Inspection on 07/09/07 for Montague Road Nursing Home

This inspection was carried out on 7th September 2007.

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

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

Other inspections for this house

Montague Road Nursing Home 21/08/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Montague Road Nursing Home 14 Montague Road Felixstowe Suffolk IP11 7HF Lead Inspector Mary Jeffries Unannounced Inspection 14:00 6 September 2007 th 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.V348443.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.V348443.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 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.V348443.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2006 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.V348443.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Key inspection of 14 Montague Road, a twenty-four bedded care home with nursing for up to twenty-four residents, over the age of 55, who have either organic or functional mental health needs. 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. The home completed an Annual Quality Assurance Assessment, (AQAA). Five residents returned pre-inspection surveys. Three members of staff returned pre-inspection surveys. The inspection took place on an afternoon and early evening in September 2007 and took six hours. The Registered Manager facilitated the inspection, and the Inspector had the opportunity to talk to both residents and staff members during the inspection. Three residents were tracked, including one who had been admitted within the last twelve months. The home was full at the time of the inspection, including one respite bed. The current fee is stated in the Statement of Purpose/Service User Guide as £364 per week. Items not covered by the fee are listed. What the service does well: What has improved since the last inspection? Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 6 Risk assessments had been produced for a recently admitted resident in relation to all risks identified as part of the pre-admission assessment. There was no evidence to suggest that any punitive measures are used in relation to residents who are non compliant, and residents are respected at all times. Incontinence pads were found to be discretely stored on the day of the inspection. Medication practices have improved. Recruitment practices had improved. Basic dementia training has been provided for twenty staff and more extensive training in dementia care for three staff. Staff training records were on individual files. An up to date list of residents accommodated was maintained in the home. A large box seen to be stored on top of a resident’s wardrobe at the last inspection had been moved. A valid Electrical Safety Certificate was available for inspection. What they could do better: The Statement of Purpose needs a further small but important change so that it is clear that the home does not provide care for people who have a physical disability who do not have a mental disorder. Appropriate safeguarding referrals must always be made if there is the possibility an injury has been caused by another person, including a resident. Training in the de-escalation of aggression must be provided to all staff and updated on a regular basis. There must be evidence of regular supervision for all staff. Proof of identity of staff must be maintained in the home. The home must develop its quality assurance to ensure that full regulation 26 visits are undertaken in line with the regulation and that a copy of the report of the visit is available in the home. Quality assurance must also be developed thorough relatives surveys or mapping; the results should influence the homes plans. The homes AQAA identified the need to have a coordinated approach to Quality Assurance. Residents’ monies should not be held in a pooled bank account unless it can be demonstrated that individual records are maintained and made available and interest is regularly paid to the residents. Montague Road Nursing Home DS0000024450.V348443.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.V348443.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.V348443.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6. 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 and their representatives can expect to be provided with a current and up-to-date Statement of Purpose. However, it may not be totally clear to them whether the home can accept someone with a physical disability and no dementia or mental health need. Residents and their families can expect to know the terms and conditions of the home prior to the prospective resident deciding to live there. Residents and their families can be assured that the home will be able to meet their individual needs which are identified through a robust and detailed preadmission assessment process. EVIDENCE: The home’s Statement of Purpose and Service User Guide are in a single document. A copy was available in the home’s reception. Although this document had been reviewed in April 2007, the statement within it, “(the Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 10 home) offers accommodation and care to people over the age of 55 who suffer from severe mental infirmity (both organic and functional) and/or physical infirmity” still implies that the home is able to accommodate residents who suffer from a physical disability alone. Elsewhere in the document the correct range of needs met is defined, but the opening statement is confusing All five residents who responded to the pre inspection survey indicated that they had received a contract. All three residents tracked had been provided with an individual placement contract issued by the local authority. The homes terms and conditions of residence are included in the Statement of Purpose. Four of the five residents who responded to the survey indicated that they had received sufficient information about the home. The home has a very detailed pre-admission assessment process in order to ensure that it can meet the needs of any prospective resident. Due to the joint funding arrangement, all admissions to the home are accessed via the Social Care Services Department. The recently admitted resident tracked had details of an appropriate admission procedure on file, including a hospital discharge information received prior to admission, and they also had a contract of terms and conditions of the home on file. The home has one respite care bed, which is shared by the Social Care and Health services. The home does not offer intermediate care. Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents living at the home can expect to be provided with a plan of care which identifies their individual needs and levels of support and active assistance required. Residents can expect both their physical and mental health needs to be met and to be enabled to access community health services. Residents are protected by the home’s policies and procedures on the administration and safe keeping of medication. EVIDENCE: Four out of five residents who responded to the survey stated that they always receive the care and support they require; one indicated that they usually did. Each resident is provided with a plan of care which provides a clear breakdown of their assessed needs and identifies the level of intervention and support required to ensure that those needs are met appropriately. The home ensures that both the physical and emotional health needs of residents are monitored and where necessary community health resources are accessible. Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 12 The home was able to evidence that moving and handling assessments are completed for each person as part of the care planning process. One resident who had been admitted within the last twelve months was found to have had risk assessments produced in relation to all risks identified as part of the preadmission process, although these were somewhat brief they were adequate. Three out of five residents who responded to the survey stated that they always receive the medical support they require, one indicated that they usually did, another that they sometimes did. One relative who assisted a person complete their survey commented; “It would be impossible to speak more highly of this home, the staff, carers, and quality of care and respect given to (residents)”. Records of GPs visits were maintained which identified the reason for the visit, the outcome of the visit, any medication change and a review date. Records also evidenced that residents are supported to access outpatient hospital services and clinical guidance is derived from the area mental health hospital services. One of the people tracked had been in a psychiatric hospital for many years before moving to the home. The home had been in close contact with specialist services following a recent deterioration in the person’s behaviour. A letter on file in respect of one of the residents tracked from the clinical psychologist stated; “ I would like to acknowledge staffs’ commitment in working with this complex (person) and all the thinking around (their) care routines.” Two residents tracked had no evidence of chiropody appointments, although both care plans stated that they needed this service. The carer advised that one had refused to see the chiropodist last time they came, and that the other may have not wanted it as they might have to pay. The carer advised that if there is a serious need, then they will refer the resident to their General Practitioner, who will refer to the hospital service. There was no record on the care plan to show that one of the residents had refused the service previously, or that this had been considered at review. The other resident tracked had attended a recent chiropody appointment. A staff hand over on one of the units was observed. Staff demonstrated a good up to date knowledge of all of the residents on the unit, as well as what they had been doing on that day. Daily entries were seen in care plans. The home’s AQAA stated that reviews are held at least annually. The Registered Manager advised that care plan reviews are held within the home on a three monthly basis. Residents filed examined showed that reviews had been held at three monthly, intervals after the initial review. The minimum standard for older people is that the plan should be reviewed on a monthly basis. Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 13 No serious errors with medication had been reported to the CSCI in the last twelve months; the AQAA states that there had not been any. The Inspector observed medication being administered to residents during the teatime on one of the living units, and inspected the records. Each unit has a fit for purpose medication trolley, which when not in use is locked away securely in a cupboard. Resident medication was administered by a registered nurse and is dispensed from pharmacy supplied blister packs. Medication was administered appropriately and Medication Administration Records completed correctly on each occasion. One gap only was found in the records inspected. The nurse advised that management do a check on the medication records, they did not know how often. The nurse showed had a good manner with the residents during this process. It was noted that in addition to the blister packs other prescribed medication was stored appropriately within the trolley, all items were in their original packing with the pharmacy label attached. No homely medicines were stored within the trolley. The nurse advised that the policy had not changed, butt that no homely remedies were currently in use. Care plans indicated that the preferences, likes and dislikes of residents are noted and recorded. Four out of five residents responding to the survey stated that staff listen, and act on what they say. None of the care plans inspected made any reference to removal of privileges, as had been found in one at the previous inspection. This was discussed with a carer, who advised that they were well aware that this should not happen and it doesn’t happen. They advised that on the advice of a psychologist they occasionally used a reward system. Staff were seen to relate well, and with respect to residents, they had a good knowledge of each individual resident discussed. One resident spoken with confirmed that staff always knock before entering their room. One relative who assisted a resident complete their survey noted that people living at the home always appeared clean and well dressed. This was found to be the case on this occasion. All residents are provided with ensuite toilet facilities, which assists in ensuring that their privacy is protected. All bedrooms doors are fitted with a privacy lock, which has an override device to allow access in an emergency. Incontinence pads were found to be discretely stored on the day of the inspection. Montague Road Nursing Home DS0000024450.V348443.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. Residents living at the home can expect to be offered a range of meaningful activities and enabled to maintain contact with family and friends. Residents can expect likes, dislikes and preferences to be acted on and to be provided with a diet, which is both nutritious and varied. 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 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. Resident care plans seen at the time of the inspection, evidenced that their preferences in relation to their everyday lives, preferred routines, dietary requirements and preferred form of address are noted and acted upon. On Wren unit residents were seen moving around freely. A resident who was asked if they could have a cup of tea when ever they want one advised that Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 15 they could make one themselves in the unit kitchen/dining room. On Robin unit a resident who had been out for the day was offered a cup of tea as soon as they came in, by a member of staff. The home’s AQAA stated that they have increased the organised activities options within the home. It states that as well as outings, and use of community facilities, art, baking, reminiscent therapy and discussion groups are provided. Three out of five residents who responded to the survey stated that there were always activities for them to join in, one indicated that there usually were, another that there sometimes were. One resident was assisted by their family to complete their pre inspection survey. In response to the query, “Are there activities arranged by the home that you can take part in?” they commented, “There are lots of activities and craft groups, we are always welcome to join in.” A member of staff who responded to the survey commented that they thought the home could improve by offering more stimulation for immobile residents who do not like going out. One relative also identified this as a need in adding to their relative’s survey. Two members of staff spoken with thought that it was not ideal to have a respite bed on that unit, as it meant that the other residents had to continue to adapt to a new person living with them. Another relative commented on a feedback form; “A family meal is arranged once a month, to which all residents and their families are invited. Even former residents sometimes attend. Staff residents and carers spoken to confirmed that they made good use of community resources. One relative who assisted a person complete their survey commented, that they were free to visit the home at any time. A relative spoken with at the inspection advised that they usually attended the monthly meal, but it had not been on for a little while due to a staff member being away. They spoke of enjoying this occasion, and being pleased with the overall care in the home. Three out of five residents who responded to the survey indicated that they always liked the meals at the home. Two indicated that they usually did. One relative commented; “The meals provided for residents are excellent and varied, any special requests are catered for.” An attractive supper was served during the inspection, and menus seen showed that residents have a choice of varied nutritious meals at midday. One of the cooks was spoken with, they gave an account of preparing diabetic diets, reducing diets and liquidised diets. They advised that the main meal that day had been toad in the hole, with fresh carrots and frozen runner beans, they advised that two residents had chosen to have ham instead. The kitchen was inspected and found to be in good order with food in the refrigerated dated when opened and covered, temperatures kept of cooked meats. Montague Road Nursing Home DS0000024450.V348443.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can expect to be provided with sufficient information to enable them to make a complaint or raise any concerns they may have about the service. Residents cannot be assured that all non-accidental injuries will be reported appropriately through Vulnerable Adults procedures, to ensure full protection. EVIDENCE: The home was able to evidence that it has a complaints procedure, which is produced by the owning organisation, a copy of which is displayed within the building. The Statement of Purpose and Service User Guide also provides information on how residents or their representatives can make a complaint or raise any concern they may have. Four out of five residents who responded to the survey indicated that they Knew who to speak to if they were not happy, and that they knew how to make a complaint. The home did not have a complaints book, having received no complaints. It was not possible therefore to find evidence that no complaints had been received. Since one of the areas in which the home has identified that it can Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 17 improve is in responding to concerns and informal complaints, this should be started up. The home has a copy of the local authority Protection of Vulnerable Adults procedure and was able to evidence that all staff have received training in the recognition and reporting of abuse. Staff who responded to the survey all stated that they were aware of the procedures for safeguarding adults. One of the residents tracked had incurred a bruised face; the cause could not be established. They had been seen by the doctor. No regulation 37 report was sent to the CSCI and no Safeguarding referral had been made. This was discussed with the manager who advised they had discussed with a doctor whether a referral needed to be made to the police, and agreed it did not. The manager was advised that wherever there is a query over something that may need to be responded to as a safeguarding referral, a referral should be made, and social care services, who take the lead, will make a decision, in consultation with the police and CSCI if required. Montague Road Nursing Home DS0000024450.V348443.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): 9,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at this home can expect to enjoy a high standard of accommodation which is homely and spacious and which is maintained to a good standard of decorative order and repair. 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 area there is a spacious communal lounge where larger home’s Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 19 functions can be held and where residents can spend some “quiet time” if desired. All units have unrestricted access into the home’s secure gardens which are very attractive and maintained to a high standard. The AQAA states that the home has a refurbishment programme. At the last inspection a requirement was made that a large box, stored on top of a wardrobe in a bedroom on Kingfisher Unit, was removed as it constituted a health and safety hazard. This room was seen and the box had been removed. One resident who was tracked was spoken with in their bedroom, which was attractively furnished and decorated. The person had their own music system and collection of music that they enjoyed listening to. Four out of five residents who responded to the survey stated that the home was always fresh and clean, one that it usually was. It was clean through out 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. Montague Road Nursing Home DS0000024450.V348443.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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 will to carry out their roles in a competent and informed manner. Residents cannot necessarily expect any challenging behaviour they exhibit to be best dealt with by all staff. EVIDENCE: Three out of five residents who responded to the survey stated that staff are always there when they need them, one indicated that they usually were, one indicated that they sometimes were. Six members of staff were on duty during the afternoon of the inspection, five carers and one nurse. Staff spoken with advised that there are often two nurses on duty. Staffing spoken with advised that they were usually able to take their allocated staff take breaks. No care or nursing staff had left the home in the previous twelve months. Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 21 Staff training certificates were on their individual files, but there was no schedule of training available which would enable an overview of training achieved to be accomplished and to guide future provision of regular training. The home employs eleven qualified nurses; seven of these are Registered Mental Nurses, four are Registered General Nurses (including one of the RMN’s) and one is an enrolled nurse. The AQAA states that 38 of care staff hold NVQ2, and another 1 is undertaking it, which will bring the percentage up to 40 . It also states that they have begun a new programme of training in dementia care. The home was able to evidence that twenty staff had received training in working with dementia within the last twelve months. One nurse spoken with had attended a national two-day dementia care conference. She had delivered the in house training on dementia. Additionally the home works in a person centred way, and this is the basis of all training. Another carer spoken with had undertaken a more extensive course on dementia, provided by the Alzheimer’s society; they advised that two other staff members had undertaken this certificated course. Staff also confirmed they had had received updates in moving and handling training. Two staff files were inspected. Both had appropriate recruitment records and Criminal Record Bureau checks but neither had proof of identity on file. The manager advised that they understood this was at head office. A member of staff spoken with advised that the home had also planned training in de-escalation techniques, but that the trainer had not been able to deliver this. One nurse spoken with advised that they had received break away training a couple of years ago. The accident record for the home showed that one of the residents tracked had been aggressive to staff. The manager confirmed that they were trying to rearrange this and provide it annually. All three staff who responded to the survey stated that they had received induction training. A schedule of the training which was linked to Skills for Care standards was seen. One of the recently employed staff had not received manual handling training, but the home was able to provide evidence that they had revived this within the last twelve months at the previous home that they had worked at. Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 22 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 to live in a home that is adequately managed, but cannot be assured that regular quality assurance is taking place in the home. EVIDENCE: 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. One relative who assisted a person complete their survey commented, “I think this home is as well run as it possible could be.” Another noted that, “The management and staff at Montague Road are all excellent.” Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 23 Over the last three years, the organisation has been reviewing the future of nursing homes within the group. The AQAA stated that maintaining staff morale against this background has been a focus of management activity, and also that a relative’s support group had recently been set up to share information and hear concerns. The AQAA states that the home does not currently have a coordinated approach to quality assurance. Regulation 26 visits are undertaken by the manager of another home in the company. Copies of these for December 2006, January2007 and April 2007, only, were available in the home, although the Registered Manager advised that they were being undertaken. A requirement was made at the previous key inspection that the Registered Persons must ensure that a quality assurance system is in place which actively seeks feedback from residents and/or their representatives. The Registered Manager advised that these have been undertaken, but not collated, and there was no evidence available. There were no comments from residents on their views of the home in the Statement of Purpose/ Service User’s Guide. The regular relatives’ meeting that has been set up provides a form of quality assurance. 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 two 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. The manager audits the finances the administrator at every monthly balance. The Administrator advised that a new system had come into place whereby the spending monies received for residents are banked in one account held purely for this purpose, residents do not receive a statement, but interest is apportioned two monthly. The last record of interests paid, was over twelve months prior to the inspection. The staff supervision file showed records of some staff having had supervision on a quarterly basis, but not all. The manager advised that the staff did not have to have their records kept on file if they did not want this. None of the staff surveys received detailed supervision in response to the enquiry about what kind of management support they had. All indicated no to the query “does your manager meet with you regularly to discuss how you are working?”. Staff also attend a once a week unit meeting and a once a month home meeting. Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 24 An up to date list of residents accommodated was maintained in the home. There had been three deaths in the home in the previous twelve months and CSCI had been informed in each case. A valid Electrical Safety Certificate was available for inspection. The servicing certificate for the lift dated June 2007 was seen. The correct Certificate of Registration was on display. The home had a fire risk assessment dated 11th May 2007. The home had a fire log book with a weekly record of tests. Fire training had taken place the previous day. Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 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 3 17 X 18 2 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 3 3 Montague Road Nursing Home DS0000024450.V348443.R01.S.doc Version 5.2 Page 26 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 OP18 Regulation 13(6) Requirement Any non-accidental injury to a resident must be reported through Adult safe guarding procedures. Training in de-escaltion techniques must be provided for staff, to equip them with the skills to minimise the risk of receiving physical aggression. The Registered Persons must ensure that a quality assurance system is in place which actively seeks feedback from residents and/or their representatives, so that this is available to be incorporated into service development. This is a repeat requirement From 15/08/07. Regulation visits must be undertaken in line with the regulation and copies made available to the home, so that it can demonstrate that routine quality checks on key areas are being undertaken by an independent person representing the organisation. Evidence of recent interest paid DS0000024450.V348443.R01.S.doc Timescale for action 07/09/07 2. OP30 18(1)(c)(i ) 30/11/07 3. OP33 12(3) 31/01/08 4. OP33 26 30/10/07 5. OP35 20(1)(a) 31/10/07 Page 27 Montague Road Nursing Home Version 5.2 6. OP36 18(2) 7. OP37 17(2) sch 4 6 into an account held by the company on behalf of residents was not available and must be provided, to evidence that residents are receiving all of the income they are entitled to. There must be evidence of documented formal supervision in line with the standard taking place for staff. Proof of identity of workers must be held in the care home, for identification purposes. 30/11/07 31/10/07 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.V348443.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Local Office Fairfax House Causton Road Colchester Essex CO1 1RJ 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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