Inspection on 29/11/06 for Montrose House Residential Home

This inspection was carried out on 29th November 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Montrose House Residential Home 13/10/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Montrose House Residential Home 10 Renfrew Road Ipswich Suffolk IP4 3EQ Lead Inspector Claire Hutton Unannounced Inspection 29th November 2006 11:45 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 House Residential Home DS0000024452.V322043.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 House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Montrose House Residential Home Address 10 Renfrew Road Ipswich Suffolk IP4 3EQ 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) 01473 710033 01473 710033 East Suffolk Mind Miss Katharine Farrow Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (10) Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2006 Brief Description of the Service: Montrose House is a care home owned by the charity MIND and provides personal care and accommodation to ten people with mental health needs, eight of whom may be over 65 years old. At the time of this inspection eight of the residents were over 65. 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 en-suite 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 £267.00 Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that focused upon the core standards relating to Older People. These standards apply to this home as the majority of people currently accommodated are over 65 years of age. All people placed at this home are over the age of 55. The inspection took place on a weekday between the hours of 11:45am and 5.00pm. The process included a tour of communal areas and one bedroom with the permission of a resident, discussions with three residents, staff and the manager, observations of staff and service user interaction, and the examination of a number of documents including residents care plans, medication records, the staff rota, and records relating to maintenance, health and safety, recruitment and training records. The report has been written using accumulated evidence gathered before and during the inspection. Four completed surveys were received back from the current resident group. Three comment cards were received back from staff members. All responses received were positive. There are currently 10 residents accommodated at the home. What the service does well: What has improved since the last inspection? The management and the staffing of the home have remained stable and Montrose House has continued to provide a consistent quality of care to their residents. Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 6 Action has been taken on requirements made at the last inspection. Other matters have been resolved as the person that these matters related to no longer resides at the home. A complaints log is being maintained in respect of each resident at the home. Environmentally - the hall carpet was cleaned, the window restrictor was fitted, wheelchairs now have evidence of maintenance and all fire precautions have been actioned either in line or exceed the recommendations fire officers report of February 2005. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, and 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to have their needs assessed and known before they move in. Residents will be provided with contracts and terms and conditions of their stay. EVIDENCE: Two new service users have been admitted since the last inspection. Records relating to these people were examined. In both cases there was evidence of thorough assessment from a multi agency approach that has been developed into a care plan. Also in place contracts and agreements about fees, housing and care support from East Suffolk Mind. Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 9 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 good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be offered access to healthcare and have a care plan in place. Regular review of care plans may not consistently take place. Residents and their representatives can be assured that staff will uphold residents’ right to respect, choice and privacy. Residents can expect that their medicines are stored securely and administered by trained staff in line with the homes policy. EVIDENCE: The care plans for the new residents were examined. These were based upon the care plan approach model and used the assessment provided by the multiagency forum. The desire of the home is to involve the residents as much as possible in the development and review of their individual care plan. This was not always possible as the decision by one resident not to participate was also respected. In these cases however the home still have a duty to review and record their findings even if the resident does not wish to participate. There was evidence of formal review through the care plan approach model and this was recorded. Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 10 There was good evidence of staff recording the support and care given to residents in line with their care plan. One plan had highlighted risk assessments that needed to be in place for one resident. Daily statements written by staff showed that they were not clear about their duties in the same circumstances. Therefore these risk assessments highlighted by the home should be completed to give guidance to staff. In other cases residents did have risk assessments in place. These focused around changes in behaviour that may link to monitoring of mental health as well as risks around daily living and high risk activities such as using tools and garden equipment. There was evidence of access to all types of health care (optician, chiropody, dentist, GP and consultants). Where a resident had declined this intervention staff had noted their choice. The medication systems currently in use at the home were examined. Staff have a policy and procedure to follow. Medication was secure. One resident self-administered their own medication with appropriate support and monitoring from staff. Staff who administer medication are trained. The medication administration records were examined and were appropriately completed. This enable one resident’s medication to be audited and this was all found to be satisfactory. Residents spoken with were asked about respect and privacy. All residents spoke highly of staff and felt they were treated well. Observations of staff showed that they work with residents in a way that promotes choice, observes privacy and shows respect. Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 11 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. Residents at this home are able to choose a lifestyle and develop their own pastimes that suit them. Residents and their representatives can expect that the home will provide a choice of wholesome and appetising meals in a sociable setting convenient to the individual resident. EVIDENCE: On the day of inspection two residents were not at home because they had gone to Norwich to do their Christmas shopping. This was arranged with staff support using public transportation and included lunch out. Two other residents had also gone the previous week and another resident said they has been offered, but declined to go. This arrangement had been decided upon through the residents meetings that are held and minutes kept at the home. From the surveys returned from residents they expressed satisfaction with the activities arranged by the home for them to participate in. Two residents on the day went to the local shop with staff to buy items that they needed. Other residents do not need support and therefore are able to use community facilities when they please. One resident explained about the garden and how they had planted several sets of bulbs and maintained the garden and pond. Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 12 Another resident explained how they liked to spend their time in the fresh air and loved the garden. Choice and control for residents is a constant theme through all the activities of daily living at the home. There were several examples seen on the day of inspection including finances, meal times and access to cigarettes. Staff were seen to give varying support depending upon the individual resident. Residents and staff spoke about relatives and their involvement in the home. This concurred with information in care plans. Contact with relatives is supported and encouraged by staff. Staff were in the process of ordering the weekly shopping on line from a local supermarket. A list had been prepared in line with the agreed weeks menu. The menu had a good variety of meals such as Chilli con Carne with jacket potato and salad. Followed by sponge and custard. The next day was Chicken in cream sauce with roast potatoes and seasonal vegetables followed by rice pudding and prunes. On the day at lunchtime the residents could choose from either minestrone or oxtail soup with a homemade bread roll. A staff member explained that the home makes a selection of homemade cakes and rolls. Residents confirmed that the food at the home was good. Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives can expect the home to have policies and procedures in place to protect them and, they can be assured processes for safeguarding residents are routinely followed. EVIDENCE: Montrose House has a complaints procedure in place that forms part of the terms and conditions given to each resident. Each resident has a form to record any concerns or complaints they may make and how these matters are resolved. The commission has also not received any complaints about this home. In relation to protection of residents at this home, the manager is aware of the local procedure on how to deal with possible protection issues. The procedure is county wide and agreed with local social services and police. Both the manager and deputy manager have undertaken the necessary protection training. There was evidence of skills for care induction for new staff that also covered protection matters. Upon examination of staff recruitment records there was evidence to show that all staff were routinely checked on the national POVA (protection of vulnerable adults) list before entering the home to work and that an enhanced CRB check was done on all staff. Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a home, that is generally clean and comfortable, is well decorated, maintained and has an ongoing plan of upgrade in place. EVIDENCE: A tour was made of all communal areas and one bedroom with the permission of the resident. The home throughout is comfortable, clean and generally meets the resident’s needs. The home is pleasantly decorated and the hall carpet has been cleaned, but now requires to be replaced. In the kitchen a new fridge has been purchased. There are plans to have the office refurbished to make it easier to use and increase storage and workspace. All repairs required are noted and prompt action to remedy was seen. One resident showed their room, which was comfortable and met their needs. The resident explained that they liked the vinyl cushion flooring, but this Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 15 choice, rather than carpet was not recorded. The resident also showed the well-equipped bathroom where they were supported to have a bath using the homes bath with integral hoist. There is also a separate shower room. Two residents were enjoying the garden, which is well equipped with seating, garden sheds, summerhouse and a pond. The home also has a conservatory used as a smoking area. Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 16 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 excellent. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can expect that the numbers and skill mix of the staff will meet resident’s needs. Residents are safeguarded as far as is possible, because the recruitment procedure for staff is routinely robust. Staff are appropriately trained. EVIDENCE: From discussions with staff and the manager the home employ sufficient staff to work the planned roster. The roster is planned up till next April, so that staff are aware of their commitments and can plan accordingly. Resident surveys state that staff are available when they need them and residents spoken with on the day state there are sufficient staff and that they are all helpful and supportive. Consistently each day the roster shows and predicts hat two care staff will be available each day. In addition the manger or deputy is available on shift most days. At night there is one awake staff member and one person sleeping in with a person on call. Two new staff have been recruited since the last inspection. The recruitment records were available for inspection and demonstrated that all required checks had been completed. There was evidence of skills for care induction being completed by both new staff members. The skills for care induction were now available at the home through an interactive medium by using both the computer and DVD’s. There was evidence of staff training in epilepsy, Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 17 break away techniques and behaviour that may challenge, manual handling training, first aid, food hygiene, health and safety and fire training. Each staff member had a training record. All staff at the home had obtained either NVQ 2 or NVQ 3 in care. The deputy manager was in the process of doing NVQ 4. Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can expect that a person who is fit to be in charge and of good character manages the home. The home operates a quality assurance system. EVIDENCE: Katharine Farrow had been approved by the CSCI as Registered Manager for this home. Three staff surveys returned state that they feel the home is well run and that they receive regular formal supervision. Evidence during inspection supported this as the manager was able to demonstrate that formal supervision is offered at least 6 times a year. Staff team meetings are also regularly held with minutes kept. Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 19 Residents meetings are held regularly. This was a action point raised in a previous quality assurance at the home. The surveys received back from resident’s state that staff listen to them and act on what they say. Quality assurance at the home is developed in many ways. The manager had recently received three completed feedback cards from relatives. East Suffolk Mind also send out an annual service users satisfaction questionnaire. There were also regulation 26 visits available for inspection at the home regularly completed by the Responsible Individual. In relation to health and safety the manager completes several monthly audit checks for the environment including, fire, electrical, 1st aid, gas, water temperatures, food temperatures and repairs. The fire risk assessment had been updated and a specialist was coming to check this was adequate. The manager confirmed that action to conform to the fire officers’ inspection has either met or exceeded recommendations made. Evidence of servicing of the two hoists was seen. Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 20 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 X 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X 3 X X 3 STAFFING Standard No Score 27 4 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 21 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. 2. 3. Standard OP7 OP7 OP19 Regulation 15 (2)(b) 15 (1) 23 (1)(a) Requirement The plan of care must be kept under review. This should be at least once a month. The plan of care must include risk assessments highlighted by the home and inform staff. The hall carpet must be replaced. Timescale for action 08/01/07 08/01/07 08/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Montrose House Residential Home DS0000024452.V322043.R01.S.doc Version 5.2 Page 23 - 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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