Inspection on 22/07/08 for Montrose

This inspection was carried out on 22nd July 2008.

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

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

Montrose 22/07/09

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/12/2008.

CARE HOMES FOR OLDER PEOPLE Montrose 40 Prince Of Wales Road Dorchester Dorset DT1 1PW Lead Inspector Sue Hale Unannounced Inspection 22nd July 2008 09:30 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 Montrose DS0000071007.V365267.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. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Montrose Address 40 Prince Of Wales Road Dorchester Dorset DT1 1PW 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) 01305 262274 01305 261330 montrosecare@aol.com Maricare Ltd Manager post vacant Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 22. First inspection, new service. Date of last inspection Brief Description of the Service: Montrose is an established, well maintained care home which provides a friendly atmosphere for older people who need the support of residential care. Montrose is registered to accommodate up to a maximum of 22 older people (age 65 and over), both male and female, and is located within a short walking distance of Dorchester town centre. The proprietor is Miss Whitehead who took over the home in February 2008.There is currently a manager designate in post who is responsible for the day-to-day running of the home .Montrose is a large detached building with Victorian frontage that has been extended and is arranged over three floors. The top floor is not a part of the registered premises and is given over to the use of management office space. The registered accommodation is spread over two floors and contains 20 single rooms and 1 double room. Refurbishment work for an additional room is nearing completion. This means the home will be able to accommodate 22 people all in single room occupancy. A passenger lift gives level access from the ground floor to all rooms on the first floor. Montrose has two lounges and a dining room for communal use. The lounge at the rear of the property which has patio doors leading out onto the back garden has a six seater dining table for use as an extra dining facility. This is ideal if residents wish for privacy to dine with visitors. The garden has accessible patio and lawned areas. No smoking inside the building is allowed. The current fees range from £520 to £675 per week. Fees include all care and accommodation costs, including meals, laundry and activities. Additional charges are made for hairdressing and chiropody. People are expected to pay for their own personal items such as private telephone, toiletries and Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 5 newspapers. Readers of this report may find it helpful if they have any queries about fees to contact the Office of Fair Trading www.oft.gov.uk. The report of this inspection is available from enquiries@csci.gsi.gov.uk. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of the inspection was to inspect relevant key standards under the Commission for Social Care Inspection Inspecting for better lives 2 framework. This focuses on outcomes for residents and measures the quality of the service under four headings; these are excellent, good, adequate and poor. The judgement descriptors for the seven sections are given in the individual outcome groups. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. This report uses information and evidence gathered during the key inspection process, which involves a visit to the home and looking at a range of information. This includes the service history for the home and inspection activity, notifications made by the home, information shared from other agencies and the general public and a number of resident and staff files. We also spoke to six people living in the home and six people who work there and observed the day-to-day routine and care practices. The registered provider/owner supplied the commission with an AQAA (Annual Quality Assurance Assessment). Information from this has been used to make judgments about the service, and has been included in this report. Surveys were distributed by the manager designate to people who live at the home, relatives of residents, health/social care professionals and staff. We received eight surveys from residents, six from medical/healthcare professionals, six from relatives and seven from staff. The findings of the surveys have been included in this report. Seven residents described themselves as British, six as Christian with one person having a different religious preference. There were nineteen people living in the home on the day of the inspection. The quality rating for this service is one star. This means that the people who use this service experience adequate quality outcomes. The manager designate had only been in post for a short time and was very open about problems that had been identified since they started working at the home. There was clear evidence of both action taken and in the AQAA that these issues were being addressed as soon as practicable which was very positive. What the service does well: Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 7 The home provides information for prospective residents and their families about the services provided. All residents have a care plan in place that details their basic care needs. People are seen as individuals with their own personalities, life history and are treated with respect by staff. Residents have access to medical and health care professionals as and when they need it. The home is introducing mental capacity act assessments for all residents and is aware of the need to educate staff on this issue and constantly review assessments to make sure they are reflective of individuals’ current needs. All the residents spoke to were satisfied with the food provided. One resident said I always look forward to the meals here. Records kept by the cook are detailed and they were familiar with individual’s likes and dislikes. The staff team is stable and provides continuity of care for residents who appeared relaxed and comfortable with staff. Medication practice is generally safe and keeps people well. People living in the home are supported to maintain their independence and enduring interests, which enhances their quality of life. Residents’ meetings have been introduced so that people in the home are able to have a say in how the home is run. A car has been purchased so that staff are able to take residents out and the range of activities available is under regular review. A recent summer event that included relatives and visitors was very popular. The The home was clean, tidy and homely. It is a welcoming environment for visitors. Some relatives commented that the home had a warm, relaxed and friendly atmosphere and that they were always made welcome when visiting. Residents are encouraged to personalise their bedrooms and bring in personal possessions when they move into the home. An ongoing programme of maintenance and refurbishment is in place. One professional surveyed said that staff appear to be ‘genuinely kind and caring’, while another commented that care staff were ‘ pleasant and respectful ‘. A professional described the communications at the home as ‘good, easy and pleasant’. The majority of staff or qualified to NVQ level 2 or above and the home is committed to supporting staff to attend courses and obtain qualifications. Staff spoken to were very positive about the changes and the introduction of staff meetings and increased opportunities for training. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 8 Health and safety is taken seriously at the home to make sure that residents and staff are safe. What has improved since the last inspection? What they could do better: The statement of purpose and service user guide needs minor amendment to make sure they include all the relevant information. All residents should be offered a contract and terms and conditions of residency relevant to the current ownership of the home and this should include the amount and method of payment of fees. Pre admission assessment procedures need to be more robust to make sure that prospective residents needs are fully assessed and can be met before they move into the home. All the documentation needs to be dated and signed. Care plans should cover all the recommended topics in enough detail to give information and advice to staff on how residents need are to be met. More attention to detail should be paid to risk assessments to make sure they are accurately completed and any action needed is identified and taken. Residents should as far as possible be involved drawing up care plans and risk assessments and consulted as to their views about the way care is provided. All complaints must be fully investigated, the outcome recorded and the complainant advised of any action that may have been taken. Signage within the home particularly on communal bathrooms and toilets should be improved so that people can retain their independence for as long as possible. All bins in communal toilets and bathrooms and clinical waste bins should be foot operated to reduce the risk of cross infection. Paper towels and hand wash should be available in all communal toilets, bathrooms and the laundry so that staff and residents can wash their hands to reduce the risk of cross infection. Infection control procedures should be put in place in the laundry to reduce the risk of cross infection. All staff should be given their own copy of the General Social Care Council code of conduct and a record should be kept of staff interviews. The staff induction should be based on the Skills for Care common induction standards. The manager designate should include the hours that they work, and the staff rota Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 9 should make clear who is in charge on each shift and who is the appointed first aider on each shift. All policies and procedures need to be relevant and appropriate to Montrose and the people living there to make sure that staff are given the right information and advice to meet residents’ needs. Information about residents needs to be recorded in a way that meets the Data Protection Act and preserves peoples right to privacy. Staff should not undertaken nursing procedures unless this has been agreed with the district nursing service, they have received appropriate training and their competency assessed. All accidents should be recorded and any event listed in regulation 37 such as the death of a resident or a serious injury reported to us without delay. The fire risk assessment should be updated in line with current fire safety regulations to make sure that measures are in place to look after residents and staff should a fire occur. Auditing and monitoring systems need to put in place to ensure that the manager designate is fully aware of all that goes on in the home and that it is working effectively. 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. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 10 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 Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home supplies written information about the services they provide for prospective residents and their relatives. People are encouraged to visit the home and spend time there before they make a decision on residency. Residents do not have a current contract in terms of residency. Pre admission assessment procedures are in place but need to be more robust to make sure the home can meet people’s needs before they move in. EVIDENCE: Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 12 The home produces a brochure with colour photographs of the interior of the home and brief details about the services provided. The brochure on display included a copy of the statement of purpose. The statement of purpose is clearly written and includes the majority of the information required by the regulations. It does not include the name, qualifications and experience of the manager designate, the size of the residents’ rooms and the complaints policy does not make clear that complainants are able to contact the Commission for Social Care Inspection at any stage for complaint. The contact address for the Commission needs to be updated to give the current details. The home produces a resident’s guide; this does include information on about the manager designate, the sizes of the private rooms available and current contact details of the commission. The guide should tell readers where they can obtain a copy of the most recent inspection report. The homes referral and admission policy does not refer to Montrose’s registration or the older people that can be accommodated there. The manager designate told us that pre admission assessments are undertaken by senior staff and that they (the manager designate) is not involved in this process. The manager designate told us that a preadmission assessment would take place and the person encouraged to visit the home before a decision would be made about residency to make sure that the home could meet their needs. We looked at the file of one person who had recently moved into the home. It included care plans in relation to continence, mobility, skin and general care. The assessment was not signed or dated and it was unclear if it had been undertaken before the person moved into the home. Although the assessment identified that the person had a difficult sleep pattern there was no care plan or information or guidance to staff on how to manage this. The pressure sore risk assessment identified a high risk but there was no care plan in relation to this and no details of any action taken to reduce the risk. There was no evidence that the resident or their relative had been involved in the assessment or care planning. Some residents spoken to told us that they had been to look around the home before they moved in while for some people that decision had been made by their relatives. The manager designate told us that none of the residents had a current contract or terms and conditions of residency relevant to the current owner of the home. Three residents surveyed said that they had received a contract of residency in three said that they hadn’t. Six people said they received enough information about the home before they moved in on two people said that they hadn’t. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 13 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents have a care plan but this is basic and does not cover all the identified needs in enough detail to give staff information and advice on how they should be met. There is no evidence of residents being involved in the development of their plan and they are not always reflective of individuals’ current situations Not all risks are assessed and those that are, are not always completed accurately. Medication practice is generally good but further improvements are needed to make sure it is safe. People living at the home were treated with dignity and their right to privacy respected by staff. EVIDENCE: Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 14 We looked at the personal files of 5 residents who had lived at the home for a while. On one file looked at the care plan covered general care, vision, hearing, eating, drinking, mobility and skincare. It included a moving and handling assessment that identified the risk of verbal aggression but there was no care plan in relation to this to tell staff how to manage this should it occur. A pressure sore risk assessment detailing a very high risk had been undertaken but this lacked detail and did not give information or advice to staff on how pressure relief should be provided to reduce the risk of sores. A falls risk assessment had been done which showed a medium risk but this had been wrongly calculated and if the use of walking aids had been taken into account the risk score was high. A nutritional assessment had been undertaken that showed that a referral to a dietician was needed but there was no evidence that this had been done. The daily record included a reasonable amount of detail. The second care plan looked at included a photograph of the resident and good details of their medical history and contact with medical and health care professionals. It did not include any social or life history. There was no care plan in relation to the residents periodic agitation and the care plan on catheter care lacked detail and did not give information of advice to staff on any action needed should the catheter become blocked. On the third care plan looked at, issues related to challenging behaviour had been identified but there was no care plan or risk assessment in relation to this. The person had fallen and sustained a minor injury but this had not been recorded in the accident book. On the fourth residents file looked at there were care plans for personal care, nutrition, mobility, dressing and undressing and bladder/bowels. The person was diabetic but there was no diabetic care plan and no information or advice for staff on the signs or symptoms of the person becoming ill. There was no care plan in relation to foot care which we would have expected to be in place for somebody with diabetes. A pressure sore risk assessment was in place; this was initially undertaken in January 2007 and was recorded as high risk. Although this had been reviewed monthly it had not been reassessed. There was no care plan in relation to this or advice and guidance to staff on what to do to reduce the risk of pressure sores. There was no record of any equipment provided to reduce the risk. Not all the records were dated or signed. There were good records in relation to contact with the district nurse and GP and checkups with medical and health care professionals including the optician and dentist. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 15 The fifth care plan looked at contained basic care plans but had similar gaps in information as detailed above in relation to the pressure sore risk assessment and lack of social history. It was very positive to see that the home is introducing a mental capacity assessment for all residents and is planning to make sure all staff is aware of the Mental Capacity Act. A key worker system has been introduced and a relative spoken to said this was very positive and was working well. Not all residents had a toothbrush or toothpaste and there were some toiletries and razors in communal bathrooms and toilets. There was no evidence that residents or relatives were involved in care planning or review or that their views were sought as to how care was delivered to see if they were in agreement with this. The manager designate told us that they did not have any input into care plans, was not involved in auditing them to see if they are effective and was unaware if any risk assessments were in place. It was clear on most of the care files looked at the residents have access to medical and health care professionals including doctors, dentists, opticians and specialists when they needed it. We observed that continence products were not stored discreetly in residents’, rooms and in one room these were kept on the windowsill. This does not respect people’s dignity particularly when seeing visitors in their room. We looked at medication practice in the home. The manager designate is not currently involved in the management or auditing of medicines. The home keeps a controlled drug register and all quantities checked were correct. Patient information leaflets and a sample staff signature list were on file. On one record looked at particular medicines should have been given in the morning but been given at teatime. On the medicines administration record (MAR) the dosage in some cases had been changed by hand but not dated or signed. Risk assessments were not in place for residents who self medicate and keep medication in their rooms. Creams and ointments did not have opening or expiry dates on them. The manager designate told us that all staff had completed training organised by Boots. Staff were observed to treat residents with dignity and respect throughout the day in the way they delivered care, spoke to them and knocked on the doors of the private rooms before they went in. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 16 All residents surveyed said that they always received the care and support they needed and that staff always listened and acted on what they said. All residents surveyed also said that they always received the medical support they needed. Six relatives responded to our surveys. Three said that the care home always met their relatives’ needs; three said that the home usually did. Three said that the care home always helps their relative keep in touch and two said that the home usually did. One relative commented that their parent often comments that they would like the opportunity of bathing more frequently. All the medical/ health care professionals surveyed said that the home sought advice whenever necessary and that they felt individuals health care needs were being met. They all felt that residents’ privacy and dignity was respected. One professional told us that the home had an ‘understanding of rehabilitation needs’ and promoted residents independence. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 17 Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 18 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. This judgement has been made using available evidence including a visit to this service. The routines of the home are as flexible as possible to suit the preferences of people who live there. An activities programme is in place and there are plans to increase the range and variety of things available. Visitors to the home are encouraged and made welcome. Residents are satisfied with the meals served at the home. EVIDENCE: Residents spoken to confirmed that they are able to get up and go to bed at times to suit themselves and spend time either in the communal lounge or in their private room. Residents are able to have their own telephone installed in their private room at their own cost. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 19 An activities programme is in place and is planned for four weeks at a time with all residents being given a copy of what is planned. There is now a car available to staff to take residents out. A summer tea party was held recently which residents and a visitor told us had been a great success. Residents had been encouraged to invite their own guests. The AQAA told us that it is hoped to arrange such an event at least twice a year. Three people surveyed said that there were always activities available that they could take part in and three people said that there usually was. One relative asked if they would be any future opportunities for residents to go on trips outside the home as these were rare. Another relative commented that they thought an increase in activities would be welcomed by people who live in the home. There were no activities being undertaken on the day of the inspection. The television has been replaced recently and also now includes ‘freeview’ so that there are more television channels available for residents to watch if they want to. The main meal of the day is served at lunchtime and on the day of the inspection was ham, egg, peas and chips. Mashed potato was available as an alternative. The vegetables and potato dishes were in serving dishes on the table for residents who are able to help themselves. There was a choice of squash or water to drink. There was no alternative hot meal available and we were told that if residents did not like the main meal they would be offered a sandwich or salad. As there is no hot food available at teatime this would mean that residents who did not like the meal available at lunchtime would not have a main hot meal that day. However, the homes policy on meals and mealtimes stated that the policy of the home was ‘based upon choice for service users’ and went on to state that residents would be asked ‘which choice they would prefer at every meal’. We spoke to the cook who kept very good records on all the residents likes and dislikes and told us that if they knew someone did not like the main meal an alternative would be provided. There were sufficient food stocks available. Five residents surveyed said that they always liked the meals available and two said that they usually did. All the residents spoken to on the day of the inspection said that they liked the food available and were able to tell staff if they wanted an alternative. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives know how to raise concerns and are confident that they would be listened to. Complaints have not been investigated in line with the homes policy and procedure. The adult protection policy does not reflect locally agreed good practice advice and needs to be updated. EVIDENCE: Information in the AQAA told us that one complaint had been received and that this had been upheld. However, on checking the complaints log the complaint had been recorded but there was no evidence that this had been investigated, that the member of staff concerned had been spoken to or that the complaint had been concluded. All the relatives surveyed said that they knew how to make a complaint. The adult protection policy did not give any information or advice to staff on what constituted abuse and said that the person in charge would investigate any allegation which is contrary to locally agreed safeguarding adults’ procedure. Although the AQAA stated that the in house training on adult Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 21 protection was based on locally agreed procedures, the manager designate told us that the home did not have a copy of this information. The training matrix supplied by the home showed that twelve members of staff had undertaken training on adult protection this did not include a manager designate and some staff spoken to were unaware of the correct way to report concerns about the possible abuse of residents and were unaware of the procedures the home would need to follow should an incident occur. The home has a whistle blowing policy but this didnt include the contact details of CSCI or Public Concern at Work. The homes policy on managing aggression was inappropriate to the people living at the home and did not recognise the issues relating to involuntary aggression due to illness or dementia. Seven residents who responded to the survey said that they knew how to make a complaint with six people saying they usually knew who to speak to if they were not happy and one saying that they usually did. However, one person spoken to said that they were unsure who was currently in charge of the home. All of the medical/healthcare professionals surveyed said that the home had responded appropriately when any concerns had been raised. All the staff surveyed said that they knew how to raise concerns. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 22 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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to personalise their bedrooms and they are able to bring personal possessions into the home when they moved in. The home was clean, tidy and homely. Improvements could be made to infection control procedures to reduce the risk of cross infection particularly in the laundry. EVIDENCE: The home was generally clean and tidy and resident’s rooms were personalised to their own taste. Residents are encouraged to bring in personal possessions Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 23 and some furniture if they want to within the space constraints of their room. Five residents surveyed said that the home was always fresh and clean with two saying it usually was. A relative surveyed commented that the home was a ‘warm and friendly environment’. Two other relatives commented that the home was ‘always clean and tidy’. The AQAA told us that a programme of routine maintenance is in place and that many items have been replaced since the change of ownership including the washing machine and dryer, dishwasher, cleaning equipment, linen, a freezer, pillows and duvets. The AQAA also tells us that a programme of refurbishment of the communal areas and residents rooms will be put in place and the residents and staff will be involved in planning this. We saw one bathroom where the bath was stained, part of one tap was missing and the room smelt unpleasant. The signage in the home particularly in bathrooms and toilets was poor and could reduce residents’ independence. Some of the laundry equipment has been replaced recently. Protective aprons and gloves were available for staff. The home does not employ housekeeping staff and laundry is undertaken by carers. There was no hand wash or paper towels for staff in the laundry and dirty washing in a bin was touching clean washing that was hanging up. The flooring in the kitchen was split and needed replacing to reduce the risk of cross infection. A relative surveyed said that they felt the home could improve by modernising facilities including the bathrooms and improve the general decor. A member of staff commented that they felt the garden could be made more accessible for residents so they could spend time outdoors if they wanted to. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 24 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. This judgement has been made using available evidence including a visit to this service. There appears to be sufficient staff to meet current residents’ needs. Recruitment processes are robust and safeguard residents. The majority of staff are qualified to NVQ level 2 or above and the home encourages and supports staff to attend training and obtain qualifications. It is unclear if the home uses the Skills for Care common induction standards. EVIDENCE: On the day of the inspection there was one senior carer, three care staff, the cook, two cleaners and an administrator on duty as well as the manager designate. The staffing reduces to two carers and senior in the afternoon. There are two carers on duty at night. A staff rota was in place that showed there was enough staff on duty to meet resident’s needs. It did not show who was in charge of each shift or who the designated first aider on each shift was. Five people surveyed said that there was always staff available when they needed them with two saying that there usually was. One person surveyed said that occasionally I have to wait a little while if they are busy and that Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 25 staff worked very hard. Two medical/healthcare professionals said that they felt the care staff always had the right skills and experience and one felt that this was usually so. We looked at the recruitment files of four members of staff which contained all the relevant documentation. All staff are given their own copy of the companies’ handbook. There was no record kept of staff interviews or evidence that staff were given their own copy of the General Social Care Council code of conduct. Information supplied by the home in the AQAA told us that ten staff (62 ) are qualified to NVQ level 2 or above and that the home support staff to undertake training. The AQAA also told us that staff have at least five days a year paid to attend training. Four members of staff have registered to start NVQ 4 training and support is available to senior staff to undertake the registered managers’ award. Six staff responded to a survey. Four stated that their induction had covered all aspects of their job very well; three said most aspects had been covered. All confirmed that they were offered relevant training. One person said there was always enough staff to meet residents’ needs, five thought there usually was, and one thought there was only sometimes enough staff on duty. Three thought that they always had the right experience knowledge and support to meet people’s needs, three thought that they usually did, and one thought they sometimes did. The home supplied a training matrix which showed that training was available in care planning, infection control and adult protection as well as mandatory training such as fire safety, health and safety and moving and handling. There was no evidence on staff files looked at that staff were undertaking the Skills for Care common induction standards and the manager designate was unaware of what induction format was being used. A relative surveyed commented that ‘staff do their best but sometimes they are just too busy to give as much attention’ as their parent would like. Three medical professionals completed surveys. Two said that there was always a member of staff to confer with when they visited one said that there wasnt. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 26 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): 33.35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager designate is not involved in pre admission assessments, care planning, review or medication and there are no systems in place to audit if these work effectively. Many policies and procedures are not relevant to Montrose or the people living there. Residents and staff meetings are being held to improve communication and find out peoples views. Plans are in place to provide formal supervision of staff to make sure that residents’ needs are being met and staff supported. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 27 Health and safety is taken seriously and measures are put in place to protect residents and staff. EVIDENCE: The manager designate has been in post since June 2008 but has not made application to the Commission for registration; this should be addressed as soon as practicable. The home completed an AQAA that provided clear information about changes they have made and plan to make in the future to improve the service provided for people who live at Montrose. The training matrix supplied by the home show that the majority of staff have undertaken training and fire safety, food hygiene, health and safety and moving and handling. It showed that the manager designate has not undertaken fire safety training. We asked staff in our survey if they felt that communication in the home worked well. Two said that it always did, two said it usually did and three people said it only sometimes worked well. One person commented that there should be more consideration of the needs of night staff when organising training and meetings and another person said that they felt all staff should be able to attend meetings and handovers, not just seniors. One relative surveyed felt that better communication from the new owner about their current and future plans for the home would be useful. The home does not have policies and procedures in relation to accidents that may occur to residents, the promotion of continence, care planning and review, and sexuality and relationships (for older people). Several policies and procedures in the home referred to younger adults not older people and were not relevant to either Montroses registration or the people living there. The communication book contained personal information about all the residents instead of this information being kept on their individual care plans. A residents meeting had been held in April 2008 and 17 residents had attended. Issues discussed included the changes made in the home by the new owner, food and menus and social activities. There was evidence in the minutes that what the residents had said had been listened to and acted upon by the registered person. Staff meetings had been held in February, April and July 2008 and looked primarily at changes introduced to working patterns and routines since the new registered provider had taken over. It was unclear if housekeeping staff are Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 28 included in team meetings. The manager designate told us that staff are paid to attend staff meetings and supervision meetings. We looked at the way the residents are supported by the home to manage their personal finances. Although a policy was in place the manager designate told us that the home does not hold any money on behalf of residents. The home has a supervision policy that meets the national minimum standards although it referred to a home of another name. The manager designate told us that there had been no formal supervision of staff before they came into post but that dates had now been set for all staff to meet with the manager designate or a senior carer for supervision. We looked at the accident book and saw that most accidents had been recorded appropriately. However, on three occasions staff had used steri strips on wounds, there was no evidence that this task had been delegated by the district nursing service or that staff had had any training in how to do this properly. The kitchen records were well kept and the kitchen was clean and tidy. After discussion with the manager designate it was clear that we had not been notified of recent deaths in line with the requirements of the Care Home Regulations. A fire risk assessment was in place but lacked specific details of the home and did not include evacuation procedures. Records showed that regular testing and servicing of fire equipment was in place. The AQAA showed that equipment at the home was regularly serviced. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 29 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 1 2 X X n/a HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 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 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 2 2 2 Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 12 Requirement The registered provider must ensure that care plans are completed in sufficient detail to identify all the needs of residents and how these needs will be met. The registered provider must ensure that as far as practicable residents are involved in care planning and review. The registered person must ensure that risk assessments are calculated correctly and any action identified is followed through and professional advice if necessary is taken. The registered person must ensure that all complaints are fully investigated and the complainant informed of any action that has been taken. The registered person must ensure that appropriate infection control procedures are in place. The registered person must give notice to the commission without delay of any circumstances detailed in this regulation. The registered person must DS0000071007.V365267.R01.S.doc Timescale for action 30/11/08 2 OP7 15(1)(2) 30/12/08 3 OP8 13(1)(b) 13(4)( c ) 30/11/08 4 OP16 22(3)(4) 30/11/08 5 6 OP26 13(3) 37 30/12/08 30/11/08 OP38 7 Montrose OP38 13(b) 30/11/08 Page 31 Version 5.2 8 OP38 23 ensure that when residents sustain an injury appropriate medical advice is sought. The registered person must ensure that a fire risk assessment that meets current fire regulations is in place. 30/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The statement of purpose should be amended and should include: the name, qualifications and experience of the manager designate the size of the rooms in the home the complaints policy should make clear that complainants are able to contact the Commission for Social Care Inspection at any stage of a complaint The complaints policy should include the current contact details of the Commission. All resident should be given a contract for the provision of services and facilities including the amount and method of payment of fees. Care plans should cover all the topics detailed the national minimum standard 3.3. All prescribed creams and ointments should have an opening and expiry date. A risk assessment should be in place for residents who self medicate. All handwritten entries on MAR sheets should be stated and signed by two people. Photographs of all residents should be kept with the Mar sheets. All medication should be given at the time prescribed. Continence products should be stored discreetly in residents’ rooms. The whistle blowing policy should include the address and contact details of the Commission for Social Care Inspection and Public Concern at Work. DS0000071007.V365267.R01.S.doc Version 5.2 Page 32 2 3 4 OP2 OP7 OP9 5 6 OP10 OP18 Montrose 7 OP18 8 9 10 OP19 OP19 OP26 11 OP27 12 13 14 15 OP29 OP30 OP36 OP37 16 OP37 Urgent consideration should be given to obtaining a copy of the locally agreed safeguarding adults’ protocol. The adult protection policy should include information and guidance of staff on what constitutes abuse and be in line with locally agreed safeguarding procedures. Appropriate signage should be considered throughout the home. Advice should be taken in relation to the need to replace the kitchen flooring. All clinical waste bins and bins in communal toilets and bathrooms should be foot operated. Paper towels and hand wash shall be available in all communal toilets and bathrooms. The staff rota should show who is in charge of each shift and who the designated first aider for each shift is. The hours worked by the manager designate should be included on the staff rota. A record of staff interviews should be kept. All staff should be given their own copy of the General Social Care Council code of conduct. Serious consideration should be given to using Skills for Care common induction standards for all staff. All staff should be formally supervised at least six times a year. The supervision policy should be relevant to Montrose. Policies and procedures in relation to the topics detailed in outcome group 7 should be developed and put in place. All policies and procedures should be relevant to the homes registration and the people living there. Personal information about residents should be kept in a way that meets the requirements of the Data Protection Act i.e. on their individual care plans. Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Montrose DS0000071007.V365267.R01.S.doc Version 5.2 Page 34 - 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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