Inspection on 13/10/08 for Montrose House Residential Home

This inspection was carried out on 13th October 2008.

CSCI found this care home to be providing an Good 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 House Residential Home 29/11/06

Montrose House Residential Home 06/03/06

Montrose House Residential Home 05/12/05

Montrose House Residential Home 21/01/05

Montrose House Residential Home 06/10/04

Montrose House Residential Home 03/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Montrose House Residential Home 10 Renfrew Road Ipswich Suffolk IP4 3EQ     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Claire Hutton     Date: 1 3 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Montrose House Residential Home 10 Renfrew Road Ipswich Suffolk IP4 3EQ 01473710033 01473710033 paul.readhead@eastsuffolkmind.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Paul Victor Readhead Type of registration: Number of places registered: East Suffolk Mind care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Montrose House is a care home owned by the charity MIND and provides personal care and accommodation to ten people with mental health needs. The home is located in a residential area of Northeast Ipswich, approximately two miles from the town centre. It is on a bus route. Accommodation is in a converted domestic dwelling with a newer extension and a shaft lift linking two floors. All bedrooms are single and two have ensuite toilet facilities. There is a lounge, conservatory and kitchen/diner. The home has a small car parking area at the front of the building and an enclosed garden, accessible from the conservatory, at the rear. Fees for this home are 89.00 10 Over 65 10 Care Homes for Older People Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection, which focused on the core standards relating to care homes for older people. The inspection was unannounced on a weekday. The first day lasted 5 hours. We left an immediate requirement to make a shower safe for a resident to use as it was a potential scald hazard. When we returned 7 days later the matter had been addressed and we concluded our inspection over another 2 hours. This report has been written using accumulated evidence gathered before and during the inspection, including information obtained from staff and service user Have Your Say surveys. The Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI) was returned completed by the new manager. This self-assessment gives providers the opportunity to inform the CSCI Care Homes for Older People Page 5 of 26 about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the Key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with people who live in the home and members of staff. The manager of the home was available during this inspection and fully contributed to the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 7 of 26 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people will be provided with information, contracts and a chance to visit the home to enable them to make an informed choice. People can be assured that their needs will be met as appropriate assessments will be completed before they move in. Evidence: We looked at records for 3 residents who had been at the home for varying lengths of time and had different needs. License agreements were in place and signed. A handbook was given to the service users and that has information about the tenancy. We saw a copy of this on file. We examined the assessment for one resident. The assessment was completed and contained an in-depth mental health assessment which included any drug and alcohol use. We saw that the individual was visited on two occasions to complete an Care Homes for Older People Page 10 of 26 Evidence: assessment by the manager of the service and the individual resident was offered two visits to Montrose before they chose to move in to the home. We saw that Montrose was provided with information and an assessment of the situation made by the social worker and this included risks screening. This information confirmed what we were told in the self-assessment that residents came through an allocations panel and had risk assessments and care plans in place. We spoke to the individual resident and they told us I came to look around and I chose to live here because it was cheap compared to other places. From the 8 surveys we received back 6 said they had received a contract and 2 didnt know. One resident wrote The contract had everything I wanted to know about the home - payments etc. We also asked did you receive enough information about this home before you moved in and 7 people said yes and 1 person did not answer the question. One resident wrote The manager told me all about the home. Another person wrote I enjoy living in this home. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new care plans are concise and contain the relevant information. People here are having their health and care needs met. Medication is well managed. Evidence: There were new care plans in place. Feedback from staff was that these are very concise and contain all the required information. One staff member wrote if there are any changes in support plans we are notified immediately as to what they are and what we need to read. Another staff member wrote handovers are good, communication between staff is also good. management are always helpful. We examined 2 care plans that also had risk assessments in place. The care plans had eight elements to them that included headings such as - mental health, housing, physical activities and relationships. There was evidence of regular review of care plans. This included feedback from residents to their key worker and this was then given to the manager who updated the care plan. The care plan reviews were comprehensive and person centered. Six residents in surveys said yes they received the care and support they needed. Two residents answered sometimes. We spoke to Care Homes for Older People Page 12 of 26 Evidence: 2 residents during our visit and they told us they were happy at the home, that they were very settled and staff and management were approachable about anything. From observation, speaking to staff and the examination of records residents are treated with respect and their right to privacy was upheld. In respect of the healthcare access for residents very recently in care notes we saw that one resident had attended the GP to have their bloods taken and reviewed. Another resident had attended a hospital appointment. One persons care plan had details on continence promotion and evidence that they had attended the opticians recently. One resident was currently in hospital having just under gone major surgery, but was due back that week. The service was preparing for their return. In relation to medication management within the home the self-assessment confirmed that there was a policy and procedure in place. Staff spoken with confirmed they had received medication training and 3 people were attending medication training during our visit to the home. We saw a member of staff on duty access the medication. They administered one person medication at a time then returned to sign. Medication was appropriately stored securely within the care home. A new storage system has been installed and there was a medication fridge in place. There was a record that showed that the temperature of storage medication was regularly taken. We examined the records relating to medication administration. All records included a photograph of each resident and records were completed appropriately. Currently there are no residents who self medicate and this was discussed with the manager and he agreed that this was an area of future development. He agreed that this would be based on risk assessments that he planned to do. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Montrose can expect to lead a lifestyle that is set to develop and meet their ongoing needs and wishes. Evidence: The lifestyle of people living at Montrose was low-key. Opportunities were presented and there were several pieces of information about activities external to the home on the noticeboard for residents. The self-assessment told us that routines were flexible in terms of meals and getting up and going to bed. Visitors were welcomed at any time and there was no need to make an appointment. Also it told us that residents did all their own finances, with trips to the post office and banks as part of their routines. The manager spoke of a culture shift that he hoped would take place following his review off the staffing rosters. This allows 1 staff member to be on duty from 9 -5 each day. The plans were to facilitate access to activities already happening in the community. One resident wrote in their survey The staff have arranged for me to go somewhere to be taught how to draw. We spoke of one residents who told us of their desire to access something that would allow them more mental stimulation and conversation. The manager said this was in hand and he was aware and was looking for something appropriate. On the day of our visit one person was going to the hairdressers and had Care Homes for Older People Page 14 of 26 Evidence: booked their own appointment. One resident spoke of visiting the pub and socialising with the locals. Two residents also told us that they had family who visited them regularly. The manager explained that one resident had regularly visited a day centre but had recently decided to stop going. Their decision was respected. The surveys returned by the residents told us that 50 of them usually or always had activities to take part in. The other 50 said that this was provided sometimes. The home had regular residence meetings. There was a weekly meeting to decide the menu for the following week. The weekly shop was done on line and delivered to the home. We spoke with residents about the catering. One person said the food has recently improved and another resident said it can be up and down due to whoever cooks. We looked at the menu and this was varied based on traditional english home cooking and had choices available each day. We saw the minutes of residents monthly meeting and this included topics such as the smoking shelter and increased lighting in the garden and comments upon the catering arrangements. This demonstrated that issues raised were also actioned. The minutes of the residents meetings were signed by the residents as a true record. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are protected, listened to and concerns are taken seriously. Evidence: The self-assessment told us that to each resident had been given the complaints procedure. The home has a policy and procedure in place and part of this is an informal procedure. The self-assessment also told us that there had been no complaints or referrals relating to safeguarding adults from abuse. Whilst at the home we saw that the complaints procedure was displayed on the wall in the hallway for anybody to see. We looked at records within the home and confirmed that no complaints had been received and no safe guarding matters had been referred to social services. We clarified with the manager what was meant by a informal complaint. He explained that this was the way the service dealt with any informal concerns that were raised by residents in relation to other residents within the project. All eight surveys returned by the residents said yes they did know how to make a complaint. One resident said I just have to tell the staff. Who will sort it out for me. another resident said yes I have made a complaint in the past. I know the staff will help you with this. Care Homes for Older People Page 16 of 26 Evidence: All five of the surveys returned by staff said that they did know what to do if a resident or a relative had concerns about the home. The one member of staff said we have a complaints policy in place at Montrose House, which is what I would follow in the event. another member of staff said if I cant help people, my managers are always on hand to help. On call systems are in place where things occur out of regular hours. The service had a policy and procedure to follow in the event of abuse. All the residents were registered to vote in elections. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Montrose House is comfortable, well maintained, clean and meets the needs of the individual residents. Evidence: Montrose House was suitable for its stated purpose it was accessible safe and well maintained. We toured the home and sought permission from two residents to see inside their rooms. Both these rooms were individual and personlised and contained many personal possessions. Both residents were pleased with their rooms and said the beds were comfortable. One resident in their survey said Staff make my room look nice and it is done weekly. My washing is done regularly. On the first day of the inspection we found that the shower in room 9 recorded a temperature fluctuating up to 52° C. This was placing vulnerable people at potential risk due to the hazard of the scalding water. We left an immediate requirement to make the shower safe for use. When we had returned in seven days to check compliance we found that the hot water was well within safe limits and safe for the resident to use. This quick response to ensuring a safe environment demonstrates that the safety and well-being of the residents was taken very seriously. Care Homes for Older People Page 18 of 26 Evidence: During our first visit we also checked the water temperature of the communal shower and the assisted bath on the first floor. We found hot water temperatures to be within safe limits. Montrose House was clean and well maintained. The home had become non-smoking. Decoration and new carpeting along with the development of the garden ensured that Montrose House was a pleasant and comfortable environment in which to live. The laundry room was well-equipped with a washing machine with sluice facility, gloves for staff, liquid soap and paper towel and colour-coded mops. The kitchen was also well-equipped. Staff spoken with confirmed that the equipment in the kitchen was appropriate and all in working order. The kitchen also had a comfortable dining area with a notice board on which we saw the latest menu displayed. In terms of adaptations and equipment the home had a shaft lift, an assisted bath, a mobile hoist and hand rails in corridors to meet residents mobility needs. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at this service are supported by appropriate numbers of staff that are satisfactorily recruited and well trained and supervised. Evidence: The self-assessment told us that a team in 11 staff support residents over 24 hours with two staff on duty. Also that 50 of staff had reached NVQ 2 or above. And that all staff were recruited in line with the regulations. The staff surveys completed confirmed that before staff started work their employer carried out checks such as CRB and references. The surveys also said that there were enough staff to meet the individual needs of the people at the service. Two staff did comment in their survey that it did take a long time to replace staff who left employment. On the day of inspection a new staff member had just started and was receiving their induction. The manager spoke of an increase in staffing numbers due to a change in the roster. The new rosters showed a third person on duty during the day. The manager also told us that staff recruitment had speeded up due to an appointment of a new personnel officer within the organisation. Care Homes for Older People Page 20 of 26 Evidence: We looked at the recruitment records for three staff and found that staff did indeed have checks completed upon them before they started work. These did include two written references (one from previous employer) and a criminal record bureau check. We were also able to verify peoples employment history and there was a statement by the person as to their mental and physical health. However, there was not written verification of the reason why in previous employment the staff member ceased to work with vulnerable adults and secondly, the section on the application form which asks for details of any criminal offences was left blank in all three cases. Both of these points were discussed with the manager and the area manager who was present and it was agreed that this matter would be addressed. For the same three staff we looked at the training record and certificates. We found that these staff had NVQ qualifications ranging from level 2 to level 4. There was also evidence of medication training and three staff were attending medication training on the day of our visit. We found that all three of these staff had current manual handling training certificates. We also found that two of the staff had a current first aid certificate. The manager was aware that staff needed to update their food hygiene certificates. There was also evidence that these staff regularly received supervision and an annual appraisal. One staff member wrote in their survey East Suffolk Mind offers extensive training to all employees. Another staff member wrote management are always available with the support if it is needed. Staff work as a team and everyone gets on with one another. All surveys confirmed that staff receive the right support. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Montrose House is managed by a skilled manager who fosters an atmosphere of openness and respect where service users feel valued and the service ensures that safety and welfare is promoted. Evidence: Montrose House was managed by a person who is fit to be in charge, of good character and able to discharge his responsibilities fully. The manager held a registered nurse qualification (psychiatric Nurse) he also had NVQ 4 in management and had 18 years experience in mental health residential care. There was also an assistant to the manager of the home who also held NVQ 4 and the Registered Managers Award. Staff spoken with and in their surveys spoke highly of the manager in terms of his support and guidance. Through out the inspection process the Manager was open and positive to the inspection process and was keen to respond to suggestions and potential developments for the service. The self-assessment completed by the manager was returned on time and was fully completed and contained good information. Care Homes for Older People Page 22 of 26 Evidence: The manager showed that he was responsive to issues of protection in terms of residents safety in relation to attending a health and safety training course recommended by the Environmental Health Department. He also responded quickly to the immediate requirement regarding the shower that could potentially scald a resident. The manager had taken the fire risk assessment of the service seriously and had developed individual evacuation plans based upon capacity to understand evacuation in an emergency. We looked at the records relating to fire and found that these were all appropriately maintained. When the fire extinguishers were serviced in May this year a decision was made to upgrade the extinguisher in the kitchen. In terms of listening to users of the service and ensuring the home was run in the best interests of the residents. We have already mentioned in this report the way care plans are reviewed starting with the feedback for individual residents, we also mentioned the use of residents meetings. In addition the organisation have set up a service user involvement project. This means that 2 representatives from this home go forward and attend board meetings that feed into the the senior management team of this organisation. So far there have been 2 meetings. In addition there were quality assurance surveys in place. This year the home have a social work student in place and they have the task of enabling all residents to complete their surveys about the project this included topics such as the accommodation, the facilities, information rights and tenancy. The outcome of these is linked to the service plan. The current service plan was influenced by the residents in this way and has resulted in a new lounge carpet and the current choice of decoration Care Homes for Older People Page 23 of 26 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, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 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 1 29 To ensure as far as possible that residents are protected all aspects of recruitment set by regulation should be completed before staff start work at Montrose. Care Homes for Older People Page 25 of 26 Helpline: 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 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 © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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