‘map of life’, which gave staff more insight into where they were born, family life, working history and interests. The residents information file, informed residents that they would be visited soon after their admission, by the activity coordinator, to help them identify what social activities/hobbies they would like to undertake. They were also asked what support they may need with their religious beliefs, and cultural interests, and were identified would be written into their ‘personal’ plan. During the inspection 1 activities organiser had taken a resident to a coffee morning at a local church. There was also a church service organised during the afternoon on one of the houses, which is a fortnightly event. During the visit, residents were making use of the various seating areas in the garden to entertain their visitors. Each of the houses also has a small lounge where they can meet their visitors in private, if they do not want to use their bedroom. One relative spoke positively on being able to use the small kitchen on the house to make drinks, for them and their mother when they visited. Staff explained that the main hot meals are sent over in a heated trolley from the kitchen, and the small kitchen units on the houses are used to provide continental breakfast and “small snacks” at any time. On the wall was a large coloured poster (it also comes in a smaller flip chart format which staff can take to the resident’s bed) showing residents their ‘nite bite’ menu, which staff can prepare at any time. This includes sandwiches, toast and soup. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 18 Residents asked (CSCI surveys) if they liked the meals at the home, all their replies fell into the ‘always and usually’ categories. Comments included ‘excellent’ and ‘could be more variety for teatime – sandwiches a bit monotonous’. The supper menu showed besides the ‘assorted sandwiches’, residents were offered soup, choice of salad, hot snack, such as Scotch Pies, omelette, and a sweet such as fruit salad or chocolate brownie. Residents and relatives asked during the inspection “I like my food, especially the roast dinners”, “every plate goes back empty”, ”cakes can be a bit dry – but like the éclairs, when they come round we all say yes please”. The home has very good monitoring systems in place to ensure that residents are enjoying their meals, and if it meets their individual preferences (which taking into account the home caters for 120 residents, they appreciate can be a difficult task). This includes involving residents in selecting the choices that go on the rotating 4-week menus, and the Manager and Chef, visiting each of the houses at lunch time, to get direct feedback from residents themselves, and sample the food – especially pureed meals to ensure they are flavoursome. The Manager had received a recognition award from BUPA, for instigating these daily visits. Residents and staff spoken with also mentioned further good practice which included after noticing a resident was “feeling down”, aware that the resident “loved suet pudding, they had a word with the Chef”, who made the individual pudding especially for them. The good work undertaken by staff in getting feedback on the meals, and ensuring people were given choice, and input into putting the menus together, was let down by the actual meal time routines. Time spent on 2 of the houses, showed that it was quite task orientated, and the dining experience for residents, who required assistance varied, depending on the member of staff assisting, and the staffing levels. For example, a carer was seen to sit next to a resident, inform them what was on the plate, and provide good eye contact, and interaction whilst assisting the resident. Whilst another member of staff sat down, did not show any of the same interaction, and was looking at the television in-between. A member of staff noticed a resident was not eating their meal, enquired if they felt sick and brought them a vomit bowl. They did not remove the meal, which was left to get cold, and the resident was left to try and push it way to make room for the vomit bowl. However, good practice was later seen with the Nurse, kneeling down, offering a drink of water and asking how the person was feeling. As soon as residents finished their main meal, this was removed and the dessert given. One resident who eat more slowly, had been given their dessert alongside their main course, making them aware of their slowness, and confirmed they were a “slow eater”. On 1 house, dinner mats, and tables were being wiped down, and residents being asked their choice for the next days meal, whilst they were still eating. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 19 The dining room had specialist tables for wheelchair users, so they were able to comfortably sit at the table. Plate guards and specialists drinks cups were used to assist residents with their independence. Paper bibs were used to protect residents clothing. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has robust complaints system in place to ensure staff take appropriate action to address any concerns, and safeguarding the interests of the people they are looking after. EVIDENCE: All residents are given a copy of the home’s complaints policy in their ‘information file’. The policy is also displayed in the reception area, and within their Statement of Purpose’. Copies for visitors are displayed in the entrance area of each house. The complaint procedure gives information on how, and who to make a complaint to. The procedure also informs the reader that they can ‘refer a complaint to the CSCI’. This needs to be amended, to reflect that the CSCI is not a complaints agency, but if a person is not happy how their complaint has been handled/addressed, they can contact the CSCI to seek further advice. Residents asked if they knew how to make a complaint, 21 relied ‘yes’ and the remaining 5 ‘no’. However, 1 resident who had replied ‘no’ went on to say ‘they never had to’. Information supplied by the home, showed that up to the time of completing their pre-inspection questionnaire in May 2007, they had received 11 complaints, 2 of which had been ‘partially substantiated’, and all had been responded to within 28 days. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 21 Prior to the inspection, the CSCI was made aware of 1 complaint being investigated, from the ambulance service, the response given by the home was discussed, which identified supplementary information, which added to the homes reply, may have been more informative. Following the inspection, the manager sent a copy of the letter they had sent to the ambulance service, which showed that they had given the complainant the extra information. Staff receive training in safeguarding residents, as part of their induction, 1 new member of staff was observed watching a tuition video on the subject at the time of the inspection. Once they have viewed the video, to test that they have understood it, they complete a questionnaire, which is seen by senior staff, and any issues discussed. Copies of completed questionnaire were seen in staffs’ personnel files. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home offers a homely environment, which meets the personal, and mobility needs of the current residents, whilst promoting independence. EVIDENCE: Duirng the inspection, time spent talking to residents in their bedroom, showed that they had personalised their room, and felt it met their needs. One resident called it their “home from home”, and felt “lucky” to have such a nice room. Another said they enjoyed the added benefit of having a door leading out into the gardens. The ‘residents information file’, informs new residents that on admission, they can have a lock fitted to their bedroom door if they wish, and if they do not like the décor of the room, it can be repainted. Bedrooms have their own wash hand basin, with communal toilets and bathrooms located close to the rooms. One of the residents discussed the new planned building work, which includes building on the end of the each house, providing a total of “26 extra bedrooms”, which will have en-suite facilities. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 23 Staff have taken time to inform residents and relatives, of the planned building works, through meetings and 1 to 1 conversations. Copies of the plan were available in the entrance hall for people to view. A resident said they were aware that there “could be some noise”, but felt comfortable that staff would monitor the situation, to ensure it did not disrupt peoples lives. Table and chairs had been set around the gardens, which residents were using to take advantage of the warm weather. Several residents had set up bird tables outside their bedroom, as a point of interest. Residents asked if they found the home was kept fresh and clean, 24 replied ‘always’, and 2 ‘usually’. This reflected the finding during the inspection, with communal areas and bedrooms found to be clean and free from any unpleasant odours. However, a shortfall was identified in the home’s infection control/cleaning procedures where a small amount of washbowls, commode lids and a bedpan, had not been cleaned thoroughly. This was brought to the attention of senior staff, who confirmed that they would address the situation. Supplies of disposable gloves and body wipes, used as part of the home’s infection control procedures, were evident in residents’ bedrooms. Soiled linen was placed in specialist bags, and taken away by the laundry staff to be processed. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has systems in place to ensure required recruitment checks are in place, and staff receive induction training, to ensure they have the required skills and knowledge to undertake their role. However, the staffing levels/rotas do not offer flexibility to adapt to residents changing needs and lifestyles. EVIDENCE: Residents completing surveys, were asked if they received the care and support they needed, 15 replied ‘always’, 7 ‘usually’ and 4 ‘sometimes’. Comments given to support their answers, referred to waiting ‘too long to go to the toilet’, which also reflected comments made during the inspection. Rotas and discussions with Senior Nursing staff identified that the staffing levels are the same for each of the houses, this being: From 8 am to 2 pm - 7 staff made up of 2 Nurses, 4 Carers and a Hostess From 2 pm to 8 pm - 5 staff made up of 1 Nurse and 4 Carers From 8 pm to 8 am - 3 staff made up of 1 Nurse and 2 Carers. The rotas show that they have been developed to ensure the home has the same set number of staff on throughout the 24-hour period, rather than adapting to dependency levels. It does not allow flexibility for staff to be able Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 25 to respond to residents changing physical, and mental health needs, and allow extra staffing during busy times of the day. Feedback from CSCI surveys, discussions with residents, and observation during the inspection, further confirmed that the current staffing levels did not always offer flexibility to fit around their lifestyles. Residents asked if staff listen and act on what they say, all but 4 replied ‘yes’. Comments included ‘they ask the question – but don’t wait for an answer’, another said ‘yes they do their best – but not always enough staff’. Relatives asked if in their opinion were there ‘always sufficient numbers of staff on duty’, out of 51 who replied, 21 said ‘No’, and 2 had written ‘not always’. A relative commented that ‘although the home may meet statutory resident/staff ratios, there are too few staff to meet residents needs, particularly for those residents who are seriously ill’. Lunchtime routines on 2 of the houses visited were observed (see Daily Life and Social Activities section of this report) and showed on 1 house that they needed more staff to assist with feeding. Staff levels did not enable staff to sit at tables to support those residents who may just requiring prompting, instead they ‘patrolled’ the dining area, offering help as required. Having staff available who could sit at the tables and offer assistance, would have made it a more sociable event. In addition to the staffing levels, each house has a dedicated part-time activities organiser, who is able to support the care staff by spending 1 to 1 time with residents, and arranging small group activities. The Senior Sister/Charge Nurse, is responsible for the day-to-day running of their house. Although discussion with 1 Sister identified that they had received 2 office days during the last 5 months, they are otherwise normally counted in the staffing levels. Their supervisory/management administration duties included 1 to 1 supervision with staff, answering the phone, induction of new staff, staff rotas and updating care records, all of which would take them away from ‘hands on care’. During the inspection a new member of staff was seen watching training videos, and completing workbooks as part of their induction. Another new member of staff was undertaking ‘shadow shifts’ on one the houses, also as part of their induction. The 8 staff who took the opportunity to complete a CSCI survey, felt that they received sufficient training to undertake their role. They also felt that the home had a good training and development programme to support staff. The inspector was shown an article in a care journal, which featured Monmouth Court, and included information on how staff were supported during their training, through role playing, to know what it feels like to be a resident. For example ‘having someone feed you’. Staff records showed training completed as part of the new staffs induction. Information supplied by the home, showed as of the 10 May 2007, 9 out of the 48 care staff held a National Vocational Qualification (NVQ) level 2 or above. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 26 Information supplied by the home on training undertaken during the past 12 months, and future training planned, did not identify any NVQ training. Information supplied showed that all staff receive mandatory training, which included Dementia training. Discussion with the Manager identified that this was undertaken ‘in-house’, by watching a video and completing a workbook. Discussion with the Manager and 1 of the Senior Nursing staff, identified that they had not undertaken any recognised dementia training courses, leading to a qualification in this area. No concerns were raised at the last inspection over the home’s recruitment procedures. A sample check of 1 new member of staff’s recruitment paperwork, confirmed that the home were still following safe practise, by validating the person’s identify prior to them starting work. This included, obtaining 2 written references, completing a medical check sheet, and applying/obtaining a Criminal Bureau Record clearance. BUPA have introduced new personnel files, to be used by all their homes, which enables information to be stored in set areas of the file, so it can be easily retrieved when needed. The inside cover also has a printed recruitment checklist for staff to complete, and confirmed required paperwork has been sent for/received. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed, and staff are committed to working in the best interest of the residents. EVIDENCE: The Registered Manager for the home, Mrs Claudette Lyons, is an experienced Nurse/Manager committed to providing a quality service. This was demonstrated during discussions, and the positive way they received feedback during the inspection. Where shortfalls were identified, they straightaway looked at ways to address them. This positive attitude was mirrored during conversations with staff who were helpful, courteous, and happy to answer any questions, or provide further information. Residents were aware who the manager was, and described her as “very good”. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 28 Each house had a clear organisational structure, and discussions with staff confirmed they were aware of their role, and the important part they play in ensuring residents are able to have a good quality of life. BUPA as an organisation, through their ‘personal best’ scheme, acknowledges work undertaken by staff to go that bit extra, by identifying and instigating ways of improving the service they give. For example, the manager’s was going down to London, to accept an award under this scheme for monitoring the quality of the lunchtime meals (see Daily Life and Socail Activities section of this report). The home has many different ways of receiving feedback from people who use the service. This includes written feedback from surveys through an annual ‘Resident Customer Satisfaction Survey’, the results of which had been published (December 2006), and made available for residents and visitors to read in the reception area. The report shows that out of the 50 of residents surveyed, 37 had replied. On a more informal basis, the manager said they had recently started residents only meetings, where they are given a chance to put them “on the spot and answer any questions”. Further discussion identified that currently they have no feedback tool, such as dementia mapping to gain feedback from those who are more mentally frail, who may be unable to complete surveys, or articulate their responses. The home has liability insurance in place. This and previous inspection have identified that that the home has safe accounting and financial procedures in place to safeguard residents interests. This includes their invoicing system, and money held for safekeeping. A letter received (28 June 2007) from the CSCI Provider Relationship Manager for BUPA , confirmed after looking at the companies accounts for 2006, they were ‘regarded as being financially viable’. Staff completing the CSCI surveys said they received regular 1 to 1 supervision. Paperwork held on file, also included ‘performance review Appraisals’, which enables staff to identify any training needs, and obtain feedback on their practice. Feedback from staff surveys, and discussions with residents, relatives and staff during the inspection confirmed that they felt the home was well run. Residents completing the home’s own Customer Satisfaction Survey (2006) were asked to rate the quality of service provided, 14 rated it as ‘excellent’, 59 ‘very good’, 23 ‘quite good’ and 5 as ‘Quite poor’. The standard of record keeping throughout the inspection was found to be of a good standard, which included the completing of Medication records. Training records, and information supplied by the home show that staff receive mandatory health and safety training, to safeguard the interests of people who live and work at the home. This includes manual handling training, and Fire Safety training. To ensure trained staff’s resuscitation techniques are up date, the manager has arranged refresher training for all the Nurses. Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 3 3 3 3 Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP15 OP26 Good Practice Recommendations Meal times/routines should be reviewed, to ensure it is a positive social/dining experience, for all residents. The home should have monitoring systems in place to ensure commode pots, washbowls, and urinals have been thoroughly cleaned. The home should review their staffing levels to ensure they reflect the varying needs of residents, throughout the 24-hour period. The home should review their NVQ training to establish how they are going to achieve having 50 of their staff training to NVQ 2, or equivalent. DS0000024449.V343611.R01.S.doc Version 5.2 Page 31 3. OP27 4. OP28 Monmouth Court Nursing Home 5. OP30 Manager and Senior Nurses caring for people with dementia should undertake recognised training course/qualification, to support them in having the skills and knowledge to support staff, and manage dementia care. As part of ensuring they obtain feedback from all the people who use their service, the home needs to look at ways of receiving feedback from residents who are mentally frail and unable to communicate, or take part in the current quality assurance systems in place. 6. OP33 Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Monmouth Court Nursing Home DS0000024449.V343611.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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