Inspection on 06/03/06 for Montrose House Residential Home

This inspection was carried out on 6th March 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 29/11/06

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 Jan Davies Unannounced Inspection 6th March 2006 10:30 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 DS0000024452.V285112.R01.S.doc Version 5.1 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. DS0000024452.V285112.R01.S.doc Version 5.1 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) DS0000024452.V285112.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th December 2005 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. DS0000024452.V285112.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place during one day in March 2006. The registered manager was not on duty on the day of the inspection. The housing project manager and care staff on duty facilitated the inspection. A number of residents were spoken with individually. Two residents files were tracked. Daily notes of a third resident were inspected and the home’s incident log was inspected and discussed. The inspection took three hours thirty-five minutes. What the service does well: What has improved since the last inspection? Positive recruitment has ensured that the service continues to appoint staff members who are appropriate to working with this resident group. Induction and supervision for staff take account of the training needs relevant to staff development. DS0000024452.V285112.R01.S.doc Version 5.1 Page 6 Medication training has occurred for staff with responsibilities for the storing, administration and recording of medicines. 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. DS0000024452.V285112.R01.S.doc Version 5.1 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 DS0000024452.V285112.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,5 Prospective residents can expect to have clear information available upon which to make an informed choice about whether they wish to live at the home. EVIDENCE: There was evidence that new service users had a detailed assessment of need undertaken prior to their admission. The information from this was used to develop a care plan and supported with risk assessments that were appropriate to their needs. A new resident had been admitted since the last inspection. The existing resident group are well established. From care plans, resident meeting minutes, talking with residents and daily records it was possible to check that new residents are made welcome and helped to settle in. DS0000024452.V285112.R01.S.doc Version 5.1 Page 9 It was not possible to fully assess admission arrangements by tracking the process and arrangements of the recent admission but by talking with residents and staff it was possible to establish that the resident’s needs had been fully assessed on admission and that they had a chance to ‘test-drive’ the home. Records of admissions in files contained a full assessment including an appropriate risk assessment. Contracts were available for all service users placed that identified the basis on which needs were met. DS0000024452.V285112.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 Personal and social care needs of service users are clearly set out in individual and comprehensive plans of care. Service users can be assured that their health care needs are identified and addressed. EVIDENCE: Individual plans of care were available and appropriate arrangements had been recorded to demonstrate that aspects of health, personal and social care needs had been identified and planned for. Plans were comprehensive up to date and reviewed within the timescale identified. Significant events in the home had been clearly recorded, daily entries into case records made, giving indication of the actual care given. This was particularly evident for one service user with specific health needs that needed regular monitoring. DS0000024452.V285112.R01.S.doc Version 5.1 Page 11 Risk assessments that were regularly reviewed and updated identified that specific and appropriate care was being given to address potential areas of difficulty. Other service users spoken with were able to describe care needs that had been recorded in their care plans. One resident told the inspector that they have a ‘say’ in the way the home is run and take turns to plan the meals of their own choice. They told the inspector that activities are arranged for them depending on their individual interests. One resident referred to shopping and visits to the local supermarket with individual support from designated staff to help them address socially related health problems. A resident who self medicates told the inspector about the arrangements for this. These were appropriate and subject to regular monitoring recorded in the care plan. Medication systems were being administered in accordance with the policy and procedure of the home. There were protocols in place which provided guidance for staff on administration of ‘as required’ medication. The inspector was informed that a mistake had been made since the last inspection with the medicine administration and that an explanation of the incident had been duly faxed to CSCI. This had been immediately rectified and all appropriate persons/authorities informed as required. Discussion took place around the arrangements for the training provided to support workers for administration of medication and records were seen to show that the training was according to the home’s time-scale for this. Only staff members who have been appropriately trained to do so administer medication. During the inspection one resident who is a smoker was asking for a cigarette, smoking it then immediately requesting another. Staff members were appropriately encouraging the resident to lessen the frequency of their smoking, gently reminding them, in line with their health plan, to do other things to lessen the craving. The care plan should also record that there is a restriction on this activity (for identified health reasons) that appropriately prevents the resident exercising full choice in this matter. DS0000024452.V285112.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,15, People using this service can be assured that social activities and meals are well-managed, creative and provided daily variation and interest for people living in the home. EVIDENCE: Recordings from the daily log confirmed that the home was responsible for planning and arranging day services as appropriate, attendance at social events and identifying any possible employment opportunities. This was being done in consultation with service users to ensure their needs identified in care plans were met. In view of the age relevance of the employment activity, only one resident was appropriate and care plans showed that this was addressed with them. Regular reviews were held and helped to identify new opportunities while ensuring the existing arrangements remained relevant and appropriate. A number of people living in the home were spoken to and everyone who commented on the food said it was good and that there were choices for them. DS0000024452.V285112.R01.S.doc Version 5.1 Page 13 Residents told the inspector that they enjoyed living in the home and got on ‘alright’ with others sharing the home. One resident told the inspector about their favourite meal and that they were able to plan this as the meal for that day. Menus seen confirmed that meals provided were wholesome and were planned to take account of residents’ preferences and dietary needs. DS0000024452.V285112.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Residents can expect that appropriate arrangements are in place for their physical and emotional health needs and that the home ensures that they received personal support in line with their assessed needs and preferences. Residents can expect that their complaints will be listened to but cannot expect to be fully protected by a comprehensive complaints policy until there is a proactive approach to all types of complaints and representation and where necessary encouragement to residents about offering suggestions for improvements and supplying information about how this can be progressed. EVIDENCE: Staff members respected the privacy and dignity of service users and staff conduct in this area was defined in the home’s information available to staff on how to perform their duties. Through discussion with both staff and service users (and observation) it was evident that the healthcare needs of the service users were being met in an appropriate and timely manner. All service users were registered with local general practitioners and have attended surgery, (if they were not too ill to do so in which instance a GP ‘house call’ would be requested/made.) DS0000024452.V285112.R01.S.doc Version 5.1 Page 15 Complaints information was available but must be updated to correctly refer to the role of the CSCI (and not NCSC) in the complaints process. Not all service users were able to identify the procedure set out for complaints that the home would follow should they need to do this but all said they were happy for (named) staff to ‘sort things’ out for them. Those service users spoken with expressed their contentment with the service being provided but were not all clear about what they should do if the complaint was more of a minor nature and they did not wish to make a formal complaint but did want to express some dissatisfaction to prevent any repetition of a situation occurring. The home should be pro-active in its approach to complaints and representation and where necessary encourage residents to offer suggestions for improvements and supply information about how this can be progressed. The home had a recent copy of the local policy and procedure on the protection of vulnerable adults and had agreed to subscribe to this as their policy and procedure. Senior staff in the home had attended training associated with the protection of vulnerable adult procedure adopted by the home. Evidence was available of courses, provided by East Suffolk Mind and undertaken by the home’s staff. The home’s Whistle-blowing policy is due to be reviewed April 2006. Since the last inspection the home has complied with the requirement to revise this in line with the local authority’s Social Care Services policy. DS0000024452.V285112.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,23,24,25,26 Minor repairs needed to the extractor fan and repair or replacement of the refrigerator detracted from the efficiency of premises, although residents’ rooms were otherwise comfortable, personalised, and well equipped. EVIDENCE: It was evident from visiting different service users’ rooms that these had been decorated and furnished in a style which they had chosen and which reflected their individuality; one resident was supported to look after their pet that had its ‘own corner’ in their room. Bathrooms and toilets were well clean and in working order. Doors had suitable working locks, and health and safety was well observed in these areas. DS0000024452.V285112.R01.S.doc Version 5.1 Page 17 The home had three toilets for communal use, in addition to two that are in en-suite facilities of ground floor rooms. One resident who had continence urgency problems required a commode, even though there was a toilet in close proximity of their room. The nature of their problem meant it was not covered. It was emptied by staff, but needed emptying at the time of the inspection. The rooms with en-suite facilities were used by residents with mobility problems, one of whom had been in that room for a long time. (This was the situation at the time of the last inspection.) The home now keeps a chart for the frequent emptying of the commode but this was not resolved, as the commode was full at the time of the inspection. The resident who requires a commode should be offered an en-suite room when one becomes available and the frequency with which the service user’s commode is emptied should continue to be reviewed. The refrigerator in the kitchen was recording high temperatures and not effective for storing and maintaining food at safe temperatures. The extractor fan in the conservatory where the residents who are smokers gather was broken. At the time of the inspection the door leading out to the garden was open to lessen the problem but this was a temporary measure. One resident, a non-smoker, spoke to the inspector about the fact that the sliding glass door dividing the living room and the conservatory meant that smoke enters the living room if any resident leaves this open. During the inspection staff were vigilant in keeping this closed but residents told the inspector that this was not always possible at times staff are working in another area of the home. DS0000024452.V285112.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 People using this service can be assured that the procedures for the recruitment of staff are robust and provided the safeguards to offer protection to people living in the home. EVIDENCE: The staff team were clearly committed to training and viewed it as an essential component to developing their practice. There was also good evidence of new staff undertaking a detailed induction programme and accessing regular and formally recorded supervision. The staff recruitment procedure was examined in relation to new members of staff appointed since the last inspection. There was evidence that references were requested and received. All had a satisfactory Criminal Record Bureau (CRB) check. The dates indicated that CRB s had been received prior to staff commencing their duties. DS0000024452.V285112.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,36,37,38 There was good leadership, direction and guidance to staff to ensure service users receive consistent quality care. Care practices indicated that the health, welfare and safety of the people using the service were being promoted but information must also be available on monthly visits by an authorised person. EVIDENCE: Policies, procedures, and codes of practice records were signed by the registered manager, dated, monitored, reviewed and ammended as appropriate and demonstrated that these were current/up to date. Information seen demonstrated that the organisation has looked at ways of making essential information contained in policies relevant to service users DS0000024452.V285112.R01.S.doc Version 5.1 Page 20 available in a format that was more appropriate to their levels of learning disability and understanding. Regulation 26 reports had not all been received by the CSCI since the last inspection. This was discussed, and the Inspector was advised that unannounced management visits are still undertaken, however, the last Regulation 26 report was not available in the home at the time of the inspection. Residents’ files were sampled and reflected that there are appropriate arrangements made by residents and their families or appointed representatives to safeguard their financial interests. The home’s staff members are not appointees for residents’ money and are not authorised in this capacity. This arrangement reflects good practice and maximises financial security for all residents. The home’s policy and procedures file reflects that staff have the appropriate information about this available to them and induction training information shows that this topic is covered when staff begin working in the home. DS0000024452.V285112.R01.S.doc Version 5.1 Page 21 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 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 x 2 x 3 3 2 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 3 x 3 2 2 DS0000024452.V285112.R01.S.doc Version 5.1 Page 22 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 OP16 Regulation 17(2) Sche4 Requirement Complaints information must be updated to correctly refer to the role of the CSCI in the home’s complaints process. Advice about how to use the meat thermometer must be obtained and cooked meat temperatures taken and recorded. Reports of monthly Regulation 26 visits must be provided to the CSCI. A smoke-free environment must be maintained within the main areas of access for all residents in the home. Where there is any doubt that the homes smoking policy is not being complied with, a risk assessment must identify this hazard and the steps to be taken to reduce it, as part of the fire risk assessment. Timescale for action 01/05/06 2. OP15 12(1)(a) 01/05/06 3. OP33 26 15/05/06 4. OP38 23(4)(a) 01/06/06 5. OP38 23(4)(a) 30/05/06 DS0000024452.V285112.R01.S.doc Version 5.1 Page 23 The responsible person must repair the extractor fan in the conservatory. 6. OP38 23(4)(a) The responsible person must 30/05/06 repair or replace the refrigerator. 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 OP7 Good Practice Recommendations The care plan should also record that there is a restriction on this activity (for identified health reasons) that appropriately prevents the resident exercising full choice in this matter. The resident who requires a commode should be offered an en-suite room when one becomes available. The frequency with which a service user’s commode is emptied should be reviewed. 2. 3. OP21 OP26 DS0000024452.V285112.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 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 DS0000024452.V285112.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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