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Inspection on 14/11/05 for Montague Road Nursing Home

Also see our care home review for Montague Road Nursing Home for more information

This inspection was carried out on 14th November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff and management of the home should be commended on the in-depth assessment work carried out prior to five service users transferring from longstay hospital care. The home provides a high standard of accommodation both communal and private and much effort had been made to ensure that facilities provided to the new service users was homely and comfortable. The home places an emphasis on ensuring that the rights and privacy of service users is upheld. Staff are very helpful and have already established good relationships with the five new service users.

What has improved since the last inspection?

Since the previous inspection, the owning organisation has ensured that the Induction Training programme for new staff is cross referenced with TOPPS standards. Monthly visits to the home by a representative of the owning organisation are now carried out in compliance with Regulation 26 of the Care Homes Regulations 2001 for the purposes of quality assurance.

What the care home could do better:

The home needs to ensure that risk assessments are carried out in relation to any risk that is identified as part of individual pre-admission assessments. As the home offers care to older people who have special and complex needs, in relation to dementia, the owning organisation must ensure that all staff receive training in the care of older people with dementia. Whilst it is acknowledged that some training is provided, this is more on an adhoc basis. To ensure continuity and consistency in practice throughout the staff group, all staff should receive the same training package in relation to dementia.

CARE HOMES FOR OLDER PEOPLE Montague Road Nursing Home 14 Montague Road Felixstowe Suffolk IP11 7HF Lead Inspector Jane Higham Unannounced Inspection 14th November 2005 10:20 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 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.V264927.R01.S.doc Version 5.0 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.V264927.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31 January 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.V264927.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Inspection of 14 Montague Road, a 24 bedded care home with nursing for service users with a diagnosis of dementia or a functional type mental health problem. This residential service is available to service users over the age of 55. The home is owned by Orbit Housing Association and is situated in a residential area of Felixstowe, close to both the town centre resources 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 first scheduled inspection in the inspection year 2005/2006. The inspection took place on 14 November 2005 over a period of six hours. 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 inspection process was assisted by Mrs. Annie Scott, Registered Manager. For the purposes of this inspection, the Inspector looked at the care and accommodation in relation to the recent transfer of five service users from long-stay hospital care. This included pre-admission assessments, care plans, risk assessments, administration of medication, training and environmental standards. Compliance with the requirements made at the previous inspection was re-assessed. During the inspection, the Inspector was able to speak to several of the service users who had recently transferred from long-stay hospital care, to one relative who was visiting on the day and to various staff members. What the service does well: The staff and management of the home should be commended on the in-depth assessment work carried out prior to five service users transferring from longstay hospital care. The home provides a high standard of accommodation both communal and private and much effort had been made to ensure that facilities provided to the new service users was homely and comfortable. The home places an emphasis on ensuring that the rights and privacy of service users is upheld. Staff are very helpful and have already established good relationships with the five new service users. Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 6 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 contacting your local CSCI office. Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 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 Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 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, 5 and 6 Prospective service users can expect to receive a thorough and detailed assessment of their individual needs before being admitted to the home and can therefore rest assured that there needs will be met. Prospective service users and their families will be afforded the opportunity to assess the quality of the service provided before making any decision about whether they would wish to live there. EVIDENCE: As part of the inspection process, the pre-admission assessments were examined for two service users who had been admitted to the home two weeks previously from long-term hospital care. The home was able to evidence that both prospective residents had undergone a detailed assessment process in order that the service could be relatively sure that they could meet the individual needs of both people. The home was able to evidence that before admission took place, the manager and key personnel visited the hospital and met with the multi-disciplinary team to discuss the individual care needs of each person. Additionally home’s staff met with the prospective residents and their families and in two cases, prospective residents visited the home before Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 9 moving in on a permanent basis. Five residents were transferred to the home on the same day, accompanied by hospital staff who worked alongside home’s staff for the whole day. This assisted residents to become familiarised with their new surroundings, different staff and helped to decrease anxiety levels. The home was able to evidence that in the case of the two residents selected for the purposes of care tracking, staff were provided with very detailed preadmission assessment information which included a breakdown of assessed needs, a daily routine sheet, a care plan and detailed risk assessments. The home should be commended on the high standard and level of work that was carried out prior to these particular residents transferring from long-term hospital care. The home does not offer an intermediate care service and therefore Standard 6 is not applicable to this service. Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 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, 9 and 10 Residents coming to live at the home can expect to be provided with a plan of care which sets out how staff will assist in meeting their needs. The systems used for the storage of medication ensures the protection of service users, although one minor recording error required addressing. Additionally residents can expect their right to privacy to be upheld. EVIDENCE: As part of the inspection process, the care plans for two service users who had recently been admitted to the home from long stay hospital care were examined. Both care plans were in the process of being completed as the residents concerned had only been living at the home for a period of two weeks. Each resident had come to the home with a detailed plan of care and an outline of daily routines which had been produced by hospital staff. The information contained within these care plans was in the process of being amended and transferred to a care plan which reflected the care and social needs of the two residents now that they were living in the home. The template used for care plans is detailed and sets out the assessed needs of individual residents in relation to areas such as personal care, communication, medication and social care. Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 11 Whilst it was noted that, in the case of the two residents selected for the purposes of care tracking, risk assessments had been completed in relation to their hospital care, no such assessments had been provided since their transfer to the home. Pre-admission assessments had indicated risks surrounding such areas as smoking, challenging behaviour, self-neglect and “wandersome” behaviour and a risk assessment needs to be produced to evidence how these risks will be minimised and managed within the home. Systems for the storage and administration of service user medication was examined on Rose Unit. All medication is dispensed in blister packs (monitored dosage system) and is stored securely in a “fit for purpose” trolley which is locked inside a cupboard. The medication administration records for the two service users selected for the purposes of care tracking were examined. In the case of one resident, despite the pharmacy providing a MAR (Medication Administration Record) sheet which was dated for the wrong week, administered medication had still be ensigned for by staff. The home was able to evidence that residents’ rights to privacy are protected. All residents within the home are provided with their own room which has ensuite facilities, thus ensuring that all personal care and medical interventions are carried out in private. Residents spoken to at the time of the inspection who had been transferred from long term hospital care confirmed that they really appreciated having their own private bathroom facilities. Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 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): Not assessed as part of this inspection. EVIDENCE: Not assessed as part of this inspection. Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 13 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 and 18 Residents living at the home can expect to be provided with adequate information to enable them to make a complaint or raise concerns about the quality of the service they are receiving. Additionally residents can expect to be protected from abuse by the home’s policies and procedures in relation to the protection of vulnerable adults. EVIDENCE: On the day of the inspection, the home was able to evidence that it had a detailed complaints procedure a copy of which was displayed within the building as well as being included as part of the Service User Guide. Since the previous inspection, the home has ensured that the contact details for the CSCI have been included. Since the previous inspection the Commission has received no complaints in relation to this service. The home has adopted appropriate procedures for the prevention, recognition and reporting of abuse. Since the previous inspection all staff have undertaken a one-day training course on the protection of vulnerable adults via a member of management staff within the organisation who is a qualified trainer. Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 14 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 living at the home can expect to be provided with accommodation, both private and communal which is maintained to a high standard of decorative order and repair, furnished comfortably, clean and appropriate to meet the needs of service users who have either organic or functional mental health needs. EVIDENCE: 14 Montague Road. is a purpose built care home and provides three living units each with its own living, dining, kitchen, bedroom and bathroom accommodation. Whilst accommodation is sited on two floors both are serviced by a passenger lift. Each living unit has eight bedrooms, all for single occupancy and all having the benefit of ensuite accommodation. In addition to ensuites each unit has a communal assisted bathroom and toilet facilities. There is a large entrance hall at the front of the building which has comfortable lounge furniture and provides a very pleasant area for residents where they can spend time watching the coming and goings of the home. In addition to this area and to the lounges sited on living units, there is a spacious, Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 15 attractively decorated and furnished central lounge. The home has secure and attractive gardens which are accessible from all units within the building. On the day of the inspection, accommodation provided to service users on Robin Unit was examined. Residents were socialising in a very comfortably furnished and newly decorated lounge. In addition to the lounge Robin Unit has a kitchen/diner which is surrounded by glass, providing a very light environment in which residents can come together and enjoy their meals. A selection of residents’ bedrooms were examined. These were spacious, furnished to a high standard and had been made to look very attractive with good use of soft furnishings. Residents who had been transferred from long stay hospital care were being encouraged to add personal belongings to their rooms to make them look more homely. Residents spoken to all confirmed that they liked their room and one resident commented on how much better the accommodation was than that previously provided in hospital. All areas of the home seen on the day of the inspection were maintained to a high standard of decorative order and repair and a good standard of cleanliness and hygiene. No unpleasant odours were noted. The home has a planned programme of repair and renewal and the upgrade of all unit bathrooms and kitchens was expected to take place within the next few months. Accommodation was provided with aids and adaptations to assist service users with poor mobility. Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 16 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, 29 and 30 Residents can expect to be supported and cared for by a level of staffing which ensures their well-being health and safety. On this occasion due to lack of certain documentation, residents could not be assured that they were protected by the home’s recruitment policies and procedures. Whilst in general staff receive appropriate training, there are certain shortfalls and inconsistencies in the availability of dementia training. EVIDENCE: On the day of the inspection the home was being staffed by two trained nurses, assisted by four care staff. This level of staffing continues throughout the waking day and throughout the night period the home is staffed by one trained nurse assisted by three care staff. At the time of the inspection the home had staffing vacancies for three members of care staff and two nurses. The shortages on individual shifts were being covered by existing staff members working extra hours. On the day of the inspection, the staffing rota did not correctly reflect the numbers of staff on shift as additional cover provided had been recorded in the home’s diary. Staffing rotas must correctly reflect the actual numbers of staff on duty on each shift. During the inspection two staff personnel files were selected and examined. Evidence was available to confirm that in both cases prospective staff members had been subject to an Enhanced Disclosure and POVA check via the Criminal Records Bureau before being permitted to commence their duties. It was noted Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 17 that in the case of one staff member no evidence was available to confirm that two written references had been obtained before commencement of duties. Since the previous inspection evidence was available to confirm that the Induction training package provided to new staff had been cross referenced with the TOPPS training standards. Whilst training records were not examined on this occasion it was highlighted that whilst staff provide care to a large number of residents who suffer from dementia, training on this subject is provided in an ad hoc manner and subject to availability. The previous inspection report highlighted the need for the home to adopt a more formal approach to staff training in relation to the care of older people suffering from dementia and to ensure that the same training programme is provided to all staff. This shortfall in the training of staff was further highlighted when a visiting relative expressed concern about the lack of dementia training provided to staff and their ability therefore to meet the needs of individual residents with this disability. Staff were observed to have established good relationships with the newly arrived residents, several of whom had commented on how kind and helpful they were. Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 18 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): 33, 35 and 38 Residents can expect the home to be run in their best interests and for their financial interests to be protected. Residents can also expect that their health and safety is protected by the home’s practices, subject to one identified minor shortfall in relation to risk assessment. EVIDENCE: Since the previous inspection, the owning organisation has ensured that monthly visits to the home under Regulation 26, for the purposes of quality assurance, are carried out and a report of such visits is provided to the Commission. During the inspection procedures in relation to the administration and safe keeping of resident finances were examined. These were found to be secure and administered in the best interests of service users. All transactions made on behalf of service users were recorded appropriately, receipted and signed Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 19 for by a staff member. The home was able to evidence that a regular audit of monies held for service users is carried out. Fire safety records were examined and evidenced that fire alarms are tested on a weekly basis and emergency secondary lighting monthly. In general the home provided a safe environment for service users and staff. As stated earlier in this report risk assessments for the newly admitted service users need to be produced around risks identified in pre-admission assessments. Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 20 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 4 x 3 N/A 3 4 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 x x 2 Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 21 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 OP9 Regulation 13(2) Requirement The Registered persons must ensure that administered medication is signed for under the correct date. The Registered Persons must ensure that the duty roster correctly reflects the number of staff on duty. The Registered Persons must ensure that two satisfactory written references are obtained prior to any prospective staff member commencing employment. The Registered Persons must ensure that care staff receive training in the care of older people with dementia. This is a repeat requirement 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. Timescale for action 14/11/05 2 OP27 Sch.4.7 14/11/05 3 OP29 Sch.2.3 14/11/05 4 OP30 18(1)(c)(i ) 31/03/05 5 OP38 13(4)(b) 14/11/05 Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 22 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 N/A Montague Road Nursing Home DS0000024450.V264927.R01.S.doc Version 5.0 Page 23 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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