Inspection on 08/05/06 for Montague House

This inspection was carried out on 8th May 2006.

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 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 Christine Grafton Key Unannounced Inspection 8th May 2006 09:50 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.V293640.R01.S.doc Version 5.1 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.V293640.R01.S.doc Version 5.1 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.V293640.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd August 2002 Brief Description of the Service: Montague House provides care for a maximum number of 19 older people with low to medium dependencies. It does not accept people with high dependency needs, such as those who cannot stand, who need lifting equipment to move, or are totally wheelchair dependent. 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, with 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 at night, with one person on duty sleeping in. On 7th May 2006 the scale of charges were: from £303.25 to £399.00 per week. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection takes account of information obtained from various sources since the last inspection, including telephone contacts with the home, written information provided by the manager and surveys completed by residents, relatives and general practitioners. An unannounced site visit was made to the home on 8th May 2006 between 09.50 hours and 17.00 hours when six residents, the manager and one carer were spoken to. The visit also included looking round communal areas of the home and a selection of bedrooms, plus checking some records. The care of three residents was case tracked. At the time of the visit there were fifteen residents. A second visit was made on 1st June 2006 between 11.00 hours and 12.30 hours to speak to the provider and manager about the findings and to clarify some issues. Information provided by the manager indicates that the scale of charges ranges from £303.25 to £399.00 per week. What the service does well: What has improved since the last inspection? Nine staff have completed their fire training since the last inspection. This has improved safety and increased staff confidence. Some efforts have been made to make the environment more homely and safe for residents. A new dining room carpet has been fitted and the flooring replaced in a ground floor toilet. Most of the exposed pipe work in the home has been covered to reduce the risk of burns from hot pipes. Redecoration work has continued, including the repainting of some radiators and woodwork. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 6 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. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home’s assessment process is not thorough enough to make sure that potential risks can be properly managed when service users move into the home. The home does not admit people for intermediate care, so standard 6 was judged as not applicable. EVIDENCE: The pre-admission assessments for three new residents were not sufficiently detailed. One new resident had visited Montague House before moving in, had settled in well and was pleased with the home. This person’s needs were not fully recorded within the home’s assessment record, but were understood by staff and in the main, being met. However, there was no planned approach to this person’s care. Important information had been omitted from the records that could result in certain health care needs not being met. No care plan had been drawn up and significant risks had not been recorded, including an important healthcare need. This communication method is reliant on verbal transfer, with the danger of it being overlooked. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 9 The assessment for another new resident had failed to pick up on warning indicators of some mental health needs. Following admission, there had been several behaviour incidents that had required contacts with the doctor and a referral to a psychiatrist. The care plan did not show how to manage the behaviour and some significant needs were not followed up. This was apparent in conversation with the resident. The risk of falls identified in another new resident’s pre-admission assessment had not been adequately addressed. A recent fall had not been appropriately followed up. Significant moving and handling needs observed, associated with transfer to a wheelchair, had not been included in the person’s care plan, or risk assessment, to make sure that all staff were aware of how to carry out the manoeuvre safely. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care planning system is inconsistent and does not provide staff with all the information they need to meet residents’ needs. The management of residents’ healthcare is not sufficiently robust with the risk that some residents’ needs are not being properly met. Residents are treated with respect for their dignity. EVIDENCE: A dependency assessment tool has been introduced since the last inspection but the results were not being used to inform the care plans, which still do not identify all apparent needs. The three care plan files read as part of the case tracking were inconsistent. Assessments were not thorough enough and were not followed through in the care plans. Staff were not using the care plans to inform their practice, but instead were depending upon the verbal transfer of information. This poses the risk of important things being overlooked. The care plan for a resident at high risk of falls did not show how to reduce this risk, or how to provide assistance with mobilising. The doctor had not been informed following a fall where the resident had sustained an injury to the forehead. The manager was unable to provide an explanation as to why this Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 11 had not been followed up, or why it had not been recorded in this person’s review records. Where a skin integrity risk had been identified in a care plan there were good instructions for staff. However, review records did not give any indication of the healing process since the person was admitted two months ago. Review records were not being regularly updated. This was especially important in the case previously referred to under standard 3, where mental health needs were not being addressed in the care plan. A staff member was observed talking to residents in a respectful manner. A new resident confirmed s/he is treated with respect for privacy and dignity. Some action has been taken to improve medication storage and procedures since the last inspection. A new medication cabinet has been ordered and the home is awaiting delivery. The manager is carrying out regular audits of the medication administration sheets (MAR) sheets and no gaps were noted. However, there was no risk assessment for a resident who was receiving Warfarin medication, which is necessary to make sure staff are aware of important side effects and possible interactions with other agents. A hand written entry for some analgesic tablets on a MAR sheet had no evidence of authorisation. Another hand written entry for a psychotropic drug had no dosage recorded, was undated and did not have the number received. There was still no staff initials list and no photo-identification for each resident with the MAR sheets. These were requirements made at the last inspection. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities available in the home for stimulation and for people to pursue leisure activities, whilst satisfactory for some residents do not reflect the diversity of all of its residents and their physical and intellectual capacities. Meals are well presented and residents like the food provided. EVIDENCE: Three of the six residents spoken to said the home’s routines are flexible and they pursue their own interests, such as reading newspapers or library books. Two other residents were observed coming and going between the lounge, dining room and their own bedrooms. One resident prefers to stay in her room but socialises at meal times. One resident regularly goes out for walks. Residents said they still have film shows once a fortnight, but could not recall any other entertainment or activities. Five residents were observed sitting in the lounge with nothing to occupy them except the television. Residents only go out if relatives or friends take them, or for hospital appointments. The case tracking of two residents with physical and mental capacity needs did not identify any participation in activities, either individual, or group activities. No group activities are arranged. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 13 The manager said there had been no development of activities since the last inspection and agreed that the provision of an activities person would be of benefit. At the return site visit, she had arranged for someone to fulfil this role in the home, with nine hours per week planned specifically for activities. Care staff sometimes spend time doing manicures. Residents are provided with a choice of food, which is pleasantly presented and served. Four residents said they like the food. Residents’ spoke of socialising with other residents at meal times and the dinnertime meal was observed to be unhurried. The day’s menu is displayed in the dining room. The part time cook knows the residents’ tastes. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents know that their complaints will be listened to and acted upon. Procedures in place to protect residents are not sufficiently robust posing a potential risk. EVIDENCE: The manager said there had been no complaints since the last inspection. She agreed that she generally resolves minor issues as they arise, but does not record them, or the action taken. Residents spoke of talking to the manager if they have any concerns and confirmed they felt able to go to any of the staff if they were not happy about something. A staff member confirmed they would speak to the manager if they saw any indication that might lead to a suspicion of abuse. The complaints procedure is displayed in the dining room. There is a policy and procedure in place on abuse and adult protection. Criminal records bureau and protection of vulnerable adults register (CRB/POVA) checks have been carried out on the four new staff identified at the last inspection, but there are still two long standing staff for whom these checks have not been made. The case tracking identified that staff were dealing with a resident’s behaviour in a reactive way. There was nothing in the person’s care plan to ensure that all staff know the correct method of handling the behaviour. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further improvements to the upkeep of the premises and overall quality of furnishings and fittings are necessary to provide residents with a comfortable and safe environment. Bathing facilities within the home do not provide sufficient choice for residents. Unguarded radiators in the older part of the building place residents’ safety at risk. Infection control procedures are not adequate enough to maintain safety. EVIDENCE: A resident said how pleased she was with her bedroom, which was comfortably furnished and had a variety of personal possessions pleasantly arranged. Several other residents commented that their bedrooms suit their needs. Some improvements have been made to the environment since the last inspection, including, a new dining room carpet, replacement flooring in a ground floor toilet, covering of exposed pipe work and the repainting of some radiators and woodwork. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 16 Whilst the environment as a whole is adequate, there are a number of outstanding things from the last inspection where little or no action has been taken to improve them. No progress had been made to guard radiators in the older part of the building, despite this being a requirement at the inspections of 30th June and 17th October 2005. The action plan submitted following the last inspection indicated that high and medium risk radiators would be covered by the end of April 2006, with low risk ones due for completion by the end of May 2006. One lounge radiator in the bay window had an extremely hot surface temperature posing a risk of burns. The provider had identified this as medium risk and due to be guarded by the end of April, but this had not been done. The need for new lounge armchairs was first pointed out in August 2004. Some old worn armchairs have been removed, but no new armchairs have been provided to replace them. There were still two worn armchairs with holes in the fabric, one of which exposed the foam stuffing. There would not be enough armchairs in the lounge if any more residents wished to sit there, as all the available chairs were being used. All but two of the bedrooms have ensuite toilet facilities, which residents appreciate. However, there is only one bath in use for fifteen residents. This was identified at the last inspection as offering no choice for residents and not being sufficient. A resident said they would like a second bath a week but felt it was not possible. The bathroom flooring is split along the seam with raised edges posing a safety hazard. Commode pots are being cleaned in one of the two sinks in the laundry room, which is also used for dealing with soiled articles. The second sink is used for washing clothes that need to be hand washed. There is no separate hand washbasin for staff hand washing. The laundry procedure has still not been revised following the last inspection and is not detailed enough. There is paint peeling off the wooden surface area adjacent to the washing machine and tumble drier. There is no proper segregation of soiled and clean articles posing a risk of contamination. All of this poses a risk of cross-contamination. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The overall number of staff on duty throughout the day and night is barely sufficient to meet the basic needs of residents and could place them at risk of inadequate protection. The home’s recruitment practices are still unsafe, resulting in residents being cared for by some staff who have not been properly vetted, placing them at risk. Residents appreciate the stable staff team. EVIDENCE: Four of the residents spoken to made positive comments about the staff complement and the care they provide. Comments from residents included: “staff are very nice”, “they treat us well” “staff are ready to help at any time” and “we have a laugh here”. Those residents spoken to were appreciative of the continuity of care provided by having a stable staff team. The manager had introduced residents’ dependency assessments since the last inspection, but had been struggling with the calculations suggested in the Department of Health Guidance. Following the first visit to the home however, this had been used to determine the staffing numbers required, which identified a shortfall in the care hours provided. The week’s rota indicated a total of eight carers to cover the day and night shifts, with two carers on duty during day time shifts and one waking and one sleeping in person on duty at night. Some staff work both day and night shifts and there was evidence that staff were working the morning shift and Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 18 returning to do the waking night shift on the same day. A resident said that a carer had worked the previous night shift, had taken a resident to hospital during the morning and was due back on duty for the afternoon shift of 14.00 hours to 20.00 hours. The manager confirmed this at the second visit to the home. Care staff also do laundry duties and are expected to do activities with residents if they have time. Residents said that the staff are very nice, but one resident spoke of having a late bath as staff were busy and another said they would like a second bath during the week but did not think this was possible. Evidence from the case tracking indicated a need for close supervision at night for two residents and another resident would need two carers for moving and handling. The manager does not have enough time to complete all of her management tasks and there is no designated senior person to assist her in some of the care management tasks. Staffing requirements made at the last inspection have not been met. Criminal records bureau checks had been obtained for the new staff identified as not having them at the last inspection. One new carer had been employed since then. The recruitment process had involved obtaining an employment history, two references and a POVA first check (protection of vulnerable adults register), but part of the employment history had not been properly verified and the process had not been completed until after the person started work. There was no evidence that this person was being appropriately supervised and the person was identified on the week’s rota as the second carer on duty for two shifts. Staff files still do not contain all the information required by the regulations. Induction records were not available but the manager stated that the ‘Skills for Care’ training programme is being followed. Some staff training certificates were seen, including one staff member’s National Vocational Studies (NVQ) level 2 & 3 certificates. Rotas submitted to address the staffing requirement following the first visit and a new rota provided at the second visit to the home indicated some proposed improvements, but these were still not sufficient. The registered provider indicated his commitment to try and address the remaining shortfalls identified. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of this home is not sufficiently robust to fully ensure the health, safety, welfare and best interests of residents and staff. EVIDENCE: The manager is continuing with her National Vocational Qualification level 4 and hopes to have completed it by the end of August 2006. The poor staffing levels have left insufficient time for the manager to fulfil her management role. The manager has not been able to put right the majority of the nineteen requirements and four recommendations of the 17th October 2005 inspection, many of which have been ongoing for the past two years. Some improvements have been made but they have not been sufficient to fully meet the standards, as can be seen throughout this report. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 20 Some of the things previously identified just need time to complete the records, which have not been done. The provider and manager agreed with this at the second site visit when the proposed rotas indicated she had freed more management time for herself. Also, the manager had started to make changes to try and improve the care planning system Efforts had been made to monitor the quality of the service provided by sending out questionnaires to families. Staff fire training had been completed in December 2005 but not recorded in the home’s Fire Book. The electrical certificate expired in 2005 and although the provider and manager both stated the electrical inspection had been done in December 2005, they could not produce the certificate. The environmental risk assessments had not been updated. Other health and safety issues have been identified throughout this report including weaknesses in moving and handling procedures and infection control. Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 1 1 3 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 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 2 2 x x 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 1 X 2 x 3 x 2 1 Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 22 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 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. (Previous requirement made 17/10/2005 not adequately met and carried forward). 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 timescale of 30th April 2005 not met). The registered manager must ensure that all of the residents files have the required documentation including a photograph. (Previous requirement made 17/10/2005 not adequately met and carried Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 23 Timescale for action 30/06/06 2. OP7 15 30/06/06 3. OP8 4. OP9 5. OP12 6. OP19 forward). 12, 13, 14 The registered manager must & 15 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 requirement made 17/10/2005 not adequately met and carried forward). 13(2) The medication policy and procedures must be 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. (Previous requirement made 17/10/2005 not adequately met and carried forward). Confirmation to be provided of this and the receipt and fitting of the new medication cabinet. 16(2)(m) The registered persons must (n) 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. (Previous requirement made 17/10/2005 not adequately met and carried forward). 23 Worn armchairs must be renewed, shower room door to be fitted with suitable lock; confirmation of portable electrical appliance checks must be submitted (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 30/06/06 30/06/06 30/06/06 31/05/06 Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 24 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 and 17/10/2005 not adequately met and carried forward). There must be sufficient numbers of baths provided for residents’ use. Action plan to be submitted. Risks from unguarded radiators must be addressed. (Previous requirement 30/6/2005 and 17/10/2005 not met and carried forward). Action must be taken to address infection control risks previously identified in the laundry on 26/8/2004, 11/5/2005 and 17/10/2005. To include the provision of a suitable sink and wash hand basin. Laundry procedure to be revised to cover infection control risks identified. Previous requirement not met and carried forward. An appropriate sluicing facility must be provided for the cleaning of commode pans. Action plan to be submitted. The registered persons must 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 having regard to the size of the home. Staffing numbers must be reviewed and increased where necessary, to include sufficient staff time at a senior level, to Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 25 7. OP21 23 31/07/06 8. OP25 13(4) 30/06/06 9. OP26 13 & 16 31/05/06 10. OP26 23 31/07/06 11. OP27 18 22/05/06 support and deputise for the manager, in addition to providing sufficient day and night care hours, cleaning and cooking hours throughout the whole week. Action plan to be submitted with 4 weeks rotas reflecting planned improvements. Previous requirement made on 11/5/2005 and 17/10/2005 not met. 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. 12. OP29 19 09/05/06 13. OP29 19 Previous requirement 17/10/2005 not met. Staff files must contain all the 30/06/06 information specified in Schedule 2, including a recent photograph, evidence of identity, 2 references, including 1 from the last employer. Previous requirement 17/10/2005 not met. The registered manager must 31/08/06 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 and 17/10/2005). The registered persons must 31/07/06 ensure that the specified records contain all the required information. The registered persons must 31/07/06 ensure that the homes environmental risk assessments and fire risk assessment are kept DS0000023499.V293640.R01.S.doc Version 5.1 Page 26 14. OP31 9 & 10 15. OP37 17 16. OP38 13(4) 23(4) Montague House under review and are sufficiently robust to protect residents, staff and other people in the home. (Carried forward from 17/10/2005). Appropriate procedures must be in place to reduce the risk of falls and to address moving and handling risks. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP12 OP18 OP29 Good Practice Recommendations To ensure that the extra 9 hours per week proposed for activities are provided and that residents are involved in arranging the activities plan. That staff are trained in the management of aggression and to ensure that procedures to be followed when dealing with aggression are recorded and staff understand them. 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 available on staff files. (Partially met and carried forward from 17/10/2005). That the homes quality monitoring process is further developed. The homes formal supervision process to be further developed. (Carried forward). 4. 5. OP33 OP36 Montague House DS0000023499.V293640.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Montague House DS0000023499.V293640.R01.S.doc Version 5.1 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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