Inspection on 17/10/05 for Montague House

This inspection was carried out on 17th October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Montague House 02/11/09

Montague House 19/03/09

Montague House 15/04/08

Montague House 25/04/07

Montague House 28/11/06

Montague House 08/05/06

Montague House 11/05/05

Montague House 19/01/05

Montague House 11/08/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Montague House 10 Brockenhurst Road Ramsgate Kent CT11 8ED Lead Inspector Christine Grafton Announced 17/10/2005 at 10:00hrs 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. Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Montague House Address 10 Brockenhurst Road, Ramsgate, Kent. CT11 8ED 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) 01843 591907 Mr Roy Edward Howse Mrs Susan Rule Registered Care Home 19 Category(ies) of Older People registration, with number of places Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11/05/2005 Brief Description of the Service: Montague House provides care for a maximum number of 19 older people and admits people with low to medium dependencies. It does not accept people who have high dependency needs, such as: those who cannot stand, who need lifting equipment to move from bed to chair (or wheelchair) or are wheelchair dependent for mobilisation. The home does accept people who use walking sticks and walking frames to move about and provides assistance with washing, dressing and bathing. Montague House is a detached two-storey building with 15 single bedrooms and 2 doubles. 13 bedrooms have ensuite facilities of a toilet and washbasin; all rooms have a call bell and television point. There is a stair lift to the first floor. There is a large well-maintained garden to the front and rear of the building, providing a number of areas for residents to sit. There is an off-street parking area to the front. The home is located in a quiet residential area of the town, close to the cliff top promenade. The nearest shops and amenities in the town centre are within easy reach. The staff complement consists of the manager, a team of carers, a part-time cleaner and a part-time cook. Care staff work a rota that includes one person on waking duty and one person on duty sleeping in at night. The registered provider usually spends four days a week at the home. Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over two days. The total time spent at the home was 12 hours 20 minutes. Additional time was spent in preparation and report writing. The inspection consisted of speaking with the registered manager, 3 staff members and 11 residents. Records were seen and an accompanied tour of the building was made. The majority of the key standards were inspected at this inspection visit. As part of the pre-inspection process, the registered manager completed a preinspection questionnaire and self-assessment, which have been used in the preparation of this report. Seven residents returned their comments cards that were sent out prior to the inspection. These indicated their general satisfaction with the home and services provided. At the time of this inspection there were 15 residents at the home, plus one in hospital. The care of five residents was case tracked. What the service does well: What has improved since the last inspection? Two more staff have completed an infection control course and one staff member has completed and passed her medication course since the last inspection. A staff member has nearly completed her National Vocational Qualification (NVQ) level 2 in care. It was clear from conversations with staff that the training has developed their knowledge and skills, thereby having a beneficial effect on the quality of care provided. Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 6 New replacement double glazed windows and fire doors have been fitted in the older part of the building. This has improved safety and security and provides a pleasant outlook for residents. Several residents commented positively about their new bedroom windows. What they could do better: There are a number of things that need improving to give residents a safe, homely environment and to make sure they are properly protected from certain safety risks that they might not be aware of, but that are important for their overall welfare. Some of these things have been identified at previous inspections, such as: improvements in residents’ initial assessments, care planning and the way their healthcare is managed; staffing numbers need to be calculated according to residents’ needs and care plans should include dependency assessments that are regularly reviewed, so that the manager has up to date information to base the home’s staffing levels on. Although some action has been taken to try and improve medication storage risks since the last inspection, some risks still remain and more improvements are necessary. No further action has been taken to address the risk of burns from hot radiator surfaces and pipe work, although the management has indicated that this will be rectified soon. This inspection has identified where some efforts have been made at improvements, but there are some significant shortfalls that need to be addressed within a limited timescale and requirements have been made to reflect this. The admission process, to assess the care needs of prospective residents, needs improving, to make sure enough information is obtained to see if the home can provide the level of care that the person requires. The residents would benefit from the provision of a programme of meaningful activities to provide them with stimulation and relieve boredom. Although there has been some investment in the building, with the addition of replacement windows, the overall standard of maintenance and quality of the furnishings has deteriorated with age and wear. Improvements are necessary to ensure residents have a comfortable, safe, more homely environment. (See the main body of this report for further detail). Sufficient numbers of staff need be to working at the home to enable the carers to provide a good quality of care. The management needs to review the home’s staffing numbers and take action to ensure that there are enough staff not only for care, but for cooking and cleaning tasks as well. The manager also needs to ensure that she has enough time to attend to her management tasks, as currently she does the cooking on Sundays and does some care shifts to cover. Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 7 Recruitment practices are not robust and do not provide the safeguards to protect residents living at the home. Police checks and checks against the protection of vulnerable adults list must be completed for the 4 staff who were not appropriately checked before they started work at the home. Some of the home’s health and safety procedures need to be improved to ensure the welfare and safety of residents and staff. 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. Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 8 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 Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 9 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) 3 & 4 Pre-admission assessments are not thorough enough. This has the potential to place prospective residents at risk of their needs not being met upon admission to the home and there is no assurance for them that the home can meet their needs. The home does not admit people for intermediate care, so standard 6 was judged as not applicable. EVIDENCE: The registered manager confirmed that she carries out pre-admission assessments for prospective residents. This might involve a visit to see the person in hospital, or in their own home. However, current documentation of this process does not provide sufficient meaningful information prior to the person’s admission to the home. Through the case tracking of three new residents, although a basic assessment sheet had been completed prior to admission in two cases, these comprised of a ‘tick list’ with minimal additional comments to expand upon the ‘yes/no’ answers. The paperwork was lacking in appropriate risk assessments. An example of this is the risk of falls and how this should be managed. This was particularly important for a person with a medical condition affecting balance. This person had fallen at the home since admission and sustained an injury. Another new resident’s care management assessment indicates a high risk of pressure sore development due to fragile Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 10 skin. Pressure relieving equipment had not been obtained prior to admission, although this had subsequently been provided. Skin integrity and nutritional assessments had not been carried out and the care plan upon admission did not cover these risks, or provide any guidance for staff on actions to reduce the risk of pressure sore development and maintain nourishment. Care management assessments had been obtained for each of the new residents case tracked, but important information in these had not been transferred and followed up in the home’s care plans. Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 11 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 Care plans are not detailed enough and do not adequately provide staff with all the information they need to satisfactorily meet residents’ needs. Incomplete assessments of residents’ health needs have failed to identify potential risks. The action taken to address medication storage risks since the last inspection still poses some risk to safety. Medication procedures are not sufficiently thorough and could potentially place residents at risk. Residents are treated with respect for their dignity. EVIDENCE: The registered manager has recently obtained some guidance and new paperwork on care planning. Some new care plan formats have been introduced for the most recent resident admitted. The manager agreed that there is still a significant amount of work to be done so that the home’s care planning system fully meets the national minimum standards. Five care plans were read as part of the case tracking. Care plans did not identify all of the residents’ needs that were apparent from speaking with the residents and staff. An example of this is a resident with an eye condition that requires the instillation of regular eye drops, but this had not been included in the care plan. There was a reference to poor sight in a monthly review but this was regarding the person’s wish for their food to be cut up “due to poor Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 12 eyesight”. Healthcare assessments, such as skin integrity and nutritional screening, have not been completed. An attempt has been made at risk assessments, but these are very basic and the same themes are used for each resident, some of which are not particularly relevant, or important to the individual – such as a bathing risk of falls, but the assessment states that staff provide assistance, a bath hoist is used and bathing is supervised. Other apparent risks have been left off and where a risk of falls is identified the instructions state merely “to supervise”, with no guidance on the specific steps to reduce risk. Monthly review records have been documented by the manager and provide a reasonable summary, but care plans have not been updated, or added to, when needs have changed. A monthly review record for one resident indicated a liquidised diet, but this was not reflected in the care plan. Weight records have recently been introduced and details of contacts with doctors and community nurses are recorded. The medication cupboard has been moved following discussion at the last inspection. The new position has reduced some of the safety risks previously identified, but the wooden cupboard has flaking paintwork that is not easy to wipe clean and maintain safe hygiene. There are no hand washing facilities, or work surfaces in, or near the room where the medications are now kept. There were two gaps in the medication administration records (MAR sheets) and one tablet was still in the blister pack for a dose that had been signed for. The manager stated she audits the MAR sheets usually once a month. The medication policy and procedure is not sufficiently detailed for staff to follow, for instance in the event of a verbal order from a doctor. Seven staff have undertaken medication training. Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 13 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 & 15 The more able residents pursue their own chosen individual activities. There is a lack of regular organised activities, to provide stimulation and motivation, particularly for the less able residents. Meals are well presented and residents like the food provided. EVIDENCE: There is no programme of activities for the residents to participate in. Seven of the eleven residents spoken to are able to pursue their own interests, such as reading newspapers, library books, doing crossword puzzles, sitting in the garden and one more able resident regularly goes out alone for walks. A resident said they have film shows every other week, but went on to say that there are no organised activities any more. Two residents said they used to like to play bingo, but this is not organised any more. The majority of residents spoken to said that they only go out of the home on outings if relatives or friends take them. Staff were seen engaging in conversations with residents, but staff and residents both said that this is dependent upon the staff having some spare time in between their care tasks. Several residents were seen sitting in the lounge areas with nothing to occupy them. Of the seven residents’ comments cards returned, six indicated that the home sometimes provides suitable activities and one indicated that it does not provide enough activities. In Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 14 discussion with the manager, she agreed that it would be beneficial if there could be a separate dedicated activities person, as care staff do not always have time and may not have the specific skills to organise meaningful activities that suit individual needs and motivate residents. The manager agreed to discuss this with the registered provider. There has been a change of cook at the home since the last inspection and some changes have been made to the menus. The day’s menu is displayed on a wipe clean board in the dining room. Two weeks menus were seen to include meals such as: turkey casserole, steak and kidney pudding, shepherds pie, chicken stew, sausages, fish in parsley sauce, roast lamb, roast pork and sliced beef in gravy. Residents said they like the food provided and confirmed that they have a choice of two options for dinner and tea. Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 15 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 & 18 Residents know that their complaints will be listened to and acted upon. Policies and procedures are in place to safeguard residents from abuse, but failure to ensure thorough recruitment checks on new staff poses a potential risk to residents. EVIDENCE: Residents spoken to said they had no complaints and would speak with the manager if they had any concerns. Residents spoke positively about the home, saying that the staff are good and listen to them if they have any worries. The home’s complaints procedure is prominently displayed with details of how to contact the Commission. Information in the pre-inspection questionnaire indicates that there have been no complaints since the last inspection. There is a system in place to record complaints. The home has a policy and procedures on abuse and adult protection. There is a ‘whistle blowing’ policy, which is discussed as part of the formal supervision process. A staff member said that abuse had been covered in their NVQ in care work and that she would discuss any concerns about this with the manager. Four new staff employed over the past year had started work without the proper criminal records bureau (CRB) and protection of vulnerable adults register (POVA) checks being completed. (See Staffing section, standard 29). Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 24, 25 & 26 The standard of the environment and overall quality of the furnishings and fittings has deteriorated with age and wear. Improvements to the environment are necessary to enhance the residents’ quality of life. The provision of a second bathroom in the home would benefit residents. Unguarded radiators place residents’ safety at risk. Hand washing facilities and the laundry written procedures need to be improved to ensure good infection control. EVIDENCE: Residents spoken to said that they like their bedrooms and appreciate having their own ensuite toilets. Only two bedrooms do not have ensuite facilities. Since the last inspection, replacement double glazed windows have been fitted to all windows and doors in the older part of the building, improving the look, safety and security of the home. On the tour of the building, it was seen that there are a number of areas that require attention, in particular: the flooring in the toilet in the front entrance hall is badly stained and there was a strong odour, despite the provision of a new extractor fan. An area of floor covering is missing in the staff toilet, exposing the concrete floor and posing a safety Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 17 and hygiene hazard. The dining room carpet is badly stained, however, an action plan provided indicates a planned renewal date of April 2006. Paintwork on lounge and dining room radiators is flaking. The carpet in the entrance hall and ground floor extension corridor is worn and stained. Several bedroom carpets were also stained. There are still a significant number of armchairs that are worn and shabby. The manager said that following the last inspection some of the worst armchairs were removed and one replacement chair provided. However, the need for new lounge armchairs was pointed out at the inspection carried out in August 2004 and there is little evidence of improvement. One lounge armchair has a worn seat cushion and the upholstery on the arms is worn down to the foam padding underneath. There is no door lock on the toilet in the entrance hall and the first floor shower room still has no lock. There is only one bath in the home. This has been fitted with a bath hoist that is regularly maintained. The manager said the shower is never used, but confirmed it is in working order and available for use if required. Therefore there is currently a ratio of 1 assisted bath to 15 residents and this does not provide any choice. It is questionable whether the current facility is sufficient. All of the radiators and pipe work in the older part of the building are unguarded, posing a risk of burns from the hot surfaces and a previous requirement is carried forward. An action plan has been submitted indicating the replacement of the laundry room sink in February 2006. In the meantime action has been taken to clean the sink. The written laundry procedure on display was outdated and there were no hand drying facilities provided. Paper towels were also missing in other areas where infected material is handled. Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 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 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 The overall number of staff on duty during the 24 hour day period is barely sufficient to meet the basic needs of residents and could place them at risk of inadequate protection. The management needs to introduce a system for determining residents’ dependencies and use the results to calculate the staffing numbers required. The home’s recruitment practices are unsafe, resulting in residents being cared for from staff who have not been properly vetted, placing them at risk. Staff morale is good. Adequate induction training is provided and there is a staff training programme in place to develop staff skills. EVIDENCE: Previous inspections have identified shortfalls in the numbers of staff on duty to meet residents’ needs. At the last inspection there had been some improvement, but this was mainly due to the manager changing her hours, working some split shifts, covering some evenings. The rota for the week of this inspection indicated only two staff on duty over the weekend day time period with a third person for the cooking. Weekday staffing levels are not much better in that there are two people for care between 08.00 hours and 20.00 hours, plus one domestic assistant and a cook in the mornings. There is also currently a kitchen assistant with special needs who has to be supervised. Care staff have to do the laundry and organise activities with residents (if they have time). Residents spoke of staff not having time to do activities with them as they are “very busy”, but indicated that the staff meet their needs. The manager still cooks on Sunday mornings as well as covering some evening care shifts, leaving her insufficient management time to attend to her Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 19 management tasks, for example, the numerous inspection requirements that remain outstanding. There is no other senior person to assist in some of the care management tasks, such as: carrying out assessments, drawing up care plans, auditing medications and to deputise for the manager in her absence. The manager agreed that there had been a deputy manager post in the past, but when the person left the post had not been refilled. The need for an overall review of staffing levels, taking account of discussion at this inspection, was agreed. The manager still has not introduced a dependency assessment tool to help her in the calculation of staffing numbers required to meet residents’ needs. A copy of the Department of Health Guidance for calculating staffing numbers has been obtained, but the manager is currently struggling with the concept and asked for advice. It is essential that a dependency assessment tool is introduced for this purpose. Since the last inspection, a resident with high dependency needs has been moved on to a home where nursing is provided. Residents spoken to feel their care needs are being met. Five staff files were checked and did not contain all the information required by the regulations, for example photographs and proof of identity. Four new staff have been employed since October 2004, without the necessary checks completed, for example, full employment histories, criminal records bureau (CRB) and protection of vulnerable adults (POVA) register checks. Induction records were not available but the manager confirmed she has been using the ‘Skills for Care’ training programme. Some staff training certificates were seen. Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 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 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) 31, 32, 33, 35, 36, 37 & 38 The management style of this home is reactive rather than proactive. The manager has an open management style and understands that improvements are needed, but there are no systems in place to indicate how these are going to be resourced and managed. An attempt has been made to undertake some quality monitoring but this needs to be further developed and outcomes acted upon. Record keeping could be improved. Some of the home’s health and safety procedures need to be improved to ensure the welfare and safety of residents and staff. EVIDENCE: The manager had been undertaking her National Vocational Qualification (NVQ) in management and care, but through no fault of her own, has had to restart the course with another training organisation. The outcome of this inspection indicates that the manager does not have sufficient time to fulfil her role and responsibilities, due to the poor overall staffing numbers on duty. (See Staffing section, standard 27). Annual quality monitoring questionnaires are Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 21 given to residents and copies were seen to cover the same format and questions each year. The quality assurance system needs to be developed to include staff and relatives’ views and to use other methods as well. The manager carries out formal supervision with staff every two months and records seen indicated a set format that has not changed since the process was introduced. The manager needs to formally demonstrate when ‘whistle blowing’, abuse and other such things are covered. Several bedroom fire doors were wedged open and the manager agreed that this was a safety risk, but said that this was at the residents’ request. The last formal staff fire training was completed in 2002 and the management have recognised that this is overdue. The home’s fire risk assessment has not been reviewed since 2003 and although environmental risk assessments have been updated, these are not sufficiently robust to reduce risk, for example several free-standing wardrobes require fixing to the wall for safety. Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 1 3 2 2 3 2 2 2 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 2 2 x 3 2 2 2 Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 23 YES 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 OP3 Regulation 14 Requirement Pre-admission assessments must be sufficiently detailed and fully documented, clearly showing the date and place the assessment is carried out. Risk assessments must be in place prior to admission, showing how risks are to be managed upon admission. Service user plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet residents health and welfare needs. The plans must be updated following reviews when health and/or personal care needs change. (Previous timescales of 30th April 2005 and 30th June 2005 not met). The registered manager must produce and implement care plans that detail all of the residents assessed needs, and provide clear instructions on how to meet those needs. The registered manager must ensure that all of the residents files have the required documentation including a photograph. The registered manager must Timescale for action 30/11/05 2. OP7 15 30/12/05 3. OP8 12,13, 14 18/12/05 Page 24 Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 & 15 4. OP9 13(2) 5. OP9 13(2) 6. OP9 13(2) ensure that residents health care needs are fully met. Care plans to show actions to be taken to reduce risks. Staff to be trained in how to complete care plans. (Previous timescale of 30/9/2005 not met). Dependency assessments must be carried out and their results used to inform the care plans. Skin integrity and nutritional assessments must be carried out, accurately recorded and their results acted upon. Medication storage must be safe 30/11/05 and comply with the Royal Pharmaceutical Society guidelines. Medication storage must be reviewed and action taken to address the previously identified risks. Action plan to be submitted. (Previous requirement made 12/8/2004 plus extended timescale of 1/3/2005 not met). Last timescale of 31/7/2005 partially met and carried forward. The registered persons must 30/11/05 ensure safe storage and safe procedures for recording, handling and safe administration of medicines. Medication cupboard must have wipeclean surfaces and be of suitable construction with appropriate fixing and lock. Action plan to be submitted showing review of medication storage to address identified risks. The medication policy and 30/12/05 procedures must be revised, developed and kept under review to include: signatures list of staff; photo identification of residents; procedure for acceptance of verbal orders; procedure to be followed in the case of error; regular audits of Version 1.40 Page 25 Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc 7. 8. OP9 OP12 13(2) 16(2)(m) (n) 9. OP19 23 10. OP25 13(4) 11. OP26 13(3)(4) 16(k) MAR sheets by an appropriately trained member of staff. A lock must be fitted to the medication fridge and temperature checks recorded. The registered presons must consult residents about a programme of activities arranged by, or on behalf of, the care home and provide facilities for recreation having regard to residents needs. A programme of meaningful activities must be planned and implemented. Worn armchairs must be renewed, shower and entrance hall toilet doors must be fitted with suitable locks, portable electrical appliance checks must be completed (carried forward from 26/8/2004 and 11/5/2005). A programme for the routine maintenance and renewal of the fabric of the premises must be drawn up. Action plan must be submitted covering all areas of the building, prioritising improvements needed and specifying timescales for work to be completed. (Previous requirement 26/8/2004 plus extended timescales of 1/3/2005 and 30/6/2005 carried forward). An Action Plan for the guarding of radiators must be submitted, prioritised according to risk and specifying timescales. (Previous requirement 30/6/2005 carried forward). Action must be taken to address infection control risks previously identified in the laundry on 26/8/2004 and 11/5/2005 for the replacement of the sinks with a suitable sink and wash hand basin. Suitable hand washing facilities of liquid soap and paper towels must be provided in the 30/11/05 30/12/05 30/11/05 30/12/05 30/11/05 Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 26 12. OP27 18 13. OP27 18 laundry, bathrooms, toilets and bedrooms where personal care is given. (Previous requirement 26/8/2004 plus extened timescale of 1/3/2005 and 30/6/2005 carried forward). Laundry procedure to be reviewed and updated. The registered persons must 18/12/05 ensure that there are sufficient numbers of suitably qualified, competent and experienced staff on duty at all times to meet the needs of residents and the size of the home. Staffing calculations must be based upon residents dependency assessments, which must be kept up to date at all times and specify whether the resident is high, medium, or low dependency. Evidence of residents dependency calculations and 4 weeks staff rotas to be submitted. (Previous requirement timescale of 1/3/2005 partly met and carried forward on 11/5/2005 to 30/6/2005 not met). New timescale set (see below). The registered persons must 18/12/05 take action to address the staffing shortfalls identified at this inspection, in addition to the requirement above carried forward from 11/5/2005. Staffing numbers must be reviewed and increased where necessary, to include sufficient staff time at a senior level, to support and deputise for the manager, in addition to providing sufficient care, cleaning and cooking hours throughout the whole week. Action plan to be submitted with 4 weeks rotas reflecting planned improvements. H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 27 Montague House 14. OP29 19 15. OP29 19 16. OP31 9 & 10 17. OP33 24 18. OP37 17 19. OP38 13(4) & 23 (4) The registered persons must not employ a person to work at the home unless that person is fit for the work required and information specified in Schedule 2 has been obtained. CRB and POVA checks must be obtained for all staff employed. POVA first checks must be carried out for the 4 new staff identified. Enhanced CRB disclosures must be applied for, for those 4 staff and confirmation submitted to the commission. Staff files must contain all the information specified in Schedule 2, including a recent photograph, evidence of identity, 2 references, including 1 from the last employer. The registered manager must have the qualifications and skills necessary for managing the home - NVQ level 4 in management and care to be achieved (Carried forward from 11/5/2005). The registered persons must establish and maintain a system for reviewing and improving the quality of care provided at the home. The homes quality monitoring process to be developed as discussed. The registered persons must ensure that the specified records contain all the required information. The registered persons must ensure that the homes environmental risk assessments and fire risk assessment are kept under review and are sufficiently robust to protect residents, staff and other people in the home. Staff fire training must be updated. Fire doors must not be wedged open. Action must be 31/10/05 30/11/05 2005 31/01/06 31/01/06 30/11/05 Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 28 taken to ensure that fire doors that need to be kept open will close automatically in the event of fire. 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 OP12 Good Practice Recommendations To consider providing a designated Activities Person to work at the home for specified periods, who has the experience and skills necessary to provide a range of meaningful activities for residents. That bathing facilities within the home are reviewed and consideration given to providing an additional assisted bath. An interview record to be kept showing that employment history has been checked out and reasons for gaps in employment explored. Induction records to be kept on file. The homes formal supervision process to be further developed as discussed. 2. 3. OP21 OP29 4. OP36 Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 29 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. Extracts may not be used or reproduced without the express permission of CSCI Montague House H56-H05 S23499 Montague House V247923 171005 stage 4.doc Version 1.40 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!