Inspection on 25/04/07 for Montague House

This inspection was carried out on 25th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 28/11/06

Montague House 08/05/06

Montague House 17/10/05

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 Montague House 10 Brockenhurst Road Ramsgate Kent CT11 8ED Lead Inspector Tina Thomas Key Unannounced Inspection 25th April 2007 09:45 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 Montague House DS0000023499.V336898.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. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Montague House Address Montague House 10 Brockenhurst Road Ramsgate Kent CT11 8ED 01843 591907 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Roy Edward Howse Mrs Susan Rule Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2006 Brief Description of the Service: 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. Montague House 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 them, or are wheelchair dependent for mobilisation. The home does accept people who use aids such as walking sticks and walking frames. The staff team work a rota that includes one person on waking duty and one person on duty sleeping in at night. Information provided by the manager in October 2006 indicates that the fees range from £312.81 to £439.00 per week and additional charges are made for hairdressing, chiropody and newspapers. Montague House DS0000023499.V336898.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, looking at key standards of care. The inspection process took place over a period of time, information was gathered, and it concluded with a site visit conducted over a one day period. Judgements were made by taking into account evidence from a range of documentation, a tour of the home, views of service users, staff and the manager. What the service does well: What has improved since the last inspection? The home has radiator covers to reduce the risk of scalds and burns to people that live in the home. Staff numbers have improved to better meet the needs of people living at the home. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 6 The homes recruitment procedures have been strengthened. All staff have CRB’s to reduce the risk to people living in the home from abuse. The manager has completed NVQ Level 4 training. What they could do better: People that come to the home ‘muddled’ or with short term memory loss, should have a plan of care that takes this into consideration. It should be properly monitored and observed. Care plans identify what care people need, but they do not sufficiently explain to staff how best to deliver care or the preference of the people living at the home for receiving their care. The manager must develop an activities programme taking into account peoples choices and abilities so that they can be meaningfully engaged throughout the day. The manager must ensure that staff have training and awareness of adult protection so that people living in the home are protected from abuse. The Provider must develop a development plan to show how he is going to improve the environment in a timely manner so that the home is a comfortable place for people to live. The manager must ensure that proper infection control procedures are in place and used by staff to ensure that both staff and people that live at the home are not at risk from infection. This will mean that the manager will ensure that staff do not use communal towels and that there are proper procedures regarding the sluicing of foul linen. The Provider must develop a more formal quality assurance process so that he can demonstrate how the home is developing and improving. The Provide has been required on three previous occasions to ensure the health and safety of people living in the home. Lack of sufficient staff training, fire practices, infection control practices and some areas of the environment continue to pose some risk for people living in the home and staff. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 7 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. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Montague House DS0000023499.V336898.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users have sufficient information about the home so as to be able to make an informed choice. The contract has been reviewed Prospective service users needs are fully assessed before they move into the home. However, there are occasions when the home cannot evidence that they can meet their needs, for example, staff do not have training regarding diminishing cognitive ability. The home does not offer intermediate care. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home has a well-documented statement of purpose and service user guide, which clearly reflects what the home has to offer and describes day-today life at the home. The manager described the changes that have been made to the homes contract with people that live in the home. The manager conducts all the pre-admission assessments. The assessments have developed over time and are now holistic in nature. They are well documented. However, sometimes people are admitted without staff having suitable training to enable them to meet their needs. The home does not offer intermediate care as described in Std 6 National Minimum Standards (Homes for older people). Montague House DS0000023499.V336898.R01.S.doc Version 5.2 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. 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. The planning of care needs improvement. Some areas of people’s health care needs are met, although psychological needs are not always addressed. Medication procedures are sound. The home adopts practices that ensure that the privacy and dignity of service users is protected. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 12 EVIDENCE: The home develops a plan of care for each person living at the home. Each person’s needs of daily living. This assessment is in-depth. However, the plan that is developed, stating how staff are to support these needs, often does not reflect the needs that have been originally identified. People who have been identified with short term memory loss have no reference made to this in their plan of care. There is no monitoring of any cognitive deterioration. Some people have signed their agreement of their plan of care. Entries in care plans showed that service users had access to G.P’s and other specialist services. However, people who came to the home with ‘short term memory loss’ or were ‘muddled at times’ had no further investigation into the cause or monitoring of their cognitive ability. The home has some equipment for the comfort of service users for example: air beds. However, many of the homes beds are aged divans. There is no facility to raise beds and the home does not have a hoist to assist staff when caring for people in bed. Procedures regarding the ordering, storage, and safe disposal of medication was audited and found to be sound. Staff that administer medication have suitable training to ensure the safety of people in the home. People spoken with said that the care staff observed their privacy. Care staff knocked on doors before entering private rooms. Most rooms had lockable facilities for people to put their private items. Doors to people’s bedrooms had locks that they could use if they chose. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have a suitable programme of activities, which considers the preferences of service users. People at the home are encouraged to maintain contact with family, friends and the community. Whilst the more able people at the home are encouraged to exercise choice and control over their lives, more dependant people do not have the same degree of opportunity. Meals are wholesome and plentiful. EVIDENCE: Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 14 Some people expressed that they were happy at the home and how for them life at the home met their expectations. Some people retire to their room when they choose, and get up and go to bed when they choose to. Staff expressed that other, more dependant people are routinely woken and got up early by staff. The decision making process in regard to this is not documented in these peoples care plans. There are limited activities at the home. The home has an activities person who works on a Monday and again on Friday and engages people in formal activities. On the day of inspection eight out of eleven people were asleep in their chairs at 10.45 in the morning. There were no activities in place to stimulate them. People agreed that their relatives were made welcome during visits. They agreed that their visitors were welcome at all times without appointment. People are encouraged to exercise choice and control over their own lives. Service users are encouraged to bring items from their own homes to personalise their own rooms. People who live at the home and staff agreed that meals are wholesome and plentiful. People felt comfortable in asking for what they wanted. Hot and cold drinks together with snacks are offered to service users regularly. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home has a suitable complaints procedure. The home does not have suitable training in place to ensure that service users are protected from abuse. EVIDENCE: A complaints procedure was available to all people that live in the home and this was included in the service user guide. Service users spoken with all felt safe, listened to, and able to speak to the manager if they were not happy about anything to do with their care. The home has a complaints policy and a complaints book, but they have no ongoing complaints. The home has a whistle-blowing policy. Staff have not had adult protection awareness training. They must have this to ensure the ongoing safety of people in the home. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 16 The policy and procedures of the home ensure Service users finances are protected. The home does not look after service users finances. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally clean. It is not well maintained in all areas. Radiators have been guarded to ensure peoples safety. Policy, procedure and practice in regard to infection control is poor. EVIDENCE: The home was clean and odourless throughout. The home is suitable for its purpose. The home has a selection of communal rooms. The home has a garden area that is enjoyed by people at the home. However, some areas of Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 18 the home are furnished with aged furnishings. Some carpets are frayed and this may cause a trip hazard. The Provider has not supplied the Commission with an action plan specifying timescales for work to be completed despite two previous requirements with timescales of 08/05/06 and 31/01/07. Doors to rooms are propped back with footstools and other items. This is a risk in the case of a fire. Radiators at the home are now all guarded and this reduces the risk to people who live there of scalds and burns. At the last inspection it was observed that staff hand sluice soiled articles before putting them in the washing machine, as it does not have a sluicing cycle. It was discussed with the provider and manager that this places staff at risk of infection from airborne droplets, as well as possible contamination risks when emptying the faecal matter in a nearby toilet. The need for a sluicing facility was again discussed and the provider agreed to consider this in his improvement plan. This has not been addressed and staff continue to hand sluice foul articles. The home does not have any suitable policy, procedure or risk assessment regarding this practice. Practices regarding infection control continue to be poor despite staff receiving training. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 19 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. Staff numbers are appropriate to the needs of the people who currently live at the home. The homes practice regarding the recruitment of staff ensures the safety of people in the home. Staff do not receive suitable induction, foundation or service specific training. EVIDENCE: The manager has increased the number of staff that are on duty in the mornings. The Provider has employed a senior carer to support the manager. The manager and staff agreed that this has been of benefit to the home. The home has two members of staff on duty of a night with the manager or senior carer on call at all times. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 20 50 of staff are trained to NVQ Level 2. New staff are enrolled on appropriate induction and foundation training. However there was no evidence in the home of the work being completed. The home has suitable recruitment procedures, so as to ensure the safety of people within the home. All staff have CRB’s prior to commencing employment at the home. Staff do have training, and this is evidenced from certificates displayed throughout the home. The manager does not have any system to evidence which staff have had what training and when refreshers are due. This was highlighted in the last inspection report but has not been actioned by the manager. Staff do not have individual development profiles and the manager does not have a budget for training. Staff agreed that whilst they received some mandatory training, they did not receive any service specific training i.e. dementia training, or incontinence care. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified to manage the home but does not have autonomy over budgeting and plans for the future. The Provider must address issues of health and safety to ensure that people in the home are kept safe. EVIDENCE: Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 22 The manager has the suitable qualifications to manage the home. However, there was little evidence to suggest that she had autonomy over her role. She does not have any influence in the budgeting within the home. She was also unaware of the contents of any development plan and in fact was not aware if one even existed. The manager has an ‘open’ approach to management. Staff and people that live in the home are offered opportunity through regular staff and residents meetings to affect the manner in which the home is run. The home does not have a suitable quality assurance processes. Surveys have been sent out to relatives but the information has not been collated into a report. Whilst the manager said that the provider visits the home daily, the Provider does not complete regulation 26 visits, which providers must complete as a quality assurance check when they are not in day-to-day control of the home. Policies, and procedures are not regularly reviewed. Agreed timescales to implement requirements identified in CSCI inspection reports are frequently not actioned. The home does not become involved in the financial affairs of people that live in the home. Apart from one bedroom, all rooms viewed provided the people that live there with suitable lockable facilities to put private items. Each person had a record of items that they had bought into the home. The health and safety of service users is not always observed. Staff do not in all cases have suitable training. The home does not observe safe fire practices, or infection control procedures. Windows on the upper floor do not have window restrictors and no risk assessment regarding this matter are in place. Some carpets are frayed causing trip hazards. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 1 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 x x 2 Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Service user plans must be reviewed in sufficient detail and updated when health and/or personal care needs change. NOT MET 31/12/06 The routines of daily living and activities made available are flexible and varied to suit service users’ expectations, preferences and capacities. Staff must have suitable training so as to protect service users form abuse. The registered person shall ensure that the premises are fit for purpose and residents live in a safe well-maintained environment. The programme for the routine maintenance and renewal of the fabric of the premises to be continued. Action plan to be submitted specifying timescales for work to be completed. (Previous requirement 08/05/06 partially met and carried forward) Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 25 Timescale for action 01/06/07 2 OP12 16 01/07/07 3 4 OP18 13 23 01/07/07 01/06/07 OP19 5 OP26 13(3) 23 NOT MET 31/01/07 Systems in place to control the spread of infection must be in accordance with relevant legislation and published professional guidance. Procedure for sluicing of soiled articles to be reviewed and any necessary action taken to ensure safety. Any necessary sluicing facility to be provided. (Previous requirement 08/05/06 carried forward). 01/06/07 6 OP38 13(4) NOT MET 31/01/07 All parts of the home to be kept free from hazards and unnecessary risks to residents’ health, safety or welfare are identified and so far as possible eliminated. Records of the weekly walking route health and safety checks to be kept and environmental risk assessments to be regularly reviewed and updated. (Previous requirement 17/10/05 & 08/05/06 partially met and carried forward). NOT MET 31/01/07 01/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 26 No. 1. Refer to Standard OP3 Good Practice Recommendations That personal profiles and details about residents’ interests are added to the assessments and care plan documentation. Not actioned from previous inspection 2. OP29 To keep separate interview records and to record any discussions with potential employees about any disclosures with the reasons for the decision to employ. Not actioned from previous inspection 3. OP30 That a staff training and development programme is devised and implemented. Staff training matrix to be forwarded. Not actioned from previous inspection 5. OP33 To develop and continue the homes’ quality monitoring process and to publish the results in the service users’ guide. Not actioned from previous inspection Montague House DS0000023499.V336898.R01.S.doc Version 5.2 Page 27 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 © 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 DS0000023499.V336898.R01.S.doc Version 5.2 Page 28 - 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. 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