Inspection on 24/05/05 for Mont Calm Lydd

This inspection was carried out on 24th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 18/10/06

Mont Calm Lydd 05/10/05

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 Mills Announced 24 May 2005 9:30 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 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 H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Mont Calm Lydd Address Manor Road, Lydd, Romney Marsh, Kent, TN29 9HR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01797 321127 01797 321127 Mr Stephen Anthony Castellani Mrs Julie Ann Downham Care Home only 22 Category(ies) of Dementia (over 65) x 22 registration, with number of places Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: There are two variation orders agreed for service users with failing mental capacity who are under age of sixty-five. Date of last inspection 24/11/04 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 failing mental capacity. 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. The registered provider for the Home is Mr Steven Castellani. Mrs Susan Page is the manager for the Home and her application for registration with the CSCI is awaited. The home has been inspected under the auspices of The Care Standards Act since 2001 Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection began at 9.15am and lasted for eight hours. The inspector spoke to the registered provider, the manager, ten residents, five relatives and eleven members of staff during the course of the inspection. A room was provided so that those who wished could be interviewed in private. Prior to the inspection comments were also received from four other relatives. A tour of the Home was undertaken. Both direct and indirect observations were made throughout the day. An inspection was made of the administration of medicines and key documentation, including a twenty percent sample of care plans, was examined in detail. This inspection confirmed that the Home continues to make progress in achieving the National Minimum Standards. Significant improvements continue to be made to the environment and in staff training. Most relatives said that they are very happy with the care given by the Home. Nearly all the residents appeared well cared for on the day of inspection. However, there were some exceptions that appeared to caused by a lack of attention to detail. The residents and their relatives, the staff, the manager and the registered provider and thanked for their assistance during this inspection. What the service does well: What has improved since the last inspection? There had already been significant improvement to the environment by the time of the last inspection, now there are further improvements. A new reception area and car park have been created. Additional bedrooms have been re-decorated and re-carpeted. Further progress has been made in developing a patio area in a shady area at the rear of the building. Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 6 The Statement of Purpose and the Service User Guide have been reviewed and revised. The manager now has a computer and the documentation used by the Home has improved. New formats for care plans, risk assessments and the preadmission form have been produced. A visitors’ policy, an equal opportunities policy and a policy to cover aggression towards staff have been developed. The whistle blowing policy has been reviewed to take into account the concerns raised at the last inspection. The organisational structure has been improved to give greater clarity of roles and responsibilities. A key worker system has been introduced and there are dedicated staff who take responsibility for liaison with health care professionals and other key tasks. Staffing levels have improved. The Home is now providing more nutritious meals and both domestic and kitchen staff have been encouraged to undertake the appropriate NVQs. 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. Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 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 standard(s) 1,2,3,4&5 The Statement of Purpose and the Service User Guide are very good. They provide residents, prospective residents and their supporters with the information they need when considering moving into the Home. Appropriate pre-admission procedures are in use. EVIDENCE: Since the last inspection both the Statement of Purpose and the Service User Guide have been reviewed and changed. They are now written in plain English and have appropriate illustrations. A new pre-admission assessment form has been developed and is now in use. Inspection of care plans showed that all new residents have been appropriately assessed prior to admission to the Home. Relatives said that they understood what to expect from the Home. Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7,8,9,10&11 There is a clear care planning process that identifies the needs of the residents. However, personal support does not always offered in a way that promotes the privacy and dignity of the residents. The Home has clear policies for the management of medicines, however, the procedures for administration are not consistent or foolproof. They potentially put the residents at risk. The Home meets the spiritual needs of the residents and gives appropriate support to those who are terminally ill and their families. EVIDENCE: Care plans and risk assessments have been reviewed and improved. The needs of the residents are recorded and there is a description of how these needs should be met. A hairdresser visits the Home regularly and the service is offered at a reduced price. Staff were observed to treat the residents with kindness throughout the time of inspection. Responses to relatives questionnaires were mostly positive with comments such as, “All the staff are so kind – it makes me happy that ****** is so well looked after”, and, “I am happy in the knowledge that ***** is well cared for”. However, on the day of Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 10 inspection, some residents were found to be shabbily dressed and possibly wearing the wrong spectacles. This clearly compromised both the health needs and the dignity of the resident. Some responses to the CSCI pre-inspection questionnaires and enquiries also raised concern about the way their relatives were dressed. Staff said that they had concerns about the way some residents were helped to get up in the morning and they expressed concern about the way in which the residents’ clothes were put away without being ironed. They also said that commodes had been left unemptied by night staff and that toilets were left dirty at weekends. The lunchtime administration of medication was observed. This is a very busy time and it was noted that the medicine trolley was left unattended and open for short periods of time in the main lounge. Staff said that they would usually leave the trolley in the entrance hall when administering medicines. Some residents clearly have difficulty swallowing their tablets and needed the attention of more than one member of staff whilst others needed a significant amount of supervision when taking their medication. The administration of medication therefore appeared confused and inconsistent with some blurring of staff roles during this process. The Home must review the procedures for the administration of medicines. Staff were observed to treat the residents with kindness throughout the time of inspection. There was clear evidence that the manager sought the support of a local minister of religion on behalf of a bereaved resident. Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12,13,14&15 The Home attempts to provide a lifestyle in the Home that meets the expectations of the residents and their supporters. Visitors and friends are made welcome to the Home. Whilst some choice is available, more work is needed to help staff understand the ways in which choice can be offered to those with diminishing mental capacity. Meals at the Home are appetising and nutritious and served in pleasant and comfortable surroundings. EVIDENCE: An activities co-ordinator visits the Home three times a week. Games of carpet bowls, skittles and dominoes are organised. A sensory garden is planned for the near future and some residents are taken for walks locally. However, staff find it difficult to engage the residents in structured activities for more than a short period at a time. Work is currently being undertaken to record the life histories of the residents. Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 12 Most relatives said that they are well supported by the Home and are given the information they need. However, some felt that communication with the Home could be better. Discussion with staff suggested that not all staff were clear as to how they might offer choice to people with diminishing mental capacity. For example, it appeared that some staff simply take the first set of clothes available for a resident. Several other staff were very clear about appropriate ways to offer choice. It is recommended that the Home builds on the skills of staff who understand how to offer choice and encourages them to share their skills. An inspection of the kitchen, discussion with the cooks and sampling of the main meal confirmed that the Home purchases plentiful supplies of local produce. The staff said that there is always plenty for the residents to eat. Indirect observation of staff at mealtimes confirmed that they supported those residents who required help to eat in a discreet and appropriate way. Residents said that they enjoyed their meal. Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16,17&18 The complaints system is satisfactory. There is some evidence that residents and/or their supporters feel that their views are listened to and acted upon. EVIDENCE: Several relatives, both in response to questionnaires and in discussion, said that they knew how to complain. They were confident that, should they need to complain, the manager would act immediately to resolve the complaint. However, a few relatives did not know how to complain and were not confident that their complaints would be taken seriously or reluctant to worry busy staff over “small” issues. The Home has reviewed its policies and procedures for the protection of the legal rights of the residents. They have also introduced a new Visitors’ policy. Staff were very clear about their responsibilities in respect of the prevention of all forms of abuse. They said that they have no hesitation in reporting any concerns to the manager and are confident that she will act upon any concerns they express. The manager has reported concerns appropriately to the CSCI in accordance with Regulation 37 and has consistently shown a willingness to address any concerns in a timely way. Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19,20,21,23,24,25&26 Recent investment has significantly improved the environment in this Home and made it a pleasant, homely and safe place for the residents and their visitors. However, the Home must be more rigorous in respect of infection control. EVIDENCE: Since the last inspection further re-decoration has taken place. A car park has been provided and a new, more accessible entrance to the Home has been created. There is a full-time maintenance person who attends to any urgent maintenance issues as they arise. No health and safety hazards were noted on the day of inspection. Work is now underway in the garden to create a patio area and sensory garden with scented plants. Therefore, the garden is not currently accessible to the residents. However, the registered provider said that work is expected to be complete within the next two weeks. A tour of the Home confirmed that all areas were clean and hygienic on the day of inspection. Some staff expressed concern about the lack of domestic Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 15 staff at weekends and said that cleaning duties on a Monday are usually more onerous. The residents’ rooms inspected were seen to be well decorated, well furnished, bright and comfortable. There are adequate toilet and bathing facilities. All these areas were clean and hygienic on the day of inspection. Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29&30 Staff morale is improving and staff demonstrate clear understanding of their roles and responsibilities. Arrangements for induction are good. And there is a good level of training being undertaken by staff and the manager. Recruitment policies and procedures in the Home are now satisfactory. EVIDENCE: Most staff said that they are very happy working in the Home and that they really enjoy caring for the residents. Some said it was “like a family” and described a “family atmosphere. They said that they are well supported by the manager and the registered provider. They said that they believe that there is a good level of training o offer and that they have the opportunity to put new skills into practice. Organisational structures for the Home define clear roles and responsibilities and staff were clear about these. Some staff have taken on additional responsibilities, for example, a named member of staff now liaises with the continence advisor to ensure appropriate advice is put into practice in the Home. The manager said that recruitment policies and procedures have recently been tightened to verify the source of all references. Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36,37&38 The manager is supported well by senior staff in providing leadership throughout the Home. EVIDENCE: The manager said that she is well supported by both the registered provider and her staff. Discussion with the manager and the registered provider confirmed that there is an open management culture. The forward planning for the Home is now more cohesive and they are committed to take into account the views of the residents and their supporters, visiting healthcare professionals and the staff. The manager has now completed all the assignments for the NVQIV in Management and Care and is awaiting validation from the College. Documentation inspected was found to be in order and up-to-date. Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 18 No health and safety hazards were noted on the day of inspection, however, at that time the residents did not have access to the grounds of the Home as improvement work was ongoing. Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 3 2 3 x 3 3 3 3 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 3 3 3 3 3 3 3 3 3 Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 20 no Are there any outstanding requirements from the last inspection? 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 8 Regulation 12 Requirement Timescale for action 31/05/05 2. 3. 4. 9 10 26 13(2) 12(4)(a) 23 the Home must ensure that all aspects of the health and welfare of the residents is managed approriateley. In particular, ensuring that personal items such as spectacles and walking sticks are kept with the individual resident The Home must review and 31/05/05 improve the way in which medicines are administered The Home must ensure the 31/05/05 privacy and dignity of the residents at all times The Home must ensure adequate 31/05/05 infection control measures are adhered to at all times. In particular, attention must be paid to the way in which commodes are dealt with. 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 16 Good Practice Recommendations The manager should be more proactive in seeking the H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 21 Mont Calm Lydd views of the residents and their supporters. Mont Calm Lydd H56-H05 S57128 Mont Calm Lydd V224589 240505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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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