This inspection was carried out on 24th July 2009.
CQC has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.
The inspector found no outstanding requirements from the previous inspection report,
but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for older people
Name: Address: Montevideo House 432 Chickerell Road Chickerell Weymouth Dorset DT3 4DQ new service which has yet to be given a quality rating The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Amanda Bell Date: 2 6 0 7 2 0 0 9 Information about the care home
Name of care home: Address: Montevideo House 432 Chickerell Road Chickerell Weymouth Dorset DT3 4DQ 0 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Althea Health Care Properties Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 51 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 51 51 The maximum number of service users who can be accommodated is 51. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Mental disorder (Code MD) Dementia (Code DE) Date of last inspection Care Homes for Older People Page 2 of 10 Brief description of the care home Montevideo House is a mostly purpose built care home with nursing, located on a main road on the western edge of Weymouth. There is a bus stop close to the home, providing a service to and from Weymouth town centre. Montevideo House is registered to provide care with nursing to elderly people with a mental disorder, including dementia. The home comprises a ground, first and second floor providing accommodation for a maximum of 51 people; all are accommodated in single bedrooms with en-suite hygiene facilities. There are assisted bathrooms and communal rooms on each of the three floors. All registered parts of the home can be accessed without the necessity to negotiate steps or stairs; there is a passenger lift. In the basement are the laundry, food storage facilities, and the heating establishment; the basement is not accessible to residents and their visitors. Laundering of clothing and household linen is carried out in the home at no additional cost to residents; items requiring dry cleaning are charged extra because it is necessary to send them out of the home for this service. There is a large attractively maintained garden to one side and rear of the Montevideo House building and car parking spaces at the other side. A hairdresser visits the home each week; there is an additional charge for this service. The home is owned by Althea Health Care Properties Ltd and was registered in their name in June 2009. They have managed the service since February 2009 prior to purchasing the service. At the time of inspection there was no registered manager in place. Fees are charged weekly; at present they range between £650 and £900 per person. Care Homes for Older People Page 3 of 10 What we found:
This focused inspection was carried out following concerns raised with use under the local safeguarding protocols. We visited the home over three days on the 24th, 25th and 26th July 2009. On the first day of this inspection a visit was also conducted by a social worker investigating the safeguarding concerns; Dorset Primary Care Trust (PCT) safeguarding investigating nurse and the quality assurance monitoring officer. On the following two days the Dorset PCT quality assurance monitoring officer also visited. The outcome areas reviewed at this inspection were those relating to care planning and the delivery of care; nutrition and wound management. This was the first inspection of Montevideo House under the ownership of Althea Healthcare Properties Ltd. The company has been responsible for managing Montevideo House since February 2009, when the home went into receivership. Althea Healthcare Properties Ltd purchased the home in June 2009.There was no registered manager in post. A Registered General Nurse and a Registered Mental Nurse took the clinical leads in the home and were responsible for overseeing the delivery of care to the people living there and, in turn, they were managed by a Regional Manager for Althea Healthcare Properties Ltd. At this inspection we found a number of serious shortfalls and requirements have been made in relation to the protection of vulnerable adults, care planning and delivery, safe medication practices and infection control. We were told by staff that a total of 38 residents were living at Montevideo House at the time of inspection. At the end of each day of inspection we gave feedback to the nurse in charge. What the care home does well: What they could do better:
We toured the premises and found the home to be malodorous. Most areas had a pervading smell of stale urine. Many of the carpets looked heavily stained. The poor infection controls procedures in the home put everyone in the home at risk. We found that the sluice areas were locked and only senior members of staff had keys. This meant that the emptying of commodes and the disposal of used incontinence pads and foul dressings was delayed whilst staff obtained a key to get into the sluice. The home must be clean and robust infection controls procedures must be in place to protect everyone one in the home from the risk of cross infection. We were informed by the staff that approximately fifteen people had a variety of wounds and pressure sores and a number of people were at risk of developing pressure sores. We saw that air flow mattresses were in place on a number of beds to reduce this risk. However they were set incorrectly and the home had no knowledge of what the correct settings should be. This meant the risk of developing a sore for those people lying on these mattresses could have been significantly increased. We made an immediate requirement that the mattresses were set to the correct level to be effective.
Care Homes for Older People Page 4 of 10 During our inspection a number of wounds were reviewed by the PCT who told us that the frequency and types of dressing used had been inappropriate. The recording of wound care management was also poor, which meant that it was not clear whether they were improving or getting worse. On two occasions, during this time, the PCT found that the wounds were significantly worse than the home had told us. We saw that a number of residents had sustained bruising of unknown origin and this had not been fully investigated or recorded by staff. Wounds must be managed appropriately and care given must be recorded accurately. Bruising of unknown origin must be recorded and reported following the local safeguarding guidance. On the second and third day of the inspection we found the medication trolley on the ground floor was left unattended with medicines which were accessible to service users in this area. We made immediate requirements on both occasions that this unsafe practice must cease so that residents were protected from the risk of ingesting medicines that were not prescribed for them. Care records showed us that some residents had lost a significant amount of weight since admission. Although we saw that a dietician referral had been made in some instances the home had not provided food enhancements or made significant efforts to increase the calorie intake for these people. Fluids were given out at certain times of the day and were not readily available. We reveiwed the fluid charts for some people and saw that intake was low. One person told us that they were thirsty and we found that their fluid intake for the previous 24 hours had only been 650 mls. The expected fluid intake was not recorded in care plans so that staff were not made aware of what was expected or what to do if insufficient fluids were taken. Nutritional screening must be in place so that any risks are identified and the appropriate level of nutrition is given. Car plans generally were not updated as the needs of the individual changed, particularly when weight loss was evident. We saw that one person had a significant cough but this was not reflected in their care plan. Daily records appeared to centre around the tasks staff had undertaken and did not reflect how the resident felt and whether they were in a state of ill or wellbeing. Care plans must reflect the current needs of each resident and give clear instruction as to how staff will give this care. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 6 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 8 12 The registered person must 29/07/2009 promote and make proper provision for the health and welfare of the service users. This must include the correct use of pressure relieving devices. To reduce the risk of people developing pressure sores. 2 9 13 The registered person must 29/07/2009 make fobust arrangements for the recording, handling, safe keeping, safe administration and disposal of all medicines in the home. To protect residents from ingesting medicines which are not prescribed for them Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 14 The registered person must ensure that a written plan is drawn up in sufficient detail to meet the health and welfare needs of service users. To ensure that staff have accurate and detailed information to meet each person health needs. this 27/08/2009 Care Homes for Older People Page 7 of 10 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action must include all aspects of their health and welfare including wound care. 2 8 12 The registered person must make proper provision for the health and welfare of service users. To ensure that people receive adequate nutrition and hydration and monitoring charts are completed and used effectively. 3 17 13 The registered person must 24/08/2009 make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being place at risk of harm or abuse. To ensure that staff are aware of safeguarding guidance and report any suspicions or actual abuse to the appropriate agencies. This must include any reports of bruising of unknown origin. 4 26 16 The registered person must 24/08/2009 ensure that the home is kept clean and make suitable arrangements for maintaining satisfactory standards of hygiene in the care home. To ensure that the risk of cross infection is minimised
Care Homes for Older People Page 8 of 10 27/08/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action and the home is a more pleasant place to live. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
