Inspection on 01/09/08 for Mont Calm Lydd

This inspection was carried out on 1st September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mont Calm Lydd 11/03/08

Mont Calm Lydd 11/10/07

Mont Calm Lydd 18/10/06

Mont Calm Lydd 05/10/05

Mont Calm Lydd 24/05/05

Mont Calm Lydd 24/11/04

Mont Calm Lydd 08/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mont Calm Lydd Manor Road Lydd Romney Marsh Kent TN29 9HR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Christine Lawrence     Date: 0 1 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 22 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 22 Information about the care home Name of care home: Address: Mont Calm Lydd Manor Road Lydd Romney Marsh Kent TN29 9HR 01797321127 F/P01797321127 stephenmontcalm@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Manager post vacant Type of registration: Number of places registered: Mr Stephen Anthony Castellani care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: Service users under 65 years of age to be restricted to two (2) whose DOB`s are 22/08/1946 and 13/11/1949. Date of last inspection Brief description of the care home Mont Calm Residential Home, Lydd is a care home registered for twenty-two older people with dementia. It is situated in the small coastal town of Lydd. There are some local shops and a church nearby. There is easy access, by road, to the larger towns of New Romney, Hythe and Folkestone. There is some car parking spaces available and parking is not restricted in the street. Currently the scale of fees is between 388 pounds and 540 pounds per week. Hairdressing, chiropody and toiletries are at an additional charge. 0 Over 65 22 Care Homes for Older People Page 4 of 22 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection visit was unannounced and started at 10.15 and finished at 16.30. We, that is the commission for social care inspection (CSCI) looked at various records in the home and also used information sent to us by the manager through her completion of the Annual Quality Assurance Assessment (AQAA). Information from the previous inspection was also referred to, as was the improvement plan completed by the home in response to the previous inspection. A tour of parts of the building was undertaken partly in the company of the manager and partly alone. We observed staff interacting with residents and we noted residents’ responses to staff. We spoke to staff on duty as Care Homes for Older People Page 5 of 22 well as the manager. A visiting community nurse also gave some information. The area manager and the provider were both on the premises at the time of the inspection and we spoke briefly to them. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 22 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 22 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that the home judges it can meet their needs because it assesses their needs before they move in Evidence: We looked at three individual records for this inspection. They showed that information is gathered before admission about what someones needs are. This assessment is carried out by the manager. The assessment covers a range of aspects of daily living and care needs. There was an example of information being provided by the placing authority, including one joint assessment involving health care professionals also. The information is used to compile a care plan. Care Homes for Older People Page 9 of 22 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having a plan of care which identifies how their health and care needs are to be met. They will further benefit when these are more individualized. They are protected by the homes procedures for dealing with medication and they can be confident that they will be treated with respect. Evidence: We looked at three care plans for this inspection visit. The assessments were all up to date and covered a range of activities relating to physical care needs, behaviour, communication, nutrition etc as well as information about memory and confusion. There are risk assessments in place and care plans with needs, objectives and actions noted. These care plan items are adequate but they need to be built on to better reflect the particular and individual needs of the people living in the home. The manager had already identified this as an area for improvement. The local community nurse team holds clinics twice a week at the home and they also visit at other times if requested. The home has a monitoring sheet in place to keep a Care Homes for Older People Page 10 of 22 Evidence: check on falls and on residents weight. A nutrition assessment tool is in place and there are individual sheets for recording what somebody eats and drinks. The records showed that health care professionals are involved with residents such as GPs, chiropodist, optician etc. The home uses a monitored dosage system for medication. We looked at the storage and record keeping with the Head of Care, who has responsibility for medication. All was satisfactory. Many of the staff have received training with regard to medication and more is planned in October. This is particularly important as at the moment some of the administration has to be done by someone coming in specially to do so at the 22:00 medication round if no trained person is on duty. The Head of Care confirmed that there are policies and procedures in place regarding medication and we suggested that copies should be in the medication cupboard as well as at the staff work station. The care plans indicate the preference that individuals have for how they are addressed. The community nurse confirmed that staff consider privacy important when helping with any medical activity. There was a very positive comment also about how the staff team had recently provided end of life care for one person, maintaining dignity at all times. We observed staff being discreet when assisting people to go to the toilet. They knocked on doors before entering and those staff observed during this visit were polite and encouraging Care Homes for Older People Page 11 of 22 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their preferences will be identified and responded to and that they will be enabled to maintain contact with friends and family. Residents will be enabled to make choices and they will benefit from healthy, well-presented food at a time and place to suit them. Evidence: There are various activities which take place within the home including exercise sessions, entertainments, craft such as painting and decorating small pots for planting and residents also pursue their own interests such as reading watching television and knitting. An activities person is in post and she works three days per week. One person attends the church of their choice as often as she wishes with both the support of the home and friends at the church. A representative from a local church visits occasionally but no one is currently expressing a wish for any more involvement. Residents likes and past history are known to a certain extent but the manager said this would be built upon through re-establishing a key worker system and the changes to a more individual, person centred care plan system. There are no restrictions on family and friends visiting and staff said that people are Care Homes for Older People Page 12 of 22 Evidence: invited to join the residents for events such as a recent BBQ. One relative is supported with transport to visit twice a week and join in for lunch. There have also been some events at other homes owned by the same provider which some residents attended. The area manager, who was at the home on the day of the site visit, said that she takes photographs of activities and celebrations and displays them and this was seen to be so at Mont Calm, Lydd. We observed staff to be encouraging to residents to help them make choices about their routines and preferences. One member of staff said - you always have to try even if they dont seem to want to make decisions, you cant just assume - and we did observe staff supporting residents to make choices such as whether or not to join in with an activity, to be on their own, to walk about the building and even to wearing a hat indoors! The menu has been changed since the new manager took over. The cooks are more involved in ordering food and we saw that the food storage area (which was a problem at the last inspection) has been improved. Food stocks were satisfactory. A nutritional assessment tool was seen in the individual records looked at for this inspection. Meals can be flexible and we noted that one resident was enjoying a late breakfast due to having a lie-in. Care Homes for Older People Page 13 of 22 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints would be handled objectively and in keeping with the homes appropriate procedures and residents/their representatives can be confident that any concerns will be listened to, taken seriously and responded to. Staff are aware of adult protection issues and there are systems in place which should create an atmosphere for protecting residents from abuse. Evidence: There is a complaints policy and procedure and this is included in the statement of purpose given to the representative of each resident. No complaints have been received at the home. A complaint received by the commission was passed to the provider for investigation and was resolved satisfactorily. A recent incident in the home (not directly involving any resident) is currently being investigated under the safeguarding adults procedure. One issue that came out of this was the lack of immediate notification to the commission under Regulation 37 of the Care Homes Regulations. This has been dealt with separately with the provider. Staff spoken to during the inspection visit were clear about their responsibilities and there are policies in place regarding the protection of residents, including the management of residents money and valuables. Care Homes for Older People Page 14 of 22 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from living in a safe, well-maintained home which is homely, clean, comfortable, pleasant and hygienic. Evidence: We toured parts of the building partly with the manager and partly alone. A lot of improvements have already been made regarding furniture and decor and we were informed that this is a continuing programme. There is a handyman two days a week and this has improved how maintenance work is progressed. A new garden area has been created and allows for residents to use safely when the weather is fine. The laundry is satisfactory and the home was clean and fresh on the day of the inspection. There are up to date policies and procedures regarding infection control. Staff have either received infection control training or this is planned. A programme for various training sessions was seen for this inspection. All catering staff have received food safety training and just over half of the care staff. Again, more is planned. There were posters on display about the importance of hand washing and facilities, including sanitizer sprays, are in place. Care Homes for Older People Page 15 of 22 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by sufficient staff who are competent and trained or who are due to receive training. Residents are supported and protected by the homes recruitment procedures. Evidence: We observed staff being encouraging and supportive to the people living in the home. There were examples of staff being discreet and sensitive and also knowing the right time for banter or a joke.The rota showed that there are sufficient staff on duty. The home is still recruiting new staff. This includes people for catering and cleaning. There is a part time maintenance person and a day activities person for three days per week. We were informed that ten staff already have a national vocational qualification (NVQ) in care at level 2 or above and six others are working towards this. We looked at two staff records for this inspection showed that the recruitment procedure is appropriate. This includes the use of an application form, references, criminal record bureau checks, terms and conditions of employment as well as a copy of the General Social Care Councils code of practice. There is also an equal opportunities monitoring form. The staff records contained relevant copies of training certificates. The manager informed us that further training is planned and provided a copy of the programme up to December. She confirmed there would be further Care Homes for Older People Page 16 of 22 Evidence: training as and when new staff are employed and when updates were needed for the current staff. There is an induction training format within the home but this still needs to incorporate the common induction standards more fully. Staff spoken to said they had opportunities for training. Care Homes for Older People Page 17 of 22 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from the home being managed by someone who is experienced and knowledgeable. They will further benefit when she is registered. Residents financial interests are safeguarded and their views are sought. Staff and residents have their health and safety promoted and protected. Evidence: There is a new manager in post. She is a qualified registered mental health nurse (RMN) and has considerable experience of working with older peole with dementia. She is planning to undertake the NVQ level four in management and has submitted her application for registration. She gave examples of training sessions she has attended since being in post. There is a clear structure of accountability both within the home and with the provider and area manager. The manager showed us some completed questionnaires that she has received from relatives of people living in the home. She is expecting more to come in and she will Care Homes for Older People Page 18 of 22 Evidence: be using the information received to look at how people see the home running and staff performing. Those already seen were quite positive. A representative of the provider visits the home frequently and completes a report monthly under Regulation 26. The annual quality assurance assessment form was completed when requested and was used to identify areas for improvement. The home helps residents to manage some of their personal allowance to purchase things they might need such as hairdressing, chiropody etc. The manager showed us the systems and procedures in place for ensuring that money is accounted for and this includes providing an account for whoever is managing an individuals finances, keeping receipts, having two people sign for any expenditure and regular audits. We looked at some of the maintenance and service contracts including fire fighting equipment, gas safety, electrical installation and hoists, and these were all satisfactory. There are policies and procedures in place relating to various aspects of health and safety and staff have either received relevant training or it is planned. Care Homes for Older People Page 19 of 22 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 20 of 22 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans need to be more individualized and person centred. To fully reflect the needs of the individual person as it relates to their dementia 31/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 18 The provider should ensure that everyone with responsiblity for notifying events to the commission is clear about the extent and detail of Regulation 37 Care Homes for Older People Page 21 of 22 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 22 of 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!