Inspection on 19/01/07 for Montana Residential Home

This inspection was carried out on 19th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Montana Residential Home 11/11/08

Montana Residential Home 14/09/05

Montana Residential Home 27/04/05

Montana Residential Home 26/10/04

Montana Residential Home 03/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Montana Residential Home East Barton Road Great Barton Bury St Edmunds Suffolk IP31 2RF Lead Inspector John Goodship and Sue Jenkins Unannounced Inspection 19th January 2007 10:00 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 Montana Residential Home DS0000024451.V325648.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. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Montana Residential Home Address East Barton Road Great Barton Bury St Edmunds Suffolk IP31 2RF 01284 787321 01284 788012 superior@montanagtbarton.wanadoo.co.uk 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) Grace & Compassion Benedictines Sister Thayawathy Moses Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th September 2005 Brief Description of the Service: Montana is a residential home for 17 older people situated in the village of Great Barton. The house is owned by the Grace and Compassion Benedictines, and is run by nuns of the Order. The home was opened in 1969 as a single storey detached building, which has been extended and refurbished over the years. Oakampton House, a sheltered housing complex of 18 flats, accommodating older people who are semi-independent, is sited next to Montana. The homes enjoy close links with each other and the occupants of Oakampton House may join residents in Montana for meals, social activities and worship in the chapel. Current fees for this home range from £330.00 to £340.00 Montana Residential Home DS0000024451.V325648.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 inspection with two inspectors lasting six hours on a weekday. The report has been written using accumulated evidence gathered prior to and during the inspection, including information from thirteen service users surveys and thirty relatives questionnaires. Time was spent talking with three residents, three staff and the Registered manager. Additionally a number of records were inspected including residents care plans, staff personnel and training records, medication sheets and policies and procedures. What the service does well: The home is run by a community of sisters and nuns who live on site and provide most of the care, they are supported by lay staff. The home does not use agency staff and the staff work flexibly to cover sickness and annual leave. The registered manager is responsive and staff spoken with confirm they are well supported. ‘The home is wonderful’ and ‘the sisters are wonderful’ and ‘very nice staff’ are some of the comments made by residents. The atmosphere is friendly and peaceful. Although the order is a Roman Catholic one, the home welcomes residents from all denominations. There is an on site chapel which is well used by staff and residents. The home is clean and comfortable and the residents have good access to healthcare. There are many opportunities for enjoying social events and activities. The home has an accessible complaints procedure and no complaints have been received in the last year. Administration of medication is safe. Staff have access to a variety of training. Four of the care staff have completed an NVQ in care and another staff member is undertaking the course. The home was awarded a food hygiene certificate by the local authority for the third year running in 2006. Comments by both service users and relatives/visitors were very positive overall about the home and the care provided. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 Standard 6 does not apply. Quality in this outcome area is good. Prospective service users can expect to be provided with the information they require to help them make a decision to move into the home, this includes visiting the home. Resident’s needs are assessed prior to admission to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents were case tracked and all three had a contract and terms and conditions. However, none had the fees payable and method of payment recorded. The Registered Manager stated she would address the matter. The service users’ guide had been updated in January 2007 and a copy was on display in the main entrance. A copy of the most recent satisfaction survey was included. All three residents stated they had received a copy when they first arrived at the home and they or their relative had visited the home before admission. One resident said they would highly recommend the home to friends. All thirteen of the returned residents questionnaires agreed they had received enough information about the home before they moved in. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 9 The home does not offer intermediate care so standard 6 does not apply. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 Quality in this outcome area is good. Residents are protected by safe administration and storage of medication. Assessments are completed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Resident’ needs are assessed in a holistic manner. However, one of the three residents case tracked care plan did not fully reflect the care needed. For one resident who needed help with washing and dressing, there was not a care plan but it was written in the daily record sheets the care they had received. This resident had a nutritional assessment completed and a referral to the dietician had been assessed as being needed but there was no evidence this referral had been made. However, this was not discussed with the home on the day. Daily records were updated and reflected the care given. Visits by other health care professionals i.e. GP, district nurse and chiropodist were recorded. None of the three residents tracked had a six-week review of their plan. However, it should be noted that one had only just been there for six weeks. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 11 Some of the entries by the key workers were more appropriate for the daily record sheets and did not always reflect a reassessment. If a resident has an accident/fall this is recorded in the daily record sheet, however, there is no evidence of a trend analysis to ascertain if any further actions are needed for that individual. All three residents had information recorded relating to arrangements when they died. All three residents spoken with said they were happy with the care they received and one said ‘staff were anxious to look after you’. Twelve of the thirteen returned service user surveys stated they always received the care and support they needed, and the last one said usually. All thirteen said they felt listened to by the staff and they acted on what they said. A comment by one resident ‘they are always ready to stand and have a chat with you’. The thirty returned relatives/visitors comments cards all stated they were satisfied with the overall care provided. A medication audit had been completed by ‘Boots’ on 17 January 2007 and medication administration records (MAR) found to be completed accurately with one exception. The only comment “that tablets marked 1 or 2 to be given” the actual amount given should be recorded. The drug fridge was locked and the medication stored with the name clearly marked. All were within date. Interactions between staff and residents were friendly and appropriate. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. Residents can expect social opportunities and to choose a lifestyle that matches their expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was an activities list on display in the dining room that included exercises, bingo, singing, board games and puzzles. On the inspection day several residents were participating in an exercise programme and singing. There was a photo board of two recent events, a Christmas pub lunch in the local village and Indian dancing. The home joins up with the local sheltered housing residents next door, they also have use of the on site chapel. Two of the three residents spoken with stated their families often took them on outings. The visitor’s book showed that many of the residents had relatives/friends visiting them and other religious personnel visited. All three of the residents case tracked stated the importance of the chapel and being able to use the chapel at any time to suit them. The Registered manager reported that if residents were unwell or wished to take prayers in their own rooms this was facilitated by one of the sisters. Eight of the thirteen service users comments said there was always activities arranged by the home they could take part in, four others said sometimes and Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 13 one of those said they had activities like reading and knitting they did on their own. Another resident said there were more activities than they wanted to join in. The residents are seated in groups of four in the dining room. The daily menu is displayed in the dining room. The menu on the day of inspection was: lunch - fish and chips, steamed fish or scrambled egg, mashed potatoes and peas. For dessert rice pudding or stewed apple. Supper, soup, cauliflower cheese, fruit and cake. There were many favourable comments about the meal choices, alternatives always available, food ‘very good’. There were thirteen residents in the dining room at lunchtime, with only one resident on that day choosing to eat in their room. The home promotes socialising and staff reported most residents choose to go to the dining room for lunch and supper. All three residents spoken with said if they wanted to have their meals in their rooms that was facilitated. Eight out of thirteen residents survey said they always liked the meals and the other five said usually. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Residents can expect that complaints and matters of protection be taken seriously. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure displayed in the main entrance and on the communal notice boards. There is also a copy in the service users guide, which is given to residents. There were no reported complaints in the last year. The Commission has not received any complaints about this service. The three residents spoken with stated they knew how to complain if the need arose. There were five recent complimentary letters/cards from visitors/relatives about the home. The home subscribes to the local policy and procedure developed by Suffolk Social Services on protection of vulnerable adults (POVA). All staff have received training relating to POVA. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25 and 26 Quality in this outcome area is good. Whilst the residents can expect to live in a comfortable home there were some minor shortfalls in cleanliness. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the communal areas and six bedrooms was undertaken, all were found to be fairly clean and tidy. The skirting boards were a little dusty in room eight, it should be noted this was an empty room. Room nine was also empty and had a rusty shower tidy rack and needed redecorating. The slats of five of the shower seats need cleaning. One commode chair was rusty. Three of the rooms had residents’ own personal furniture, photographs, pictures and books. Some of the skirting boards in bedrooms and in the main hallway were dusty. The communal lounge had comfortable chairs; a television and music centre and next door was a quiet room/lounge, which both residents and staff used as Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 16 necessary. The dining room is directly next to the kitchen and residents sit with groups of four people. The communal notice boards in the main entrance and the residents dining room were very overcrowded and some of the information duplicated and/or out of date. The registered manger addressed this on the inspection day and removed some of the notices. The laundry room has two washing machines, a drier and hand washing facilities. The home employs a laundry assistant. There is a separate hairdressers room, which was clean and tidy. The assisted bathroom is spacious, however the underside of the hoist needed cleaning. The hoist was last serviced 29/11/06. There were paper hand towels and a soap dispenser available. There were two soap bars and two flannel/sponges left in the bathroom. The laundry basket was dusty. The water temperature recordings in the logbook were between 37 – 40 degrees Celsius. On the day of inspection the wash hand basin water temperature in room one was 41 degrees Celsius, this is within the accepted range. All the residents bedrooms shower and wash hand basin water temperatures were checked monthly and recorded as between 40 – 42.8 degrees Celsius. The freezer temperature records were checked daily and recorded as being between 18 – 22 degrees Celsius, which is within the accepted range. There were monthly log sheets for the cleaning of showers, fridge and freezer. Also daily records for the cleaning of microwave, kitchen sinks and floors, worktops, bins and the fruit and vegetable store. A food safety inspection had been completed on 18 January 2007 and passed. There was evidence of an ongoing maintenance programme. Rooms two and eleven, the dining room, lounge have all been redecorated in the last six months. Further rooms were planned to be redecorated in the next few months. One of the relatives comments cards stated the library was cluttered. On inspection day there were some book cases that were not easily accessible, as smaller bookcases had been placed in front of them. The registered manager said they now had too many books and needed to address this issue. There was a wide variety of reading matter available. All fire exits were clearly labelled and the fire extinguishers were last serviced February 2006. There is a certificate of inspection for the fire alarm system dated 5 June 2006. The fire extinguishers are checked monthly to ensure the instructions are legible and seals are not broken. A fire risk assessment was completed in September 2006 by an external specialist and the home found to be compliant with fire regulations. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 17 The gardens are accessible by wheelchairs and there are places for residents/visitors to sit outside. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is good. Residents can expect to be supported by sufficient numbers of staff that are well trained and can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff rota was seen and this reflected the number of staff on duty, three carers and the registered manager, the laundry assistant, handyman, cook and a domestic. Two of the relatives/visitors comments cards said they felt there were not always sufficient staff on duty. However, the inspectors observed the buzzers were answered very quickly. One sister was facilitating an exercise class and all staff were calm and carried out their duties well. The registered manager explained that even when prayers or a service was taking place in the chapel there was always a member of staff on the floor and should help be required the resident’s bells could be heard in the chapel. The three residents spoken with said they always had the help/support needed at the time it was needed. The recruitment process was reviewed and four staff records seen. All had two written references and a CRB check (Criminal Records Bureau.) Training records were up to date and a wide variety of training had been undertaken including infection control, adult protection of abuse, bereavement, health and safety, stoma care, fire, first aid, food hygiene, moving and handling. Four staff have completed NVQ in care at level two and one carer is currently Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 19 undertaking the course. One staff member has NVQ in care level three. Formal supervision is given to the staff by the senior sisters. The home has a strong commitment to training for all staff. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. Residents can expect to live in a home that is managed by an appropriately qualified manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home has been working in the care profession for several years. She was the deputy manager of Montana for four years before becoming the manager in May 2006. She completed the Registered Managers Award (RMA) in July 2004. The staff and residents spoken with view her leadership style positively and is very supportive and conscientious. The home does not act as agent with regard to any residents finances. The home does keep a small amount of personal money for residents and allows them access when they need it. The money is in individual envelopes and locked away. The money is signed in and out by a staff member and the Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 21 resident or relative. One of the resident’s accounts was checked and the logbook and balance found to be correct. There are both residents and staff meetings minutes available. The most recent residents meeting discussed activities for Christmas. Attached to the Service users guide/statement of purpose is the latest copy of the residents and relatives/visitors and Health care professionals survey, which is very favourable to the home. The home keeps very good records for training, cleaning and health and safety checks. The homes certificate of registration and employers liability is displayed in the main entrance. The home has a quality-auditing tool that was completed. There are also regular visits to the home by the provider and copies of these reports are sent to the Commission. There were some minor shortfalls in relation to cleaning within the home. (see section on environment) Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 22 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 3 3 x 3 3 3 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 3 3 X 3 3 3 3 Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP2 Regulation 5 (1) (b) Requirement The registered manager must ensure the fees payable and the method of payment are included in the individual residents contract. The registered manager must ensure that care plans reflect resident’s needs. The registered manager must ensure residents have six weekly reviews and care plans are reviewed regularly in line with good practice. Timescale for action 14/02/07 2 3 OP7 OP8 14 (1) (a) 15 (2) (b) 14/02/07 14/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP8 OP19 Good Practice Recommendations The registered manager should undertake a trend/needs analysis of resident’s accidents to ascertain if any further interventions are required. The registered manager should ensure notice boards have information that is up to date and relevant to the DS0000024451.V325648.R01.S.doc Version 5.2 Page 24 Montana Residential Home 3 4 OP19 OP7 residents. The registered manager should ensure all the books in the library are accessible. The registered should consider allocating key workers on an individual named basis to ensure review of residents care plans. Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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. Extracts may not be used or reproduced without the express permission of CSCI Montana Residential Home DS0000024451.V325648.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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