Inspection on 18/10/06 for Mont Calm Lydd

This inspection was carried out on 18th October 2006.

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

Mont Calm Lydd 01/09/08

Mont Calm Lydd 11/03/08

Mont Calm Lydd 11/10/07

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 Wendy Jones Key Unannounced Inspection 18th October 2006 11:00 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.V300364.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.V300364.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 01797 321127 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 Susan Edna Page Care Home 22 Category(ies) of Dementia - over 65 years of age (22) registration, with number of places Mont Calm Lydd DS0000057128.V300364.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service users under the age of 65 are restricted to one (1) whose DOB is 27/11/1940. Service users under 65 years of age to be restricted to one (1) whose DOB is 22/08/1946. 5th October 2005 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 £367.82 and £500 per week. Hairdressing, chiropody and toiletries are at an additional charge. Mont Calm Lydd DS0000057128.V300364.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Wendy Jones, Regulatory Inspector, carried out this key inspection. It was carried out over a period of time and concluded with a site visit to the home between 10:55am and 15:50pm on 18 October 2006. A range of evidence has been used to inform this report and judgements have been made based on this evidence. Evidence used includes concerns, complaints, allegations and other information received, reports of incidents and deaths that have occurred since the last inspection, a tour of the home, inspection of some records, comments received from 6 care managers or placement officers, 2 residents, with the help of their relatives and discussion with the manager, deputy manager, residents and staff. What the service does well: What has improved since the last inspection? What they could do better: Care plans and risk assessments must be reviewed regularly, particularly following incidents of falling and records must be kept up to date. Induction records should be more robust and show the actual dates each area of the induction is covered to evidence that there has been enough time to learn and show understanding and competence. The trainer should also record when they have checked that the new member of staff has understood and is competent in each area. Mont Calm Lydd DS0000057128.V300364.R01.S.doc Version 5.2 Page 6 Formal, recorded supervision had not been carried out for a number of months. This should be done at least six times a year. The manager should put this in place very shortly as intended. The manager should ensure that records of residents’ monies are kept up to date at all times and carry out regular audits to ensure the cash kept matches the records. 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. Mont Calm Lydd DS0000057128.V300364.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.V300364.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3-5 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives have the opportunity to try out the home to be sure it is able to meet their needs before moving in permanently. EVIDENCE: The manager carries out assessments before potential residents move into the home. She has taken the head of care and senior staff with her to give them the knowledge and skills to undertake these assessments if necessary. The pre-assessments are used, along with assessments from care managers, mental health and other healthcare professionals to develop individual care plans that show residents needs and goals. Mont Calm Lydd DS0000057128.V300364.R01.S.doc Version 5.2 Page 9 Staff have a clear understanding of dementia needs. Training in dementia care for staff who have not received this has taken place since the last inspection and continues. Residents’ comments received prior to the site visit stated that they had been able to visit on a trial basis. The manager advised that prospective residents are admitted for one months respite care on a trial basis. Their relatives, care manager and the home then decide whether they should be made permanent. Mont Calm Lydd DS0000057128.V300364.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents’ general health and personal care needs are met. EVIDENCE: Care plans were clear and easy to follow. Daily records were being kept. Needs and risk assessments were comprehensive and clearly identified the residents needs and risks to their health and wellbeing. They outlined the action staff are to take to meet these needs and reduce or remove any risk. Some care plans seen were being reviewed regularly, but some were not. One seen indicated that the resident had been falling regularly between January and September 2006. The care plan and risk assessments had not been reviewed since April 2006 and there was no information in the file about action staff had taken to reduce the resident’s risk of falling. However, accident records for September and October showed that the number of times this resident had fallen had reduced significantly. Mont Calm Lydd DS0000057128.V300364.R01.S.doc Version 5.2 Page 11 The manager was confident that appropriate action had been taken regarding the number of falls the resident had had, but that this information had not been recorded. She confirmed that the remaining care plans and risk assessments would be reviewed within the next few days and she would ensure that records are kept up to date. In contrast the care plan regarding another resident who’s health had been deteriorating showed that appropriate action had been taken. Records seen and discussions with the manager and senior staff showed that prompt action had been taken. The resident’s GP and other professionals had been fully involved and their care plan and risk assessments had been regularly updated to take account of changes. This resident was seen and they had made good progress. Care plans also contained details of when the resident had seen their doctor, or district nurse and of optician, dentist etc appointments. Residents are weighed regularly to help ensure they are receiving an appropriate diet. Residents’ medication administration records were up to date and had been completed accurately. The initials of the staff responsible for giving medication were seen. Medication is kept in the medication cupboard and transported in a medication trolley. All staff who have responsibility for giving medication have received appropriate training and those spoken with were confident they carried this out safely. Staff were polite and caring to residents. The staff on duty at the time of the site visit clearly understood the needs of the residents and treated them with respect and courtesy. Mont Calm Lydd DS0000057128.V300364.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 - 15 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The daily routines and activities provided meet residents’ needs and are flexible. Residents keep in contact with their family and friends. EVIDENCE: Two activities co-ordinators provide a range of activities for the residents. Photographs are displayed in the corridor and lounge showing residents enjoying games, arts and crafts, and visiting entertainers. Residents were enjoying music in the lounge. Some were drawing and staff were playing games with others. The residents were clearly enjoying themselves. Staff spoken with said that more meaningful activities have been provided since the new manager started and a further activities person has been involved. They said that staff feel more comfortable and work more closely with the residents. They also join in with activities more. A number of people came to see residents during the site visit. Mont Calm Lydd DS0000057128.V300364.R01.S.doc Version 5.2 Page 13 Copies of menus had been received before the site visit. These showed that residents have a balanced, nutritious diet that gives them variety and choice. Some residents had the midday meal in the dining room. Others who needed assistance to eat their meals were in a more private, separate room. Mont Calm Lydd DS0000057128.V300364.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives’ complaints are taken seriously and investigated. Staff take the correct action to safeguard residents from abuse. EVIDENCE: Information received before the site visit showed that no complaints had been received since the last inspection. More staff have been trained in adult protection and those spoken with were clear about what to do if they suspected a resident was being abused in any way. The manager explained that further training is to be provided for the remaining staff who have not yet received this training. The manager advised that a care manager had contacted her and asked her about a report they had received. This stated that a resident’s safety had been put at risk as they had wandered outside the home and had received bruising and injuries on a number of occasions. The manager advised that she was not aware of any incidences of this resident wandering outside the home. Security in the home had, in fact, been increased recently and residents were unable to leave the home without being accompanied. Records showed there had been Mont Calm Lydd DS0000057128.V300364.R01.S.doc Version 5.2 Page 15 an incident when this resident had fallen out of bed and bruised their eye, but no records were found regarding the resident wandering outside the home. Mont Calm Lydd DS0000057128.V300364.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 – 21 and 23 - 26 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and comfortable home with private and communal rooms that meet their needs. EVIDENCE: All areas of the home were attractively decorated. There is a lift for residents to reach all floors of the home. A staircase also reaches all floors but access is restricted for residents for their safety. The lounge has a music system and comfortable seating. The dining room has new tables and chairs so that residents can eat in comfortable surroundings. There is a small patio garden area leading from the rear of the home. The manager Mont Calm Lydd DS0000057128.V300364.R01.S.doc Version 5.2 Page 17 said that residents had enjoyed sitting in this area in the summer when the weather was warmer. All doors that lead from the building are kept locked at all times so that residents cannot wander into the very busy main road that is immediately in front of the home. Residents’ rooms are individual to them and meet their needs and tastes. They have their own personal items including photos, pictures, televisions etc. There are sixteen single rooms, eight with en suite toilet and hand basin and three double rooms. None of the double rooms have en suite facilities. There are two communal bathrooms with bath hoists, and five communal toilets. Those seen were clean and hygienic. The laundry is a very small, cupboard-like room at the end of the main corridor on the ground floor. This small space houses one industrial and one domestic washing machine. The industrial machine has a sluice facility. There is also one drier and a sink. However, there is no room for ironing to be done in this room. The manager said that the ironing is now to be done in her old office on the first floor. (The manager’s office had been moved to the top of the building the day before the site visit.) The laundry person explained how clean and dirty laundry is kept separate and was clear about the procedure to follow to control the spread of infection. It was noted that the laundry person was doing a good job despite the limited area she has to work in. Mont Calm Lydd DS0000057128.V300364.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 - 30 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the home’s recruitment procedure. They are supported by staff who have the skills to meet their needs. EVIDENCE: Staffing rotas received before the site visit showed staffing numbers were appropriate at all times. At the time of the site visit there were four care staff on duty two of which were senior staff. This was enough staff to meet the needs of the 21 residents in the home at this time. Care managers surveyed said that there was always a senior member of staff available to speak with them when they visited or contacted the home. Of the 18 care staff employed 8 are trained to NVQ level 2 or above. The manager advised that 2 more members of staff have just completed NVQ2 and a further 3 are currently doing this qualification. When these staff have completed the qualification more than 50 per cent of the care staff will be trained to NVQ level 2 or above. Mont Calm Lydd DS0000057128.V300364.R01.S.doc Version 5.2 Page 19 New staff complete an application form, provide two references and attend an interview. Checks are carried out with POVA first and the Criminal Records Bureau and records of these were seen. Staff files confirmed that new staff had received induction training. However, all parts of the induction had been signed off on the same day and there was no evidence that their competence in these areas had been confirmed before signing off. Records should be more robust and show the actual dates each area of the induction is covered. This will evidence that there has been enough time to learn and show that understanding and competence. The trainer should also record when they have checked that the new member of staff has understood and is competent in each area. Training certificates displayed around the home and seen in staff files showed that staff had attended training in manual handling, adult protection, health and safety, fire drills and evacuation, food hygiene, dementia and infection control since the last inspection. Training for staff who are still to do training in dementia and adult protection is due to take place shortly. Mont Calm Lydd DS0000057128.V300364.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 – 33 and 35 - 38 Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-managed home that is run in their best interests and safeguards their rights. EVIDENCE: The manager has been in post for three months. She has a number of years’ experience of managing a care home and has achieved NVQ level 2, 3 and 4 and the Registered Managers Award. The manager, deputy manager and senior staff all now have their own specific roles to play in the management of the home and clear lines of accountability are being put in place. Mont Calm Lydd DS0000057128.V300364.R01.S.doc Version 5.2 Page 21 On the day of the site visit the manager and head of care were on duty. The provider was also present for a short time. The home was being well run and the staff were welcoming. Staff said that they enjoyed working at the home and felt there had been improvements to the way things were done. This had helped them work together better as a team. They said that they are well supported by the manager and feel they have the skills and resources they need to do their jobs well. Quality assurance surveys were sent out at the beginning of September. The manager explained how she intends to assess the responses for themes and any action that needs to be taken. The provider regularly visits the home to review the service provided and copies of the latest reports of these were seen. All records were safe and secure. Service users monies were recorded and stored individually and safely. However, records were slightly out of date and the monies checked for one resident did not match the records. A receipt for a payment that was still to be entered into the records was seen. The manager should ensure that records are kept up to date at all times and carry out regular audits to ensure the cash kept for each resident matches their records. The manager keeps in contact with staff on a daily basis and has good communication with them. Staff felt well supported by the management and said they were approachable at any time if they needed help or guidance. However, formal, recorded supervision had not been carried out for a number of months. This should be done at least six times a year. The manager explained that this is something she intends to put back in place very shortly. Staff training records showed all have attended manual handling training and receive regular updates. Information received prior to the site visit showed that all relevant maintenance and checks for equipment and services have been done and are up to date. Mont Calm Lydd DS0000057128.V300364.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 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 3 3 Mont Calm Lydd DS0000057128.V300364.R01.S.doc Version 5.2 Page 23 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. 1. Standard OP7.3 Regulation 13(4)(c) Requirement Unnecessary risks to the health and safety of service users must be identified and so far as possible eliminated. Risk assessments must be reviewed and updated following incidents of falling. Residents’ care plans must be reviewed regularly and these reviews must be kept up to date. Timescale for action 25/10/06 2. OP7.4 15(2)(b) 19/11/06 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. 3. Refer to Standard OP30.2 OP36.2 OP35 Good Practice Recommendations Induction records should be more robust. They should show the actual date areas are covered and evidence assessment of competence. Care staff should receive formal supervision at least six times a year. The manager should ensure that records are kept up to date at all times and carry out regular audits to ensure the DS0000057128.V300364.R01.S.doc Version 5.2 Page 24 Mont Calm Lydd cash kept matches the records. Mont Calm Lydd DS0000057128.V300364.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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