Inspection on 01/02/06 for Montague Road Nursing Home

This inspection was carried out on 1st February 2006.

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 Road Nursing Home 21/08/08

Montague Road Nursing Home 07/09/07

Montague Road Nursing Home 15/08/06

Montague Road Nursing Home 14/11/05

Montague Road Nursing Home 31/01/05

Montague Road Nursing Home 28/07/04

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

CARE HOMES FOR OLDER PEOPLE Montague Road Nursing Home 14 Montague Road Felixstowe Suffolk IP11 7HF Lead Inspector Jane Higham Unannounced Inspection 1st February 2006 10:45 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 Road Nursing Home DS0000024450.V280811.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 Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Montague Road Nursing Home Address 14 Montague Road Felixstowe Suffolk IP11 7HF 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) 01394 670111 01394 276021 Orbit Housing Association Mrs Anne Amelia Scott Care Home 24 Category(ies) of Dementia (24), Dementia - over 65 years of age registration, with number (24), Mental disorder, excluding learning of places disability or dementia (24), Mental Disorder, excluding learning disability or dementia - over 65 years of age (24) Montague Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 2005 Brief Description of the Service: Montague Road is a 24 bedded residential home with nursing, providing care and accommodation to older people who suffer from either organic or functional mental health problems. The home was initially registered in April 1993 and is purpose built, sited in a residential area of Felixstowe, close to both the town centre and sea front. All admissions to the home are via the Social Care Services Department due to the joint funding arrangements with Orbit Housing Association who staff and administer the premises. Living accommodation is sited on two floors and is divided into three main living areas. Each of these consists of eight bedrooms with ensuite facilities, a communal bathroom, toilets and a lounge and kitchen /dining room. A secure garden surrounds the building and there is limited car parking to the front. Montague Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Inspection of 14 Montague Rd., a 24 bedded care home with nursing for service users over the age of 55 with a diagnosis of dementia or a functional type mental health problem. The home is owned by Orbit Housing Association and is situated in a residential area of Felixstowe, close to both town centre and sea front amenities. Orbit Housing is a non-profit making organisation run by voluntary committees and providing a cross section of housing throughout the country. The home is operated in conjunction with both health and social care services and as such admission can only be accessed via these agencies. This was the second inspection in the inspection year 2005/2006. The inspection took place on 01 February 2006 over a period of four and three quarter hours. All core standards have been assessed over the two inspections and this document should be read in conjunction with the report of the Unannounced Inspection dated 14 November 2005. The home was inspected against the National Minimum Standards: Care Homes for Older People and the Care Standards Act 2000. The National Minimum Standards and Care Homes Regulations 2001 are referred to throughout this report and any non compliance identified. The Registered Manager was available at the time of the inspection and assisted with the inspection process. On this occasion, core standards not assessed as part of the previous inspection were examined and any requirements made at that time were re-assessed. During the course of the inspection, the Inspector spoke to four residents and six members of staff. Residents provided some feedback in relation to the quality of the service and care provided, although it was difficult for some to verbalise this due to impaired cognitive ability. What the service does well: The home provides a very spacious and unrestricted environment for service users in a comfortable, homely and domestic style setting. All areas both communal and private are furnished and maintained to a high standard and domestic staff should be commended on the cleanliness of the environment. The home places a strong emphasis on providing residents with a range of Montague Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 Page 6 activities which are appropriate to their needs and abilities and at the same time fulfilling. Residents appeared happy, relaxed and very much at home and one service user reported that they very much enjoyed living at the home. What has improved since the last inspection? 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 Montague Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 Page 7 contacting your local CSCI office. Montague Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 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 Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 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 the following standard(s): Not applicable EVIDENCE: Both of the key standards were assessed as part of the unannounced inspection carried out on14 November 2005. Montague Road Nursing Home DS0000024450.V280811.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 and 9 At the time of the inspection residents coming to live at the home could not necessarily expect to be provided with a current plan of care or risk assessment. Residents could however expect to have both their physical and mental health needs monitored and met. Residents will be protected by the home’s procedures for the administration and safe keeping of medication. EVIDENCE: As part of the inspection process the care plan for the most recently admitted resident was examined. The care plan was detailed and provided a clear picture of the assessed needs of the resident and the interventions required to ensure that these needs were met. It was also noted that a care plan had not been provided for a resident who had been admitted to the home in November 2005 and staff were still having to refer to a care plan prepared as part of the discharge documentation from long term hospital care. Whilst in the case of both residents, risks associated with their care were identified in the discharge documentation, neither resident had been provided Montague Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 Page 11 with a risk assessment. It was identified at the previous inspection in November 2005 that an assessment of risk must be carried out in relation to the care of each resident. In the case of the two residents selected for the purposes of care tracking, risks in relation to smoking and possible aggressive behaviour required assessment. The home was able to evidence that staff monitor and respond to both the physical and mental health of residents. Residents physical and mental health needs are met by registered nurses some of whom are qualified registered mental health nurses. The home also derives clinical support from the Psychiatry of Old Age Directorate as part of the local Mental Health Partnerships Trust. All residents are registered with a General Practitioner and all GP visits to the home are documented. On this inspection the home had ensured that systems used for the administration and storage of medication were appropriate and secure. As a response to a requirement identified at the previous inspection, the manager had circulated a memorandum to all staff advising that they must check that service users medication is being signed for after administration on the right date entered on the Medication Administration Record. Montague Road Nursing Home DS0000024450.V280811.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 and 15 Residents living at the home can expect to be provided with a programme of activities which is appropriate to their needs and abilities. Residents can also expect to be supported to maintain contact with family and friends and to be supported to use local facilities and resources. The home supports residents to make choices around their daily lives and ensures that they are provided with a nutritious and varied diet. EVIDENCE: On the day of the inspection, the home was able to evidence that it provided a planned programme of activities for residents. These activities are appropriate to the needs and abilities of service users and not only include group sessions such as reminiscence and bingo but one to one activities, where for example, residents can be supported by staff to use local shopping facilities. The home employs an activities co-ordinator for 20 hours per week. The home has a proactive approach to the provision of activity and has recently purchased a book entitled “Activities with Persons Disabled by Alzheimer’s Disease and Related Disorders.” The home was also able to evidence that a programme of prearranged outings is provided. Montague Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 Page 13 The home provides a warm welcome to resident’s families and friends and service users are assisted on a one to one basis to access facilities and resources in the local area. On the day of the inspection, one resident informed the inspector that they were looking forward to going out with their daughter that afternoon. Whilst all service users being accommodated suffer from some form of mental health problem, be it organic or functional the home endeavours to support them to make informed choices. Care Plans seen evidenced that residents and/or their representatives are consulted about preferred daily routines. During the inspection, the menu of meals provided to residents was discussed with the relief cook. On the day of the inspection, residents were being offered a choice of steak and kidney pudding or cottage pie, accompanied by a selection of fresh vegetables. Fresh vegetables are included in the mid-day meal on all days apart from a Friday. Supper menus evidenced that residents are provided with a hot option or a selection of sandwiches. On the day of the inspection, one resident was celebrating a birthday and a home-made cake had been prepared by kitchen staff. It was noted that the dietary likes and dislikes of residents were displayed on the white board within the kitchen. The relief cook was able to evidence that a written cleaning schedule for the kitchen was maintained and adhered to in relation to the daily and weekly cleaning of kitchen equipment and surfaces. The Relief Cook also advised that they had just undertaken food hygiene training at an intermediate level. The kitchen was well equipped and was provided with adequate food storage units. On the day of the inspection three residents were able to report how much they had enjoyed their mid day meal and one reported that the standard of food was very good. Montague Road Nursing Home DS0000024450.V280811.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): Not applicable. EVIDENCE: These standards were assessed as part of the Unannounced Inspection on 14 November 2005. Montague Road Nursing Home DS0000024450.V280811.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): 19-26 Residents can expect to be provided with accommodation, both private and communal which is well maintained, comfortable and which meets their individual needs and preferences. Residents can also expect to live in a clean and hygienic environment. On the day of the inspection, residents could not necessarily expect to have sufficient access to communal bathroom facilities. EVIDENCE: As in the previous inspection, an environmental tour was carried out and a selection of bedrooms and communal accommodation on Wren and Kingfisher Units were viewed. As in the previous inspections, the home provides a high standard of accommodation to service users. The three living units create a very homely environment. Each unit has its own kitchen/dining facilities, a very comfortably furnished lounge and eight bedrooms, all of which are individually decorated and furnished. All bedrooms are very spacious and many had been made to look very homely with the addition of personal belongings. One resident was in their room watching a popular day-time soap opera. They reported that they liked their room very much and felt very comfortable sitting Montague Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 Page 16 and watching the television. The home also has a large entrance hall area which is furnished with comfortable sofas and provides a central area for residents to spend time watching the “comings and goings” of visitors and staff. There is also a very attractive galleried landing seating area on the first floor of the building. First floor accommodation can be accessed via a passenger lift. All bedrooms are for single occupancy only and have the benefit of ensuite toilet facilities. Two bedrooms on each unit also have the benefit of ensuite shower facilities. Each living unit is provided with a communal bathroom, with an assisted bath and toilet facilities. Since the previous inspection, all three living units have been provided with new assisted baths. On the day of the inspection, the communal bathroom on one unit was out of service due to a blocked pipe requiring attention. This meant that service users living on this unit were required to use the bathing facilities in one of the other units. The home has well maintained attractive, secure gardens which can be accessed independently by all service users. The home was maintained to a high standard of cleanliness and hygiene and no unpleasant odours were detected. Montague Road Nursing Home DS0000024450.V280811.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 and 30 Residents can expect to be supported and cared for by a level and skill mix of staff that is appropriate to ensure their needs are met. Whilst in general staff receive appropriate training, shortfalls remain as to the inconsistency in the availability and content of dementia training. EVIDENCE: At the time of the inspection, the home was in the process of changing to a staffing rota which was more user friendly and negated the need for two systems to run concurrently. As found in previous inspections, the home was being staffed by a sufficient number of qualified nurses and care staff. Throughout the day the home is staffed by two qualified nurses, supported by four members of care staff. This level decreases for the night period to one qualified nurse, supported by three members of the care staff. The staffing rota seen at the time of the inspection, correctly reflected the number of staff on duty. The home has a staffing group comprising of qualified nurses, both RMN and RGN and care staff who have achieved various levels of NVQ in Care. Out of a group of eleven members of care staff who work during the day, six have now achieved an NVQ Level 3 in Care. Three care staff who work during the night period have also achieved this level of qualification. Whilst it was established at the previous inspection that all staff receive a structured Induction training package and are provided with all areas of mandatory training, it is still of concern that a more formal approach is not adopted to the provision of training for care staff in the provision of care for Montague Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 Page 18 older people suffering from dementia; taking into consideration that the home provides a specialist residential service for this service user group. Whilst the Induction training package may make reference to caring for older people with dementia there was nothing to suggest the level and content of dementia training provided. Discussions with the Manager again highlighted that training is derived from various resources on an informal basis. At present the home can not evidence the content, consistency and level of training provided to staff in relation to the care of older people suffering from dementia. One member of care staff spoken to at the time of the inspection reported that their knowledge in relation to the care of older people with dementia had been acquired through experience rather than training. This member of care staff felt that new staff should receive a more formal training package in relation to this field. Another member of nursing staff reported that several care staff had expressed an interest in undertaking training on person centred dementia care. During the inspection, staff were observed to relate well with residents and carried out their roles in a competent and professional manner. One resident reported that they were very well looked after and another commented on how helpful they found staff. Montague Road Nursing Home DS0000024450.V280811.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 and 38 Residents can expect to live in a home that is competently managed and administered. At the time of the inspection, residents could not necessarily expect that their health and safety would be protected through appropriate risk assessment. EVIDENCE: The home has been managed by Mrs. Annie Scott for the past five and a half years. Mrs. Scott is a Registered General Nurse but has undertaken conversion training and is therefore additionally registered as a Mental Nurse. She has also achieved an NVQ assessors award and is currently undertaking the Registered Manager’s Award. Whilst in general the home provided a safe internal and external environment for service users and staff, the provision of a risk assessment in relation to all service users’ identified risks must be addressed as a matter of urgency. As Montague Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 Page 20 stated earlier in this report, it was identified at the previous inspection on 14 November 2005, that a risk assessment had not been completed in the case of several residents in order to ensure that identified risks in relation to certain activities of daily living were minimised. During this inspection it was again identified that these required risk assessment shad not been completed. Montague Road Nursing Home DS0000024450.V280811.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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 3 3 2 3 3 4 3 4 STAFFING Standard No Score 27 3 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x x 2 Montague Road Nursing Home DS0000024450.V280811.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 2 Standard OP7 OP21 Regulation 15(2) 23(2(j) Requirement The Registered Persons must ensure that all service users are provided with a plan of care. The Registered Persons must ensure that there is a provision of one assisted bathroom on each of the eight bedded living units. The Registered Persons must ensure that care staff receive training in the care of older people with dementia. This is a repeat requirement from 14/11/05 4 OP38 13(4)(b) The Registered Persons must ensure that risk assessments are produced for all residents in relation to any risk identified as part of the pre-admission assessment. This is a repeat requirement from 14/11/05 01/02/06 Timescale for action 28/02/06 28/02/06 3 OP30 18(1)(c)(i ) 31/03/06 Montague Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. N/A Refer to Standard N/A Good Practice Recommendations None Montague Road Nursing Home DS0000024450.V280811.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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