Inspection on 11/03/08 for Mont Calm Lydd

This inspection was carried out on 11th March 2008.

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

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

Mont Calm Lydd 01/09/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mont Calm Lydd Manor Road Lydd Romney Marsh Kent TN29 9HR Lead Inspector Paul Stibbons Unannounced Inspection 11th March 2008 10:00 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 Mont Calm Lydd DS0000057128.V359601.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. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mont Calm Lydd Address Manor Road Lydd Romney Marsh Kent TN29 9HR 01797 321127 F/P 01797 321127 stephenmontcalm@aol.com 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) Mr Stephen Anthony Castellani Post Vacant Care Home 22 Category(ies) of Dementia - over 65 years of age (22) registration, with number of places Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users under 65 years of age to be restricted to two (2) whose DOB`s are 22/08/1946 and 13/11/1949. 11th October 2007 Date of last inspection Brief Description of the Service: Mont Calm Residential Home, Lydd, formerly known as The Manor House, 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. Currently the scale of fees is between £377.38 and £520 per week. Hairdressing, chiropody and toiletries are at an additional charge. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced inspection was carried out over a period of 6 hours. A range of evidence has been used to inform this report including information from other agencies, examination of a variety of records and documentation, and a tour of the building. Discussions were held with the area manager, acting manager, deputy manager, head of care and members of staff. What the service does well: What has improved since the last inspection? Since the last inspection a number of improvements have been made to the home. For example, carpets have been cleaned or renewed, hot water outlets have had temperature control valves fitted, curtains have been replaced, damaged furniture has been repaired or replaced, testing of portable appliances has been carried out. Weekly health and safety checks are now being conducted and a maintenance log maintained. Staff members are now receiving regular supervision. Quality assurance questionnaires have been sent out to relatives and other health care professionals, and the registered provider is making monthly visits and submitting his reports to the CSCI. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 7 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 Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 8 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): 1,2,3,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents or their representatives have sufficient information on which to base an informed decision as to whether the home is able to meet their needs. Comprehensive assessment of need is carried out with prospective residents prior to admission to the home. Prospective residents have the opportunity of a trial period to assess the suitability of the home for their needs. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 9 EVIDENCE: The home provides a statement of purpose that is specific to the individual home and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a service users guide. The guide details what the prospective residents can expect and gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. Admissions are not made to the home until a full needs assessment has been undertaken. For people who are self-funding and without a care management assessment, a skilled and experienced member of staff always undertakes an assessment. The assessment is conducted professionally and sensitively and involves the individual and their family or representative, where appropriate. Where the assessment has been undertaken through care management arrangements the service insists on receiving a summary of the assessment and a copy of the care plan. The home does not provide for intermediate care. New residents are provided with a statement of terms and conditions or a contract. This sets out in detail what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People living in the home benefit from having their health, personal and social care needs set out in an individual plan of care. However, not all records are being completed and concerns followed up appropriately. People living in the home are protected by the home’s policies and procedures for dealing with medication. People living in the home are treated with respect. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 11 EVIDENCE: Four care plans viewed evidence that people have access to health care services both within the home and in the local community. People unable to access local services are supported by visits to the home by health care professionals. Staff do not adequately record health care issues within individuals care plans and there is little evidence that action takes place as a result of health monitoring. Consequently health care appears to be reactive and residents would benefit from a more proactive approach and ongoing monitoring of health. Some residents have reportedly lost body weight and members of staff have stated that not all falls by residents are being recorded and appropriate action being taken. Staff members do not have specific dementia training to meet the health care needs of the people who use the service. Discussions with the area manager and acting home manager acknowledged the need for staff training around working with people with a dementia type condition. The acting manager states that a ‘dementia’ training course has been arranged for senior staff. This training needs to include all care workers. The home has a medication policy which is accessible to staff. Medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. Observations of interactions between staff and residents evidenced a friendly and mutual respect. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 12 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): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home are offered a range of activities to satisfy their social, spiritual and recreational needs. People living in the home are supported in maintaining contact with family, friends and the local community as they wish. People living in the home receive a varied diet but the nutritional needs of some individuals may not be being met. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 13 EVIDENCE: The acting manager has made arrangements for the residents to visit a local library on Monday mornings where people can meet socially over tea and biscuits and choose books that interest them. Some residents had a trip to the Lakeside shopping centre and the New Romney visitor centre where a talk on wildlife was held. The home had employed an activities coordinator for two days per week but unfortunately they have recently resigned and recruitment is taking place for a replacement. One resident attends church three times per week to meet with her friendship group. Relatives and friends are free to visit at any reasonable time and are made welcome by the home. Following allegations of inadequate food supplies in the home, KCC contracts department investigated, their findings raised concerns over the quality and nutritional value of meals being served. It is a requirement that Nutritional screening of residents must be undertaken periodically and care plans revised accordingly with records of weight gain or loss and the action taken recorded. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 14 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): 16,18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents and their relatives and friends have access to a complaints procedure in the home. However, given the needs of the residents, the complaints procedures are not readily accessible to them and this means staff have to be relied upon to initiate complaints on behalf of the residents. Policies and procedures are in place to safeguard people living in the home from abuse and neglect. However, residents may be at risk because staff find it difficult to bring concerns relating to possible abusive practices to the attention of the manager. EVIDENCE: Information received from carers indicated that some female residents are unhappy that male carers are attending to their personal care. In addition some night shifts have been staffed with solely male carers. A discussion with the acting manager revealed that male carers had only done night shifts on a rare occasion when there were staffing difficulties but the practice would cease forthwith. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 15 Communication difficulties prevent many of the people living in the home to express their concerns, however staff spoken with state they raise concerns on the residents behalf. A letter of concern from staff received by the Commission states that any concerns raised about the welfare of residents does not receive a positive response from the acting manager. Staff members have received training around safeguarding vulnerable adults but have expressed concerns in writing to the Commission about being victimised if they raise concerns. Subsequent conversation with area manager confirmed that there were some concerns to validate the views of the staff. The area manager agreed to address these issues as a matter of urgency. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 16 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): 19,20,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from living in a well-maintained environment with adequate personal and communal space to meet their needs. Resident’s benefit from having comfortable bedrooms with their own possessions around them. Residents’ benefit from living in a home that is clean, pleasant and hygienic. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 17 EVIDENCE: A tour of the building was carried out and the home has made many improvements following the last inspection. Residents’ bedrooms have had repairs to walls and decoration where necessary and damaged furniture replaced. New curtains have been purchased for the lounge and some residents’ bedrooms. New carpeting has been fitted on the first floor hallway and carpets throughout the home have been professionally cleaned. All hot water outlets that residents have access to have been fitted with temperature control valves for the safety of individuals. A new lock has been fitted to the entrance door of the building for the security of people living and working in the home. There is adequate personal and communal space for residents needs but consideration of colour coding and pictures on doors could be of benefit to them. The bathrooms and toilets are fitted with appropriate aids and adaptations to meet the needs of the people who use the service, and are in sufficient numbers. The home conducts weekly inspections of the premises and records any required repairs in a maintenance book. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by sufficient numbers of competent staff to ensure they are cared for appropriately. People living in the home are protected by the home’s recruitment policies and practices. EVIDENCE: Staffing rotas viewed evidence an increase in staffing levels since the last inspection and there are consistently sufficient staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for residents and is not led by staff requirements. All staff receive relevant training that is focussed on delivering improved outcomes for residents. A number of staff training certificates were viewed that addressed statutory requirements but a lack of fire training was noted. Staff members spoken with confirmed they had not had fire evacuation Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 19 training for some time. The acting manager states that this training will be addressed and to update the training matrix to ensure that shortfalls in training are identified. There is a good recruitment procedure that clearly defines the process to be followed. Four personnel files viewed confirm this procedure is followed in practice with the home recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is managed by a qualified person currently completing the process for registration. Residents can feel confident that their financial interests are safeguarded. Residents and staff may be put at risk because of identified shortfalls in the home’s health and safety practices. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 21 EVIDENCE: The home has not had a registered manager for approximately two years. The acting manager has achieved NVQ 4 in care and the Registered manager’s award and is applying for registration. Staff are of the opinion that the acting manager is unapproachable when they wish to raise issues. The acting manager is aware of the need to promote safeguarding and has developed a health and safety weekly checklist that generally meets health and safety requirements and legislation. The acting manager is aware of areas where they need to make improvements and has an action plan for undertaking the work. Portable appliance testing has been carried out for the safety of people living and working in the home. As stated previously in this report there has been no recent fire training for staff members and the acting manager acknowledges that no fire drills have been practised for some time. The acting manager states this will be addressed and is to include night shift workers. A previous requirement for fixed electrical installations to be tested has been conducted and the report identifies areas that require urgent attention. It has been confirmed by Metroline (electrical contractors) that this work will be started on week commencing 31/05/2008. Four supervision records were viewed and the acting manager confirmed that formal supervision was being conducted for all staff on a regular basis. The acting manager has sent out Quality Assurance questionnaires to relatives and other health care professionals but results were not available as of yet, the acting manager states that a copy of returns will be forwarded to the CSCI. The registered provider has been conducting Regulation 26 visits and forwarding copies to the CSCI. Records of resident’s financial transactions were viewed and seen to be complete and securely stored. Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 22 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 3 X X X 3 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 3 X X 2 Mont Calm Lydd DS0000057128.V359601.R01.S.doc Version 5.2 Page 23 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 OP38 Regulation 13 (4) (a) Requirement The registered person ensures the health and safety of service users and staff including fixed electrical installations. Work scheduled for week commencing 31/03/08. Evidence of completion to be sent to CSCI. Outstanding requirement from 11/10/07. If this is not met then the Commission will be minded to take appropriate enforcement action. Timescale for action 30/04/08 2 OP7 15(2)(b) (c) 3. OP8 14(2)(a) (b) The registered person shall keep 30/05/08 the service users care plan under review and where appropriate revise the care plan. In this context risk assessments with particular attention to prevention of falls. 30/05/08 The registered person shall ensure that the assessment of the service user’s needs is kept under review and revised when necessary. In this context that nutritional screening is undertaken on admission and subsequently on a periodic basis, DS0000057128.V359601.R01.S.doc Version 5.2 Page 24 Mont Calm Lydd 4. OP15 16(2)(i) 5. OP16 12(4)(a) 6. OP18 12(1)(a) 12(5)(a) a record maintained of nutrition, including weight gain or loss, and appropriate action taken. The registered person shall 30/05/08 provide, in adequate quantities, suitable, wholesome and nutritious food that is varied and is suited to individual assessed needs and recorded requirements. The registered person shall make 30/04/08 suitable arrangements to ensure that the care home is conducted in a manner that respects the privacy and dignity of service users. In this context the use of male carers for female personal care against their wishes. 30/04/08 The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users and maintain good personal and professional relationships with service users and staff. In this context addressing concerns from staff about service user welfare in a professional manner. 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 OP11 Good Practice Recommendations Staff members would benefit from training around care of the dying and dementia care. 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