CARE HOMES FOR OLDER PEOPLE
Mont Calm Residential Home 72-74 Bower Mount Road Maidstone Kent ME16 8AT Lead Inspector
Lynnette Gajjar Key Unannounced Inspection 14th December 2006 10:20 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 Residential Home DS0000067183.V320792.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 Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Mont Calm Residential Home Address 72-74 Bower Mount Road Maidstone Kent ME16 8AT 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) 01622 752117 MGL Healthcare Ltd Mrs Marie Lisette Lisis Care Home 39 Category(ies) of Dementia - over 65 years of age (39) registration, with number of places Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Shared rooms are used for married couples, siblings or those whose professional assessments determines it meets their needs. The home is restricted to care for one service user who is under 65 years of age whose date of birth is 06/03/1948. First inspection as a new service Date of last inspection Brief Description of the Service: Mont Calm Residential Home is registered to provide personal care and accommodation for 39 older people with Dementia. The home is owned by MGL Healthcare Ltd. A family run business by Mr John Lisis, Mr Michael Lisis and Mrs Lisette Lisis. Having one other home nearby in Maidstone and another in Canterbury. The home consists of three properties directly next door to each other (70,72 & 74 Bower Mount Road). Mont Calm has twenty-four single rooms, twelve of which have en-suite facilities and seven double bedrooms, three of which have en-suite facilities. There are shaft lifts in the houses and a staff call system. It has large rear gardens and ample parking to the front of the building. The home employs care staff, working a roster, which gives 24-hour cover. The home also employs other ancillary staff for catering, activities, maintenance and domestic duties. The home’s current fees range from £400 to £475 per week. The home does not make any additional charges such as for chiropody, hairdressing, newspapers etc. these are dealt with directly by the families. The home does not have a previous inspection report, as this is their first inspection since the providers purchased the home on 3rd July 2006. The report will be available from the home on request. Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key unannounced inspection, for the year running from April 1st 2006 to March 31st 2007. The visit lasted from 10.20am until 15:30pm with inspectors Lynnette Gajjar and Maria Tucker. A number of concerns raised by the inspector in previous visits were pertaining to the previous leadership and management of the home under the previous owner. New owners MGL Healthcare Ltd purchased the home on 3rd July 2006. This is their first inspection. Whilst there are a number of areas needing action in respect of good practice and developing administration, care planning and policies, these are to be set against a developing service and new leadership. The providers have demonstrated their commitment for good personalised care and consideration for older people, with a drive to explore opportunities to improve service provision and develop a committed, experienced and skilled staff team. At the time of this visit Mont Calm had no vacancies but one resident was in hospital. The visit was spent talking directly with residents, privately and collectively, care and ancillary staff, the registered manager Mrs Lisis, the proposed deputy manager due to start in January 2007 and other directors Mr Lisis senior and junior. Some residents experience levels of confusion, which prevent direct questions and answer. One inspector spent the majority of the inspection sitting with residents in the lounge/dining area with the opportunities to observe interactions during the day. Throughout the visit, there was a relaxed atmosphere with residents going about their business supported discreetly and courteously by staff. The inspectors noted a marked improvement in individual’s interaction with each other, in conversation, mobility, freedom of movement and general well-being. This report includes evidence and judgements made through conversation, observation, records and previous inspection reports. Additional information was obtained through receipt of the manager’s pre-inspection questionnaire, a partial tour of the premises and conducting a case tracking exercise, by reading the file and care plan of the one resident and two care staff, as well as some policies and records maintained by the home. Questionnaires feedback was also received from a further 3 residents, 10 relatives/carers, 5 health and social care professional, 1 care manager and 1 GP. Overall the ladies and gentleman living here, relatives and professionals are satisfied with the service received. Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 6 Comments included: “I have assessed clients at staff request, I have always found the staff to be extremely caring & understanding of client’s group needs. Staff are most cooperative’’. “ A very welcoming home with a warm friendly atmosphere. Have always worked well in helping me settle my clients. Work together in care planning.” “We are so pleased with the care that mother is receiving.” “Staff are very friendly and welcoming, never mind me asking questions” What the service does well: What has improved since the last inspection?
Mont Calms new manager/owner are qualified nurses each with over 30 years experience in working with the elderly and dementia. Their leadership and motivation to develop person centred care has been the driving force of the cultural changes at Mont Calm. The main focus of work has been to develop an ethos of care that gets to know the resident, offers personal choices and preferences that is respected. Management are working closely with the staff and residents daily. There is a marked improvement in working relationship with health professionals and care management to reassess and support residents who may challenge the service to offer a more personalised care. There was a unanimous positive response to questionnaires returned. Full reviews of residents’ medication have been undertaken with changes of times and dosages being made, which have improved the resident’s quality of life, cognitive ability and personal well-being.
Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 7 Policies and procedures are being reassessed and rewritten to comply with current legislation and good practice in supporting those with dementia. Staff are receiving formal supervision and appraisal to discuss the running of the home, their involvement and personal development with this. Senior carers from another home owned by MGL Health Care Ltd have been transferred to assist with assessment and development of care planning records and support in training care staff at Mont Calm. Staff working rosters have been reviewed to offer consistent staff in each house, with a further review of staff hours worked currently taking place. There has been a small turnover of staff due to the new owners’ strict monitoring and management of staff not working excessive hours to ensure the safety of residents. Staff are receiving training and support in current good practice to support and care for those with dementia, using different techniques to aide better communication and management of behaviour. Mealtimes have been changed to allow personal choices to be offered, more varied meals and alternatives to menus to meet personal preferences. New activities have been introduced such as a Tai Chi. A new activity coordinator has been recruited to start their post from January 2007. Bed linen laundering has been contracted out to an external company providing crisp, white, ironed linen but also reducing the home’s laundry tasks and giving it time to concentrate on personal clothing only. Personal rooms were not kept locked unless required by the resident. Alternative security and locking devises are being explored to replace the current door locking and key system to offer a safe but less institutional feel to the home. Carers groups have been started to offer support and involvement of relatives and friends offering another method to find out how the home is doing and what can be done to improve it further. This has included speakers from other professionals of interest to them. It is acknowledged all of the above areas are an ongoing process at present but it is clear steady progress has been made since registration. Feedback received: “The ethos of the home has changed dramatically with the new ownership and client centred care is now paramount, the wishes of the residents that I have been involved with have been heard and any advice or changes that I have suggested to their care have been incorporated into the resident’s care plans.
Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 8 A concerted effort has been made to have a section for communication and behaviour in each residents care plan, they have recognised that these areas are of great importance when caring for someone with dementia. Also they have set up a carer’s group for relatives and friends of residents these are regular meetings and give a chance for relatives to have a voice’’. 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 Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 9 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 Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4,5,6 Quality on this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Residents and representatives have access to the information needed in making a decision as to whether Mont Calm home can best meet their needs. Further development of the documentation using visual information would assist those with limited memory and concentration. EVIDENCE: The home has developed a detailed statement of purpose and service user guide. Both are in written formats that can be reproduced in larger font if required. Alternative formats to include photographs, are being explored to assist those with more visual information and prompts, particularly for those who are unable to visit the home and have limited short-term memory. When the home was purchased it was running with 14 vacancies. This required careful assessment and planning to ensure that those moving in did so in as relaxed manner as possible. The manager limited one new admission
Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 11 per week (even longer on some occasions) to allow for the resident, peers and staff to become familiar with each other. It is the home’s policy that all prospective residents are visited in their current home, time is spent with relatives and carers to build a picture of the support needs before a decision to offer a place is made. Where possible a visit to the home is also arranged. New forms are being devised by the deputy Manager to be used to gain more information. Mrs Lisis very clear what the home can provide and where the home will decline a referral, thereby showing a good understanding of the home, service users in residence, compatibility and staff skills. Residents spoken with found it difficult to remember if or who had visited them before moving in. All said their relative sorted that out, or the hospital. One lady could remember someone visiting her and asking lots of questions but also that she was not staying here for long it was a ‘short term thing’. Residents’ contracts from the previous owners have been honoured by the new owners and remain unchanged. The owners are considering reviewing these as part of the inflation increases due next year and, in agreement with residents and representatives, issue revised contracts that comply with the Office of Fair Trading recommendations for contracts in care home that are clear of each personal responsibilities and easier to understand. The owners are in receipt of the amended regulations relating to contract and fees and as part of their contract review will ensure all areas are included as required. New residents have a contract with MGL Health Care Ltd. Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are developing to offer better information to ensure consistent care. Daily recording could be improved to offer more accurate information of the individual and personal support observed. Residents are protected by regular medication reviews with specialised health professionals. EVIDENCE: One care plans was assessed and care tracked. New formats as have been introduced and staff are still working to improve the information held. A senior carer from the organisation is taking the lead with these and training other care staff in their use. Records seen today had improved to hold more information to make them personal to the individual and ensure consistent support. But it is acknowledged that this is a lengthy process and will take time to develop into detailed documentation that is clear, easy to use and track care and support given. Risk assessments including strategies to reduce risk are now included in all aspects and sections of the care plan and an ongoing process. Residents spoken with described personal care and support given by the staff. Reviews are taking place at least monthly including key worker
Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 13 meetings with the senior carer and resident. Direct observation demonstrated staff on duty showing genuine consideration and respect for each resident on a personal level. The understanding of offering personal choice and preferences in daily routines, food and drink and activities has improved from direct observation today. Records are stored securely. Residents look well and in clothes that were well cared for. Medication for residents has been reviewed with significant changes in time of administration and dose reduction, which has improved residents’ quality of life, social interaction and personal well being. Staff have been working closely with medical professionals and taking on board their recommendations and guidelines. The location of the medication storage in no 74 remains a concern and the new owners are exploring other options for this. Liaison with health care professionals takes place. The staff and records detailed district nurse input for specialist equipment for pressure sores and prevention. Support is also received from local PCT psycho geriatricians and Community Mental Health Nurses. Dental and optician care has been set up. As stated in the summary, professionals feel that there has been a considerable improvement in the care home’s ethos of care and the working together with them to improve the residents’ quality of life. Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 14 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. Residents are living in a home where they are being encouraged to be active and have more social contact. EVIDENCE: Mont Calm has just employed a new activities organiser to arrange activities and outings but will work between this and a sister home near by from Jan 2007. To date staff have undertaken this role. A programme of events planned was displayed in the home and letter sent to relative/ residents. As the lead up to Christmas, the Christmas party with live entertainment is booked for the following week, local children are coming to sing carols and being involved in making Christmas cards and decorations. Residents are now supported to go shopping and have one to one time with staff. Residents were sitting in the lounge and dining room listening to music and reading magazines/books and chatting to each other. Residents who smoke are supported to access the garden as they wish, as this is the smoking area. Others were walking freely around the parts of the home that were accessible and engaging in conversation with peers and staff. Religious
Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 15 services are arranged in the home and where possible residents are supported to attend church if they wish. New activities are being introduced such as Tai Chi that was received with some interest by residents. Routines that are not the practice of the new owners are being tested and changed to ensure that because the older person is in a residential home, their right to choice and decision making isn’t taken away. Residents are encouraged to bring personal possessions with them and every effort is made so that they are in an environment where they feel content. The new owners have been working with a nutritionist and good food guides to develop a more varied and wholesome menu, offering more choices and a more pleasant experience. Residents’ families and friends are in regular contact, with an ‘open door’ visiting policy. A carers group has been set up with regular meetings taking place to offer support and develop better relationships. Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 16 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 adequate. This judgement has been made using available evidence including a visit to this service. Those living here and their relatives would feel more confident to raise concerns or complain through with a detailed complaint procedure being made available to them. Protection from abuse will be better promoted through all staff having better understanding of the support and actions they may need to take in incidences abuse EVIDENCE: The owners are reviewing all procedures in place. The complaint policy is not the practice of the new owners, as it does not offer adequate information so that residents and representatives would have better information of how to raise a concern by telling them what they need to do, who to contact at Mont Calm and it must include the full address and contact numbers of the Commission. However direct contact has been made, through the owners being available and approachable during the day, carers meetings occurring and direct contact with residents, these all offer opportunities to discuss and air concerns directly. Of those spoken with and residents and families who responded to questionnaires said that if they had a concern they would openly discuss it with the owner and staff. The home has no record of complaints as none have been made.
Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 17 A training matrix has been developed and indicates not all staff have undertaken training in Adult Protection. The owner stated a senior carer has now undertaken the trained trainer course for this and they are looking to ensure all staff who have not done this training have so within the next few months. It is acknowledged that adult protection is part of the induction training and that some staff may have been trained prior to working at the home. The home does not have any current adult protection investigations underway. Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 18 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): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from living in a warm, welcoming home, that would benefit further from an environment designed and equipped to promote their personal independence, safe freedom of movement around the home and access to the garden. EVIDENCE: Residents live in two houses, located side by side. Both having their own lounges and dining rooms. The main kitchen in 74 cooks food for both houses and is transferred between units by staff. 72 has a small kitchenette to provide drinks and snacks. Adequate recreational, dining, toilet, bathing and individual accommodation are provided, with the ongoing exception of shared rooms, which could not provide access to both sides of the beds if necessary. Furnishings were of good quality. Good supplies of personal toiletries are observed in the rooms visited today
Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 19 Some aids, adaptations and equipment were provided. Raised toilet frames were fixed securely to the floor. Written signs have been fitted to doors to assist residents in knowing where they are or assist them to locate their rooms / toilets etc. Locks have been fitted to drawers in bedrooms. Rooms visited today were not locked, although upstairs bedrooms were not accessible due to locked corridor doors and residents inability to access the lift independently. All residents’ rooms and communal areas seen were fresh and tidy. There were no offensive odours evident in the areas visited today. Sluicing facilities have been installed to both houses. All action recommended by the Health Protection team have been implemented. Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are being supported by staff that are receiving regular supervision to ensure residents’ rights and personal choices are respected. Resulting in better morale and enthusiasm to improve the ladies’ and gentlemen’s whole quality of life. Further training in core health and safety will develop staff knowledge and experiences. EVIDENCE: Staff allocation has been altered to ensure staff work consistently with the same residents and houses. The new owners have spent time looking at the working roster, hours that staff work and the safety of not working too many long shifts. Rosters showed three carers in each house and a senior carer during the day and 2 carers in each house at night. In addition to this there is the chef and kitchen assistant during weekdays and cleaners and laundry personnel. The registered manager, newly appointed deputy manager and administrator support the care staff. During this visit a senior carer from another service was here working on care plans and the two remaining directors were also on site. There has been a small turnover of staff but the owners had prepared for this and had recruited staff through their other homes to transfer to Mont Calm. Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 21 The staff are undertaking direct ‘hands on’ training from the registered manager and owners into the high expectations in the standards of personal care expected for the residents, as well as planned external training. This has and continues to be a developmental area for staff and acknowledged as an ongoing process of change. But direct observation showed some improvement in attitude towards residents, their rights and offering more personalised care. The staff are receiving close monitoring, management and supervision due to the lack of leadership and direction that they had experienced previously. Different dynamics between day and night staff have been identified. The owners have introduced new working practices to offer fair equity of work and resident choice. The owners have identified staff core training undertaken and those that still require to attend these. Formal supervision and identifying target goals for development are now taking place. Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents at Mont Calm are benefiting from having an experienced and competent manager and the strong commitment from the directors to ensure safeguards and that residents’ best interests are promoted and their health, safety and welfare is also protected. EVIDENCE: Mont Calm is one of three-care home owned by MGL HealthCare Ltd. Mrs Marie Lisette Lisis (manager/owner) is currently registered as Manager with the support senior carers. Mrs Lisis is a registered Nurse and has 30 years experience in care of the elderly and specialising in dementia care. A deputy manager has been appointed and is being transferred to the home from January 2007 and will be commencing their RMA award.
Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 23 Residents, relatives expressed a positive regard for their management approach to the home. Residents continue to feel the registered manager and owners are approachable and staff said they felt better supported and listened too. Direct observation showed regular contact and familiarity between residents and the management, with lots of two-way banter and genuine conversation. “We only want to do things that are going to be good for the residents”. Carers meetings have been introduced on a regular basis and key workers meet regularly with their resident and senior carer to discuss their care, interests and what they would like to do. Formal quality assurance questionnaires are planned to be undertaken in the New Year as six months after the sale to gain information about what they are doing well and what can be further improved upon. Core health and safety training has been evaluated and the manager is aware of staff that are required to complete these and is planning further training. The manager is closely monitoring accident/incidence recording and a recent falls survey completed by staff to assess patterns and risk areas. Frequency of night checks has been increased for a number of residents. The manager stated they are looking to seek further advice from the PCT’s Fall Co-ordinator for identified residents. The home does not manage any personal resident monies. This is done by families or appointed power of attorneys. The manager has spent the first months of registration concentrating on personal direct care for residents and this is very much evident in the attitude, interaction and resident well being during this visit. It is acknowledged that this still required time and commitment from her to instil and maintain the high standards expected by the care staff. Policies and procedures are being reviewed and amended as part of the organisation’s development of the service and is very much an ongoing process from evidence gathered. Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 24 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 2 2 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 3 2 2 Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NA 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 OP9 Regulation 13(2) Requirement The home must ensure the safekeeping and safe administration of medication: In that: 1) Review of safety and security of medication storage in 74 is appropriate and has adequate ventilation. 2 OP16 22(7) The copy of the complaints procedure to be supplied shall include: The name, address and telephone number of the Commission Having regard to the number and needs of residents, suitable adaptations, equipment and facilities must be provided as necessary for residents who are old, infirm or physically disabled; In that: 1) The home be assessed by a qualified individual to ensure that any equipment and
Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 26 Timescale for action 31/01/07 31/01/07 3 OP22 23(2)(n) 31/03/07 adaptations used were able to meet the needs of residents. 2) Appropriate grab rails and adaptations installed as recommended by the aforementioned assessments to promote residents safety and independence. Particularly where there are steps leading to bedrooms. Suitable arrangements must be 31/03/07 made to prevent infection, toxic conditions and the spread of infection in the home with regard to the laundry rooms; In that: 1) The lack of hand washing facilities in the basement laundry area and 2) Freezers/ food storage in close proximity. 5 OP28 18 (1) (a) The registered person, shall having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed to work at the care home receive training appropriate to the work they perform. In that all staff undertake and are deemed competent in the core health and safety training: Training in Basic Food hygiene/food hygiene awareness where the member of staff prepares, handles or stores food. Training which includes caring for older people with dementia Updated moving and handling training Training in the safe handling of
Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 27 4 OP26 13(3) 31/07/07 medication if they administer medication Adult Protection Fire safety, COSHH, With refresher training and assessment of competency within good practice guidelines. 6 OP37 17(2) Schedule 4 The registered person must maintain within the home documents and records specified within Schedules 3 and 4 and make sure that they are kept up to date. It is acknowledged that this is an ongoing process as paperwork is assessed and reviewed by the new owners. 31/03/07 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 OP1 Good Practice Recommendations It is recommended that the service user guide is reviewed to be more accessible and a visual memory tool using more pictorial referencing for those with cognitive difficulties and who do not get the opportunity to visit the home before moving in. It is recommended that through reviewing of policies and procedures that the home works within the amended regulations June 2006 to ensure that the contract and terms and conditions contain all information required regarding fees and content of the contract to comply with the Office of Fair trading recommendations for contracts in Care homes. It is strongly recommended that the care plans continue to be reviewed and transferred to the new format offering better information for care staff and personalise care.
DS0000067183.V320792.R01.S.doc Version 5.2 Page 28 2 OP2 3 OP7 Mont Calm Residential Home 4 OP8 5 OP12 6 7 OP15 OP16 8 OP27 9 10 OP28 OP33 11 OP38 It is strongly recommended that further opportunities are given for appropriate exercise and physical activity appropriate interventions are carried out for residents identified at risk of falling. It is strongly recommended that the owners continue to explore the resident’s interests and they are given opportunity for stimulation through leisure and recreational activities in and outside the home, which suits their needs, preferences and capacities. Particular consideration is given to people with dementia and other cognitive impairments, visual, hearing and dual sensory impairments. It is recommended food be served from hot trolley to enable resident further choice and portion control and make mealtimes amore pleasurable experience. It is strongly recommended any concerns or complaints are logged in a bound book, with clear evidence of investigation, outcome and action taken within set policy timescales. It is strongly recommended that homes rosters show all staff on duty (including management/directors and administrators) at any time during the day and night. This includes their full name and designation. It is recommended that a ratio of 50 trained members of staff to NVQ level 2 or equivalent is achieved by 31st December 2005. It is recommended that quality assurance methods are shared with both residents, relatives, visitors, health and social care and other professionals six months after registration and report of findings and action shared with tem and the Commission. The registered person ensures the health and safety of residents and staff including, maintenance of a safe environment including outdoor steps, ramps, pathways, and garden and specialist equipment. As well as security of the premises and residents based on an assessment of their vulnerability. Mont Calm Residential Home DS0000067183.V320792.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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