Inspection on 21/08/08 for Montague Road Nursing Home

This inspection was carried out on 21st August 2008.

CSCI found this care home to be providing an Adequate service.

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 07/09/07

Montague Road Nursing Home 15/08/06

Montague Road Nursing Home 01/02/06

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 13/11/2008.

CARE HOMES FOR OLDER PEOPLE Montague Road Nursing Home 14 Montague Road Felixstowe Suffolk IP11 7HF Lead Inspector Mary Jeffries Unannounced Inspection 3:00pm 21 and 22 August 2008 st nd 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.V370527.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 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 annie.scott@orbit.org.uk 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.V370527.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th September 2007 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. A Statement of Purpose / Service User Guide provides detailed information about the home, the services provided and access to local services. This is available at the home. The Statement of Purpose/ Service User Guide was to be revised; it will show the new fees, which the manager advises us are £790.00 per week. These charges cover all care, accommodation, heat, lighting, meals, and laundry and continence products. They do not cover additional services such as the dentist, optician, hairdresser, personal items such as toiletries, clothing, or daily newspapers. Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection, which focused on the core standards relating to care homes for older people. The inspection was unannounced over two weekdays, and lasted twelve hours. The inspection focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from 2 relatives and eleven staff “Have your Say” surveys. We also included information from a third relative who received a survey and chose to speak with us on the telephone. The Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI) was returned completed by the manager. This self-assessment gives providers the opportunity to inform the CSCI about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the Key Lines of Regulatory Assessment (KLORA). The Registered Manager facilitated the inspection, and the assistant manager assisted. The Inspector had the opportunity to talk to both residents and staff members during the inspection. A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Four residents were tracked, including one who had been admitted within the last twelve months. What the service does well: The home provides a high standard of accommodation which is maintained to a good standard of decorative order and repair. Accommodation is very spacious and unrestrictive and provides residents with a very homely and relaxed environment in which to live. We visited most areas of the home and found everywhere to be very clean and fresh. The home has maintained a stable staff group through a period of some uncertainty over the future management of the organisation. They are positive Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 6 about their work and this contributes to the positive a caring atmosphere in the home which the manager fosters. Where new staff are appointed a proper recruitment process is undertaken. The home provides a good quality of daily life for residents who are treated as individuals and whose needs are well known and understood by staff. Relatives are well consulted and encouraged to support the residents. . What has improved since the last inspection? What they could do better: The Service User Guide needs some further information to be added so that prospective and current residents have all of the information they are entitled to. Risk assessments are not well developed and would not meet the requirements of the mental capacity act. Work must be undertaken to improve the quality of all risk assessments involving any form of restraint or co-coercion. This was evidenced to be a need in respect of bedsides, and should also be in place in the event of consideration of disguised medication being given. Medical Administration records must be complete and any changes must be signed to evidence who has amended them on the basis of a proper record of the decision, so that unauthorised changes cannot be made. A number of requirements made at the last inspection have not been met. Regular regulation 26 visits have not been evidenced, and linked to this, where omissions in recording and practice were found these were generally one off incidents which would be picked up by better quality assurance (QA). There is a repeat requirement for proper QA. The homes system for managing residents’ banked money must be in line with the written policy; where a joint account is held, there must be clear evidence that all interest due to individual residents has been, and continues to be, attributed to them. A repeat requirement was made for formal supervision in line with the standard to be undertaken and proper records to be maintained. Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People cannot be assured that they or their relatives will have all of the information they need or are entitled to before they move in. EVIDENCE: We were provided with a copy of the Statement of Purpose (SoP) and Service Users Guide (SUG). This contained a lot of information about how to access the home, fees and the type of care provided. It did include information regarding the fees and how they are to be paid but it does not state how items and services not included within the fee are to be charged and paid for. The Service User Guide must include a copy of the most recent inspection report; it did not. It would be acceptable, if the SUG stated that this is available and references where the inspection report is freely accessible in the home, and/or on the internet, but no reference to it was included in the document provided to us at the inspection. (The latest inspection report was on display in the reception of the home.) Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 10 Being a joint Statement of Purpose Service User Guide, the document contains a lot of information that may not be readily needed or indeed accessible to people of all abilities. Key information needed by residents would be better presented in a separate Service User Guide. The Statement of Purpose does not indicate whether residents can visit the home prior to admission, or whether a trial period is offered, although the homes AQAA states that “We also ensure that as much as is possible within the needs of the prospective client, potential residents are enabled to visit the home, and where possible have a short stay before making a final decision.” The home’s Statement of Purpose/Service User Guide states that residents are required to undergo an assessment of their needs prior to moving in. Prospective residents are referred through the Mental Health Intermediate Care Team. This arrangement means that they will be assessed before admission; additionally the home’s manager advised that they visit prospective residents to assess. A relative who was visiting a resident advised that the resident had been to the home on respite care several times before they came to live here permanently. They advised that the manager had visited them at home before the permanent move, to get up to date details. The records for four residents who were tracked during the inspection contained preadmission assessments, but the record for a recently admitted resident did not. The manager advised that the resident had been assessed in hospital sometime prior to admission, but at that time that they had not wanted to move. The resident eventually accepted a move into this home, having, in the interim moved elsewhere. The AQAA indicated that there had not been any placement breakdowns in the previous twelve months, which indicates that they have been able to meet the needs of those admitted. The home does not provide intermediate treatment. Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 &11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to have a care plan that is regularly reviewed, and to be treated with respect and dignity. They cannot be assured that all options will be considered before a solution is put in place in managing the risks they face. EVIDENCE: The two relatives who provided us with pre-inspection surveys both indicated that they fell the care home always meets the needs of their relation, and that their relative gets the care and support that they expected or agreed. Both indicated that they are always kept informed about important matters affecting their relative, and that they always get enough information about the care home to help them make decisions. All eleven staff members who responded to our pre inspection survey advised that they are always or usually given up to date information about the needs of the people they support and care for. Seven thought that the ways in which information about residents in a way that always works well, two thought that Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 12 it usually worked well and two that it sometimes worked well. One member of staff wrote; “Any questions I need to know, the answers are always given to me immediately.” Four residents were tracked. All had care plans and all had daily notes. Three entries were made each day for the residents, although these focused mainly on health issues rather than progress towards increased independence which is the aim of the home. Separate records were kept of activities undertaken by each resident. Care plans contained a good range of assessments including malnutrition screening and Waterlow tissue viability assessments which indicate where there is a risk of pressure areas. Care plans evidenced that case reviews are carried out on a 6 weekly basis and statutory reviews take place for those who are subject to aftercare orders. Relevant parts of the person centred care plans were updated, although there was scope for an aspect of a plan to be overlooked. One resident’s care plan noted that they had their own teeth, and stated that regular dental checks were required. The resident was asked about this as it was noted that they had not eaten their batter at lunchtime. The resident advised that they get toothache and jaw pain. They said that they had not seen a dentist in a number of years they had been at the home. The manager advised that this person would have been offered a dentist appointment, but there was no record of any dentist appointment or offer of an appointment that was refused on file. The care plan had not been updated in respect of this. Records of appointments with other community health professionals such as chiropodists and district nurses were maintained. Each care plan included a general risk assessment and then specific risk assessments. These were examined in some detail for two residents who had bedsides in place. These were not adequate, as they detailed the risk as bedsides being required, which is a solution not a risk. They did not show the actual risk, for example, may fall from bed or wander in the night, nor did they show that a range of options had been considered to show how the risk might be managed in the least restrictive way. The two seen were not countersigned by a relative or a G.P., so there was no evidence that consultation had taken place. Residents are vulnerable to inappropriate restraint unless the home can demonstrate full consideration and consultation has taken place; there was nothing to suggest that the bedsides were inappropriately employed in the case of either of these residents, but the proper process of risk assessment and consultation must be evidenced. During the day residents were seen to be treated with respect and politeness by all staff. One of the residents tracked was receiving in palliative care. The G.P. has visited on the day of the inspection, and the manager continued to Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 13 keep informed of the resident’s state through out the day. The resident was observed to be comfortable in a cool room with soft music playing. Staff were in constant attendance. During the inspection two staff were observed appropriately moving a resident into a chair in a lounge using a hoist. The resident appeared secure and relaxed. The administration of medicines was observed and records were inspected. Records contained photographs of residents. There were two gaps only in five days of recording on the Medical Administration Records (MAR) inspected. These were both in respect of a resident who at times refuses their medication. In one case a prescription had changed form 1 to 2 tablets at lunchtime; an alteration had been made on the MAR sheet, but had not been signed. Any alteration to a MAR sheet must be signed and dated, to evidence the authority of the person who has made the change and safeguard against unauthorised changes. In other places, changes made had been signed. The nurse administering medication had a good manner with residents. One resident was reluctant to take their medication. The nurse advised that they had permission to disguise this resident’s medication in their food if they refused, but was able to persuade them to take it. The nurse was unable to find a record of the G.P’s consent. They advised that this they also had consent to disguise medication for one other resident; they were able to produce a file note that stated the G.P’s consent had been given for this, but no original documentation. The manager clarified that the home was given advice that they could disguise the first resident’s medication when they were discharged from hospital, but have never needed to do so. They have subsequently forwarded us with the documentary evidence required in respect of the second resident. Should there be any possibility of the first resident requiring this, as the member of staff thought, then written permission also needs to be obtained for them. The home reported on the AQAA that there had been no serious incidents involving controlled dugs in the previous 12 months. A full audit of controlled drugs kept in the home was undertaken and these were found to be in good order. Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home can expect to make choices about their life, to be offered a range of meaningful activities and enabled to maintain contact with family and friends. EVIDENCE: The home is conveniently located near to both the town centre of Felixstowe and the sea front and residents are supported to access these local facilities and resources. The home has two part time activity workers. Scheduled activities take place mainly on Tuesdays and Thursdays. In the morning of the first day of the inspection a number of residents had been baking with the assistance of an activities worker. A group were due to go out to Eastern Farm park the following Tuesday. The assistant manager advised that the home had hired a beach hut for a couple of days during the summer and residents had been taken to spend time at the sea based at the hut. A poster on display in the home advertised a singing act that was due to visit. Records were maintained of the activities which residents participate in. One of the residents tracked Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 15 attended lunches out, but otherwise did not participate. They advised, however, that they had been out shopping independently that morning. Another, who is hard to engage had joined in special meals, and attended two entertainment sessions and one activities afternoon since March. The home’s AQAA states that the home wishes to develop the range of activities available. During the inspection some residents were seen helping themselves to drinks in the kitchen. A resident spoken with advised that they get their own breakfast. The manager confirmed that those who can do tasks for themselves will be supported to do so. Menus were displayed in the home. They showed a range of good home cooked meals, and that choices were available. These were in large print. The cook advised that they go round and see what everybody wants to eat. There was a board up in the home’s kitchen with the individual requirements of each resident, one resident was on a reducing diet and one was on a diabetic diet. We sat with one of the resident who was tracked at lunchtime on the second day of the inspection. There was a calm pleasant atmosphere during lunch. The residents had a choice of fish or scampi. Frozen meals are available if residents do not want either of the main choices. The resident who was tracked had not eaten their batter; they advised that they had found it hard, however other residents had eaten theirs. The home has an open visiting policy and residents are welcome to entertain their visitors within the privacy of their own bedrooms or in one of the many communal seating areas sited around the building and garden. A regulation 26 visit report undertaken in April 2008 notes that a family meal for relatives to join with residents is a monthly feature. The two relatives who provided us with pre-inspection surveys both indicated that the care home helps them keep in touch with their relation, one commented that they could visit at any time, and noted that visited regularly to help their relative with a daily meal. “ The home feels like a family home. We are welcome any time day or night. There are lots of activities, family meals, music afternoons, days out and pantomimes at Christmas.” Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have access to a proper complaints policy, and to be protected from abuse. EVIDENCE: During the year one safeguarding alert was made. Social care services have since written to us advising that no further action was to be taken by police or social care regarding allegations made, and that these were based on a misunderstanding. The home had full documentation of this available in the home. The complaints book was seen, no other complaints had been made, this was in line with information provided in the home’s AQAA. All eleven staff members who responded to our pre inspection survey advised that they know what to do if a resident, advocate or resident has concerns about the home. Both relatives who replied to our survey stated that they know how to make a complaint of they need to, and that the home ahs always responded properly to any concerns they have raised. One commented; “ The manager is …..very caring and always asks if we have any concerns or worries.” One resident said that that some staff were better than others in picking up little concerns, and that you get to know which ones will listen and Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 17 respond, they thought that about 75 of staff would always give them feedback. The manager was spoken with, they had a clear understanding of the referral routes for any safeguarding concerns. Staff spoken with had a proper understanding of protecting vulnerable adults. As noted under the staff section of this report, staff do not commence work without a Criminal Records Bureau check in place. Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,23, & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe well-maintained and comfortable environment which is well designed to meet their needs and is very clean. EVIDENCE: The home is divided into three living units each accommodating eight residents. In addition to bedroom facilities which are all for single occupancy and have the benefit of an ensuite (some with shower), each living unit has its own lounge, dining room, kitchen and communal bathroom, with assisted bathing. There are two living units on the ground floor and one on the upper floor which can be accessed via a stairway or passenger lift. To the front of the building there is a large reception area, with comfortable seating, where residents can sit and watch the “comings and goings” of the home. Leading off the reception Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 19 area there is a spacious communal lounge where larger home’s functions can be held and where residents can spend some “quiet time” if desired. All units have unrestricted access into the home’s enclosed gardens which are very attractive and maintained to a high standard. The home was clean throughout on the day of the inspection. Bathrooms were inspected and found to be clean and uncluttered with appropriate paper towels and liquid soap. There were stocks of protective clothing and gloves. Hot water is regulated by thermostatic valves; it was found to be at an appropriate temperature on the day of the inspection when it was tested at a number of outlets. This minimises the risk of people living in the home scalding themselves when taking a bath or shower. Two residents’ bedrooms seen were attractive and personalised. One had a good quality non-slip vinyl floor, which is not very homely. The manager advised why this was necessary for this resident. As a rule, vinyl flooring should not be used; the manager explained why this was considered necessary in this instance. One of the residents showed us that they had a locked drawer available to them; it was not locked and they did not know where the key was, but said that this did not concern them. The home was nicely decorated, and furnished, with the exception of carpets around the central kitchen/dining rooms on two units which were badly stained. It was warm and comfortable offering a good standard of accommodation. Evidence was seen that people are provided with aids and equipment for the prevention of pressure areas, where required. Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents living at the home can expect to be supported and cared for by an appropriate level of staff to meet their individual needs. Residents can also expect to be cared for by a stable staff group who have a good understanding of their needs and carry out their roles in a competent and informed manner. EVIDENCE: Feedback from relatives and staff about staffing levels were positive about meeting the care needs. Seven of the eleven staff members who responded to our pre inspection survey advised that there are always enough staff to meet the individual needs of all the residents, four indicated that there are usually enough staff. The staffing levels at this home were examined and discussed with the manager. The rota for the month prior to the inspection showed that there was a minimum of five staff on duty at all times, in addition to the homes managers who are present in normal office hours. Many of the staff involved with care are trained nurses, and there is always one and often two trained nurses on duty. The home’s AQAA states that a large proportion of the care staff have at least NVQ 2. Taken in conjunction with the nursing staff, over 50 of staff are trained to a good basic level. A carer spoken with confirmed that she had NVQ2, she explained that the nursing staff took the lead in care. Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 21 The home’s AQAA stated that only one member of part time staff had left in the last twelve months, the assistant manager confirmed staff turn over was very low. One member of staff spoken with advised, “I am very lucky to work here.” In speaking with staff they confirmed what the manager told us, that they were well trained in manual handling, medication, 1st aid, infection control and food hygiene. A senior member of staff advised that although they get all of the statutory training and updates, they would like more specialist training. All staff, including ancillary staff had received basic training in dementia. The home has previously evidenced that some staff have had further training in working with dementia. During the inspection staff demonstrated good interaction with residents, that was calm and warm. A small group staff including the manager and deputy manager had received training in the Mental Capacity Act; the manager advised that they would cascade this down. Staff spoken with confirmed they had had received updates in moving and handling training. Recent training completed by staff at the home had included dealing with challenging behaviour. All staff including domestic staff had received one day training from Unisafe, and a follow up was to be held. A member of staff spoken with advised that she feels more confident having received this training. The assistant manager advised that behaviour charts that consider the triggers for challenging behaviour were used with some residents, and that they thought the training had made a big difference to staff confidence. Ten staff members surveyed thought that the training they received helped them understand the needs of individual residents, one thought not. Nine of the eleven staff surveyed indicated that they thought they were given training which was relevant to their role, two thought not. These staff members answered the enquiry “Are you being given training that keeps you up to date with new ways of working” in the same way. Both relatives who provided surveys noted that care staff always have the right skills and experience to look after their relative properly, and that the home always meets the different needs of different people. We saw a committed team of staff meeting peoples needs. Those spoken with were able to give in-depth accounts of the health and personal care needs of people and new exactly how to look after them. One relative spoken to was unreservedly positive about the staff. They advised that the home was much better than they had expected and that the staff were very good. Another said that they managed very well in caring for their relative who they themselves described as very difficult. A resident commented that they liked some staff more than others. All eleven staff members who responded to our pre inspection survey advised that their employer carried out pre employments checks including Criminal Records Bureau (CRB) checks. One commented; “ It took four months for my Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 22 CRB to come through, I had to wait that time before I could start my job.” Two staff files were inspected. They held full documentation to show that a proper recruitment process had taken place, including proof of identity, photographs and CRB checks which had been received by the home before the workers commenced working on shifts in the home. They also included induction details. Seven of them thought that their induction covered everything they needed to know to do the job when they started very well, three thought it mostly did and one thought it partly did. Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect the home to be positive, open warm and caring, and that their health and safety will be protected. They cannot, however, be assured that full quality assurance systems and records will be in place or to ensure that all matters requiring attention are identified and attended to, or that the home’s arrangements for managing their banked monies fully safeguards their interests. EVIDENCE: The AQAA (annual quality assurance assessment) the self-assessment we have commented upon through out this document was completed by the manager and the information gave a reasonable picture of the current situation within the service. Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 24 The home is managed by Mrs. Annie Scott who took up the post some seven years ago. Mrs. Scott is a Registered Mental Nurse and a Registered General Nurse. She is undertaking the Registered Manager Award, and has one unit left to do before completion. The home also has an assistant manager, who is a qualified nurse. Over the last four years, the organisation has been reviewing the future of nursing homes within the group. The manager confirmed that maintaining staff morale against this background has been a focus of management activity, as had keeping relatives informed. It was clarified that at this point in time, this home was not to be sold, but will remain within Orbit for the time being. Staff spoken with during the inspection and those completing questionnaires commented that the home had a friendly supportive atmosphere which came from the top down. One relative’s survey noted; “ (…………) is very happy , the atmosphere is always calm and staff are always helpful.” The other noted; “The home is run so well because of caring staff and management. It is hard to put your (relative) in a care home. (….) has been there ( a number) of years and (they) have always been treated with kindness.” One relative advised that “The heart of the home is in the right place.” They thought however that they would like to see more hands on presence of management in the home. At the last inspection a repeat requirement was made that quality assurance based on eliciting residents’ and relatives views, to inform developments in the home, must be undertaken, The manager advised that a formal questionnaire survey of residents and relatives views has yet to be undertaken. She had a residents’ satisfaction survey template ready for a survey, however, the manager advised that since the management of the home had been uncertain in the period, it was difficult to plan to make any significant changes. The manager also advised that they doubted what could be achieved with it, as many residents would not be able to respond to a survey, although the deputy was spoken with and they thought that some could. The manager advised that the home receives relatives and residents’ comments verbally on an ongoing basis, and that there is a relative’s support group shared information and hear concerns. One relative who received one of our questionnaires and was spoken with on the telephone. They confirmed that these meetings were very useful. Under what could the service do better, one staff member had commented; “……..talking to staff & relatives and Questionnaires our amongst everyone in the service.” Given the focus there has been in the home on a possible change of management, and the open communication that is in place, we do not intend to take action on the unmet requirement, however the home needs to evidence consultation about the home with residents, using advocates to assist if necessary. This will ensure the home to continues to be responsive to residents’ expressed needs and preferences. We asked to see copied of regulation 26 visit reports; these unannounced monthly visits are required as a form of quality assurance provided by the organisation of activity in the home. The last monthly visit report available in Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 25 the home was dated 29th April 2008. It made no reference to checking whether there were any complaints. Prior to that there was a report dated 20th Feb 2008, 7/01/08 and 31/12/07. (No March report available). The manager advised that these visits had been undertaken by the organisation who were considering taking over the home, but had now stopped. In the absence of these, there is no external checking being made of the homes activities on a regular basis by anyone outside of the home; and would normally support the home meet the requirements made by CSCI at the previous inspection. Several requirements made at the previous inspection had not been met, although the home had submitted an action plan to us indicating that they would be. The AQAA states that there are sound procedures in place for the management of residents’ monies, and that residents are provided with safe storage facilities. As part of the Inspection process, the Inspector examined the procedures for the administration and safe keeping of resident finances for three of the residents selected for the purposes of case tracking. The home’s administrator was able to evidence that they maintained appropriate records for any transactions made on behalf of residents or where residents wished to draw cash out. Amounts of cash for each resident were held separately and securely and tallied with the amount recorded on the accompanying transaction sheets. Two signatures supported transactions. At the last inspection a requirement was made that evidence of recent interest paid into an account held by the home on behalf of residents must be provided, to show that residents are receiving all of the interest they are entitled to. The home has a joint account into which most of the residents’ spending monies are pooled. The manager advised that there was no policy on handling residents’ banked finances; they have however subsequently forwarded a policy, but it did not refer to joint accounts or interest payments for residents. There was evidence in the home that the manager had been advised that by pooling monies into a joint account a higher rate of interest could be achieved, and that at the end of the year when a final figure for interest was available it would be allocated to residents’ accounts. The statements seen on this occasion showed monthly interest paid in January 2008 but no other interest had been paid since May 2006 when monthly interest was applied. It was not clear that residents had received all of the interest they were entitled to. Our staff survey enquired; “ Does your manager meet with you to give you support and discuss how you are working”. Four noted that they often did so, six noted that they regularly did so and one noted that they sometimes did. One member of staff wrote a comment; “I have always felt that the right support is there and regular encouragement to help me do my job.” Whilst staff felt very well supported, the assistant manager confirmed home did not have records of formal regular supervision. The manager advised that mid term appraisals had commenced, but that only one had been completed. The Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 26 AQAA noted that where there is a problem with work, staff will be assisted to understand the issue. Without regular formal supervision and monitoring, management cannot be sure that all aspects of performance are being appraised, would not have the supporting evidence for disciplinary action should this be necessary, and cannot be confident that all gaps in knowledge or skills are identified. The relative’s comment reported under the complaints section of this report, that 75 of staff will listen and respond, and the two staff surveys which indicated that they did not think they always got training which was relevant to their role or which kept them up to date with new ways of working indicate that there are areas that need attention. Environmental Health had inspected the food hygiene in the home in April 2008. A copy of their report was provided and it was seen that no requirements or recommendations were made, and the report commented that good procedures and practices were in place. The homes “Safer food better Business” file was seen to be in use on the day of the inspection; this shows records of actions and observations against a management plan devised by the home. Chemicals were safely stored in the home and we sampled hot water in baths and showers and found these to be within safe limits. Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 27 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 2 X 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 1 2 X 3 Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 5 Requirement The Service User Guide must contain all of the information required by regulation, so that prospective and current residents have direct access to all of the information they are entitled to. All risk assessments must consider the actual risk, demonstrate that the range of options that could minimise the risk have been considered and, determine the least restrictive satisfactory solution. They must be countersigned by a relative or G.P s where the resident is unable to consent to demonstrate consultation. MAR sheets must be complete, including a signature to any change. This is to ensure that there is accountability of any changes made to medication, and to ensure proper audits can be undertaken. Regulation visits must be undertaken in line with the regulation and copies made available to the home, so that it DS0000024450.V370527.R01.S.doc Timescale for action 31/10/08 2. OP7 12(7) 31/10/08 3. OP9 13(2) 13/10/08 4. OP33 26 21/08/08 Montague Road Nursing Home Version 5.2 Page 29 6. OP35 20(1)(a) 6. OP36 18(2) can demonstrate that routine quality checks on key areas are being undertaken by an independent person representing the organisation. This is a repeat requirement from the inspection of 6/09/2007. Residents’ finances must be handled under the terms of the financial policy Any outstanding interest due to residents whose money is held in a pooled account must be paid, regular interest must be paid on an ongoing basis, and residents must be issued with regular statements. This is a similar requirement to that made at the inspection of 6/09/2007. There must be evidence of documented formal supervision in line with the standard taking place for staff. This is a repeat Requirement from the inspection of 6/09/2007. 21/08/08 21/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Montague Road Nursing Home DS0000024450.V370527.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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