Inspection on 20/10/05 for Mount Elton

This inspection was carried out on 20th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Mount Elton 25/02/09

Mount Elton 09/03/07

Mount Elton 03/05/05

Mount Elton 14/12/04

Mount Elton 20/05/04

Mount Elton 26/02/04

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mount Elton 25 Highdale Road Clevedon North Somerset BS21 7LW Lead Inspector Patricia Hellier Announced Inspection 20th October 2005 09:00 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 Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 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. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Mount Elton Address 25 Highdale Road Clevedon North Somerset BS21 7LW 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) 01275 871121 01275 343245 mountelton@fsmail.net Churchill Property Services Limited Mrs Lisa Brain Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 24 Patients aged 50 years and over, and 1 Nursing Patient in Bedroom 5 until vacated Staffing Notice dated 06/01/2000 applies Manager must be a RN on Parts 1 or 12 of the NMC register Date of last inspection 3rd May 2005 Brief Description of the Service: Mount Elton is a converted Victorian house situated on the Clevedon hillside providing nursing care for up to 24 older people. The home is well maintained, comfortably furnished and has a homely atmosphere. Accommodation is provided in 12 single and 6 double rooms, arranged over 2 floors. Eight of the single rooms, and two of the shared rooms have ensuite facilities. These are individually decorated in keeping with the character of the building. Many rooms enjoy panoramic views over the surrounding countryside. A passenger lift and built in ramps offer access to all areas of the home. The grounds are well maintained, and used for a variety of social events over the year. The home has been suitably adapted for the current resident client group with handrails in corridors and grab rails in toilet facilities. The home has a nurse call bell system throughout. There is a Registered Nurse on duty at all times. An Activities co-ordinator is employed one day a week and provides a varied programme of creative activites for groups and individuals according to need. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was the second statutory inspection of the current year and took place over seven hours. Before the inspection the information about the home was received from the pre inspection questionnaire. No residents or relatives returned comment cards. During the course of the inspection 11 residents, 5 relatives, 5 members of staff and two visiting professionals were spoken with. All residents and relatives spoken with told the inspectors that the home was very good and the staff very kind. Comments received were “it is very homely and comfortable”; “my relatives care needs are well met”. The staff and visiting professionals spoke of the clear leadership and the kindness and competence of the staff. The inspectors looked around the whole of the building and inspected a number of records. What the service does well: What has improved since the last inspection? Ongoing maintenance to this old building has continued with the refurbishment and redecoration of a number of areas of the home. These look very nice and residents were seen enjoying them and spoke appreciatively of the new décor, which is of a high standard. Two new boilers have been installed and the heating and hot water systems are thermostatically controlled. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 6 There has been the introduction of a twilight shift, which enables the residents to have more choice about times of going to bed and their needs to be met in a more relaxed way. Care documents have been rewritten and now clearly contain all the information needed to care for each resident. Emotional and social needs are well recorded along with personal preferences. 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. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 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 Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 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): 1,2,3 The Residents’ booklet is comprehensive and provides prospective residents with information to make an informed choice. The home’s assessment process is thorough and ensures that it is able to meet residents’ needs EVIDENCE: Residents are provided with a comprehensive Residents’ booklet containing the Statement of Purpose and all the information required to ensure they or their relatives have access to the relevant information at all times. Contracts inspected for five residents did not state the room to be occupied thus not providing residents with clear tenancy agreements. It is recommended that this is included in the resident guide and contract Care needs are well met through a full assessment process and the completion of a care plan from this information. The assessment includes all the elements listed in the standard. A comprehensive assessment was seen for a recently admitted resident. The resident when spoken to said ‘I am well looked after, they know what I need’ Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Residents benefit from care plans that are well formulated and give clear information to enable staff to meet residents’ health and social care needs. . Risks to residents are not fully assessed and actions to minimise these planned, which potentially places residents at risk. The systems in place for the management of medicines are good. Respect and dignity are well maintained by kind and caring staff. EVIDENCE: Individual records are kept for each of the residents, which include a social history. Four care plans were inspected and all clearly reflected current identified health and social care needs. Good practice was seen in two care plans that all care needs were referenced to psychological needs. Actions stated for the managing of challenging behaviour showed some understanding of how to manage such situations. This gives an holistic picture of care and is to be commended. Clear actions to meet identified needs were recorded and regular evaluation noted. None of care plans showed resident or relative involvement. This practice needs to be implemented. All care plans contain Manual Handling risk assessments and one of the four inspected had a generalised risk assessment. Waterloo scores had been recorded but these had not been used to inform the care plan of pressure area care actions needed, or evaluated. Daily records were up to date and written in a Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 10 respectful manner. All residents were neatly dressed, and attention had been paid to hair and nail care. Detailed conversations with eight of the residents confirmed a good standard of nursing and personal care. Several residents gave examples of how their condition has improved since their admission to Mount Elton. Hand transcribed prescriptions were seen on the Medication Administration Records and these had not been signed by two members of staff when written thus not providing the recommended safeguard for residents. The medications fridge was not locked and did not provide for the safe storage of medicines. All residents spoken with felt that kind and caring staff respected their dignity and privacy. One resident stating “they always knock on the door”. Resident’s wishes following death were well recorded. However in discussion with the manager some conflict between the staffs’ duty of care and residents wishes was identified. It is recommended that this is reviewed and a clear policy put in place to protect resident’s wishes while maintaining professional duties. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: Care staff take responsibility for arranging activities on a rota basis and provided a weekly programme of activities, outings and events. There is an activities coordinator who provides the resident with creative activities once a week. Four residents spoken with said that they liked the outings and two residents said they enjoyed the music provided. A programme of outings is displayed on the hall notice board. An in house shop is provided and the residents enjoy this facility that enables them to purchase their own toiletries and sweets. Several visitors were seen coming and going during the inspection. Relatives spoken with said they could come any time and felt that their relatives were well looked after by friendly staff. There was evidence of a good rapport between residents and staff, with lots of laughter and encouragement. Records of recent admissions to the home contained clear information about their likes and dislikes. All of the care records reviewed contained information about the residents’ preferred daily routine. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 12 All the residents said that the ‘food is good’ and that they liked the daily choices offered. For example one resident said ’if you don’t like something they’ll change it’. Menus showed a varied, balanced and nutritious diet. The meal on the day of inspection reflected this. The dining room is homely and tables well presented. Good practice was observed in the dining room where care staff were helping residents with their meal. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents are confident that they are listened to and their requests acted upon. EVIDENCE: The home has a complaints procedure which all residents have a copy of. While it is not publicly displayed there is a copy of it on the back of each residents wardrobe door. It does not contain any timescales for complainants to measure response against. This is recommended. There have been no complaints and residents stated that if they were not happy about anything they would speak to the manager. Staff and residents spoken to, say the manager is very approachable and understanding. One service user said ‘I’ve nothing to complain about, it’s the best home I’ve been in”. A record of complaints received with actions taken and outcomes was not available due to the lack of complaints. However this is recommended should complaints be received. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,26 Residents are provided with safe, comfortable surroundings. Outdoor space is attractive and accessible for residents to enjoy. The home has suitable equipment to maximise resident independence. Robust Infection control practices are followed. EVIDENCE: The property is well maintained, with homely and comfortable communal spaces. The living accommodation is well decorated and homely. Residents’ rooms are personalised and comfortable. A maintenance plan is recommended to evidence the ongoing routine maintenance and renewal of the fabric for the benefit of residents. A new shower room is appreciated by all the residents, as are the new dining room furniture and armchairs. More height adjustable nursing beds have been provided for resident comfort and enabling better care provision. Two new boilers have been installed and thermostatic equipment to ensure the whole house is maintained at an ambient temperature for the residents. Residents said that they appreciated this investment in the home. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 15 The home has grab rails situated at relevant points and a shaft lift that is easily used to assist resident mobility and aid independence within the home. The home was clean and free from offensive odours throughout. The laundry facilities were well organised. Staff interviewed and observed demonstrated good understanding of Infection control procedures and practices and maintained a clean and hygienic environment. The home has good facilities for ensuring that staff can maintain good hand washing practices between caring for residents. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27.29,30 The home’s staffing levels are sufficient to manage the current care needs of residents. The procedures for the recruitment of staff are inconsistent and do not always provide the safeguards for the protection of people living in the home. Staff access external training to ensure training is matched to the residents needs. EVIDENCE: The home has a staffing notice agreed between the CSCI and the home’s management. Copies of two weeks staffing rosters were supplied to the inspector. Staffing levels rostered are in accordance with CSCI requirements. A sufficient team of ancillary workers supports care and nursing staff to ensure the smooth running of the service. Staff interviewed said that they were kept busy, but still had time to chat with the residents. Call bells were answered promptly during the inspection. The introduction of a twilight shift following a good piece of research into the evening routine has benefited residents and staff. Two residents stated “I can now stay up later and watch the TV”. A number of the staff team have worked at the home for a long time and provide good continuity for residents. Recruitment practices for new staff employed are satisfactory, however some staff have not been subjected to the same recruitment procedures. Of the four personnel files inspected 2 did not have a current Criminal Records Bureau check, one only had one reference and another had no references available. A POVA first check had not been obtained for any of the staff whose records had been inspected. The above practices leave residents potentially at risk. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 17 Newly appointed staff confirmed they had completed an induction programme and evidence of this was seen in personnel files. Evidence of specialist training e.g. Care of the elderly, diabetes, was seen from invoices in the training file for training received, however there was no evidence of training received in personal training files. Discussion with staff confirmed training had been obtained. Documentation to evidence training should be kept available ion the home. The implementation of this practice is recommended. While staff access training there is no planned training programme to ensure training equips staff to meet all identified needs. Training is seen as key to quality care and a number of staff have obtained their NVQ level 2 or 3 qualification. Another two members of staff have just commenced the NVQ level 3 course. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,38 The manager provides clear leadership and guidance to staff to ensure residents receive consistent care in a safe environment. Quality assurance processes in the home are formal demonstrating that the home consults with residents, families and visiting professionals but are in complete with no analysis and feedback. Resident’s monies are not kept in the home to ensure financial safety for them. All additional extras are invoiced to residents or families and clear records are maintained for audit purposes. Health and safety issues are monitored in the home to ensure that issues are identified and addressed where they arise. EVIDENCE: The manager has a number of years experience of caring for the elderly and has recently obtained her NVQ 4 / Registered Managers Award. She gives clear leadership, guidance and direction to staff. Residents feel the manager is approachable, available and seeks to ensure all their needs are met. Staff interviewed stated that they felt well supported by an approachable manager. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 19 A formal quality assurance tool was available for inspection in order to demonstrate that the home consults with residents and that comments from them are acted upon. An analysis of the results is not preformed or feedback to residents and staff given. This is recommended to complete the Quality Assurance process. The management of resident monies by the home were inspected. No resident monies are kept in the home to protect the residents. All additional extras are invoiced to the resident or relatives on a three monthly basis. Records inspected showed a clear audit trail. Records inspected indicated regular safety and fire checks are carried out. Staff spoken to confirmed that regular fire instruction and drills had taken place. A number of staff have received First Aid training. Records inspected indicated regular safety and fire checks are carried out. Staff spoken to confirmed that regular fire instruction and drills had taken place. A number of staff have received First Aid training. A record of accidents is kept however the format does not comply with Data Protection to maintain staff and resident confidentiality. The home has the new forms available \and should start using them immediately. Environmental risk assessments for wedged open fire doors had not been completed and this potentially puts residents at risk. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 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 3 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 X X 3 X X X 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 3 2 X 3 X X 3 Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 15.1 Requirement Timescale for action 30/11/05 2 OP7 15.2 (c) 3 OP9 13.2 The care plan risk assessment must include clear actions and to meet assessed needs and evaluation of those needs. E.g in relation to pressure sores Resident care plans must be 30/11/05 reviewed and revised regularly in consultation with the resident or their relatives Staff must sign and date hand 21/11/05 written entries on the medicine administration records. Previous timescale of 03/05/05 not met. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 22 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 2 3 4 5 6 Refer to Standard OP11 OP29 OP30 OP30 OP33 OP38 Good Practice Recommendations That the home develops and end of life care policy to protect residents wishes while maintaining professional duties. To ensure that all relevant checks are completed prior to staff commencing unsupervised practice. The maintenance of training records in the home. The implementation of a training programme to ensure training equips staff to meet all identified needs. A formalised system of Quality Assurance that analyses the results of a resident survey, produces an action plan and feedback to residents and staff, should be developed. Individual and environmental risk assessments are formulated and clearly documented for the protection and safety of residents. Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Mount Elton DS0000020353.V255028.R01.S.doc Version 5.0 Page 24 - 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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