Inspection on 03/05/05 for Mount Elton

This inspection was carried out on 3rd May 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 20/10/05

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 Alison Murray Unannounced 3 May 2005 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 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 D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Mount Elton Address 25 Highdale Road Clevedon North Somerset BS21 7LW 01275 871121 01275 343245 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Churchill Property Services Limited Mrs Lisa Brain Care home with nursing 24 Category(ies) of Old Age - (24) registration, with number of places Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. 24 Patients aged 50 years and over, and 1 Nursing Patient in Bedroom 5 until vacated 2. Staffing Notice dated 6 January 2000 applies 3. Manager must be a RN on parts 1 or 12 of the NMC register Date of last inspection 14 December 2004 Brief Description of the Service: Mount Elton is a converted Victorian house situated on the Clevedon hillside. It provides nursing care for up to 24 older people Accommodation is provided in 12 single and 6 double rooms, arranged over 2 floors. These are individually decorated in keeping with the character of the building. Eight of the single rooms, and two of the shared rooms have ensuite facilities. 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.Mr Martin Granville, trading as Churchill Property Services Limited, owns Mount Elton. Mrs Lisa Brain is the registered manager; Mr Ken Granville, the administrator takes responsibility for the fabric and equipment in the home. Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced inspection, over 5 hours were spent in the home. Although four sets of care records were reviewed, the day-to-day care and experience of the residents was the main focus of the inspection. Even though some of the residents were unable to express an opinion, it was possible to observe their body language, and the way staff and residents responded to each other. A number of the residents were happy to chat with the inspector and give their opinion of the Mount Elton. Staff were not formally consulted during this inspection. They were observed as they went about their routine work. Time was also spent with Mrs Brain and Mr Granville. What the service does well: What has improved since the last inspection? Residents and staff appreciate the ongoing programme of redecoration and refurbishment. This has been completed to a high standard and is in keeping with the character of the building. Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 6 Recent changes to the management structure of the home are working well. The appointment of a deputy manager has freed Mrs Brain from some of her clinical duties, and allowed her to concentrate on her management skills. 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 D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 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 standard(s) 3, 4 and 5. Mount Elton does not provide intermediate care, so standard 6 is not applicable. Residents’ needs are thoroughly assessed before admission to the home. They are given good information about the home, and the services it offers. EVIDENCE: Three of the current residents have been admitted for a respite stay. One of these said that she had chosen Mount Elton because it was easy for her family to visit. Mrs Brain had visited her at home and told her about Mount Elton, and the range of services it offered. She asked the lady about her health and care needs, and spoke to her social worker. This assessment was well documented in the care records. The social worker had sent Mrs Brain an up-to-date care management plan. The lady has complex needs, and requires specialist equipment. Mrs Brain had liaised with the family to ensure that this was delivered to the Mount Elton in good time. The lady said that she felt comfortable that the staff understood her medical needs, and knew how to operate the equipment. She said that she is planning further respite stays in the home, to give her carer a break. Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 9 Another resident was initially admitted for a brief respite stay. She said that she had enjoyed herself so much, she had now decided to stay permanently. Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 Residents’ physical and personal care needs are well met. Staff are less skilled at managing emotional and mental health needs. There is a good rapport between staff and residents, but staff must ensure that this not at the expense of individual privacy. Care documentation is basic, and needs further development to provide staff with the information they need to care for each resident. EVIDENCE: A significant number of the current residents are very frail. It was clear that very few were able to look after their own personal care needs. All 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. One resident has limited speech. She is now able to communicate very effectively using a tool adapted by staff, to meet her particular needs. Another lady was admitted to Mount Elton with severely impaired mobility. She is now independently mobile around the home. Although this has increased her risk of falls, staff have agreed a mutually acceptable level of risk with the resident and her family. Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 11 There was an informal atmosphere in the home, and evidence of a good rapport between the majority of residents and staff. One resident said that ‘All the staff are lovely, and they keep popping in to see me, but I do wish they would knock on the door first’. A number of staff observed during the inspection did not seek permission, before entering a residents’ room. Five care records were inspected. Care plans took the form of basic ‘core’ plans. In four cases, person specific information was not included in this plan. They did not provide staff with clear guidance how to meet the assessed needs of the resident. All of the care plans placed a strong emphasis on the physical needs of residents. Although staff had signed each month, to confirm that the care plan had been reviewed, there was no other evidence to confirm this. A number of residents had care plans indicating nutritional needs. Staff were not monitoring their weight. Care records contained pressure sore risk assessments, but there was no record of actions taken to reduce this risk. It was clear from entries in the communication sheet, and conversations with the individuals concerned, that two of these residents have long-term emotional needs and can present with potentially challenging behaviour. These were not reflected in the care plan. Comments made by these residents and the language used in the care records suggest that some staff would benefit from training in the management of challenging behaviours. Medicine administration records (MAR sheets) for long-term residents were clearly printed and demonstrated good practice. Staff had hand-written MAR sheets for respite residents. These were easy to read, but had not been signed or dated, and contained no indication of the number of tablets brought into the home. Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 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 standard(s) 12, 13 and 15 Residents enjoy the meals provided at Mount Elton. It is not clear if mealtimes and daily routines meet the wishes of residents. EVIDENCE: The inspection started at 12:30pm, whilst lunch was being served. It was clear that some residents had chosen to take their meal in their room, whilst others were served in the dining room. All the residents consulted said that the standard of food was good. They said they enjoyed the ‘home cooking’. Staff started to serve the evening meal at 4:30pm. Mr Granville said that milky drinks and a snack were available to those who wished later in the evening. He added that the majority of residents liked to go to bed soon after 6pm.Even so, lunch and the evening meal seemed very close together (especially as tea and biscuits were served at about 3pm), and there is a long gap until breakfast at about 8:30am. After lunch, some of care staff joined residents to watch a TV quiz game. There was evidence of a good rapport between residents and staff, with lots of laughter. Records of recent admissions to the home contained brief information about their likes and dislikes. This information had not been recorded in respect of long standing residents. None of the care records reviewed contained information about the residents’ preferred daily routine. Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 13 Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 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 standard(s) 16 and 18 The complaint procedure in the home is satisfactory. Staff demonstrate a good awareness of adult protection issues. EVIDENCE: Residents said that they would have no hesitation voicing concerns to Mr Granville or Mrs Brain. At the last inspection, staff were completing an investigation into a complaint sent to CSCI via the local social service department. Their investigation was very thorough, and the complaint was not substantiated. Staff have access to a copy of ‘No Secrets in North Somerset’. In conversation, they demonstrated a good awareness of these issues. Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 15 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 standard(s) 19, 20, 21, 22, 23, 24, 25 and 26 Recent and ongoing investment has significantly improved the appearance of the home, creating a comfortable environment for residents. EVIDENCE: Since the last inspection, work has continued to upgrade the accommodation and décor of the home. New curtains have been provided in the lounge, and new dining furniture ordered. Several bedrooms have been redecorated and more height adjustable beds bought. New laundry equipment has been provided. Residents said that they appreciated this investment in the home. The tenants of a self-contained flat on the top floor of Mount Elton have recently moved out. Mr Granville is currently drawing up plans to convert this to addition accommodation for residents. He is aware of CSCI registration requirements in respect of this accommodation. Mr Granville has asked staff to draw up a ‘wish list’ of equipment. The home already has a good selection of patient hoists and lifting equipment. Over recent weeks there have been problems with the boilers. Mr Granville was able to provide estimates from several contractors to replace the boilers. He Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 16 anticipates that this work will be completed within 2 months. In the meantime, a core group of staff have been shown how to fix the problem on a short-term basis. Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The numbers of staff on duty are adequate to meet the needs of the resident. EVIDENCE: There were 24 residents in the home during the inspection. Conversations with staff and residents indicated that staffing levels were appropriate to the needs of residents. Staff said that they were kept busy, but still had time to chat with the residents. Call bells were answered promptly during the inspection. Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 Recent changes to the management structure of the home are working well. Communal toiletries pose an infection control risk, and must not be used. EVIDENCE: Since the last inspection, the management structure of the home has been reviewed. One of the trained nurses has been promoted to deputy manager, in order to free Mrs Brain from some clinical responsibilities. Mrs Brain has taken on all personnel issues, leaving Mr Granville to concentrate on the financial administration and ongoing refurbishment of the home. This system appears to be working well. Mrs Brain said that she is enrolled on an NVQ level 4 management course. During the inspection, her tutor visited to collect some completed work. Health and safety procedures were generally sound. One of the communal bathrooms contained tubs of non-prescription creams. These were stored on a Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 19 shelf above the toilet. It was not clear when each tub had been opened, or for whom they had been used. This poses a potential infection control issue. Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 N/A 15 2 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 2 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x x x x x x 2 Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? 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 A specific care plan must be written for each area of identified need. These care plans must provide staff with clear guidance to meet the health, emotional and social needs of the individual. this requirement was made at the last inspection in December 2004 Residents needs must be regularly reviewed and revised as necessary. This requirement was made at the last inspection in December 2004 The use of pressure relief equipment must be recorded in care records. If staff assess that a resident has nutritional needs, they must keep a record of action taken to meet these needs. Any weight gain or loss must be documented. Staff must sign and date hand written entries on the medicine administration records There must be a clear audit trail Timescale for action 03/06/05 2. OP7 15.2 03/06/05 3. 4. OP8 OP8 17.1a Schedule 3 14.2 03/06/05 03/06/05 5. 6. OP9 OP9 13.2 17.1a 03/05/05 03/05/05 Page 22 Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 7. 8. 9. OP10 OP25 OP38 Schedule 3 12.4 23.2 13.3 of all medicines into the home and administered to the resident. Staff must knock on a residents 03/05/05 bedroom door before entering. Mal-functionning boilers must be 03/07/05 repaired or replaced. Communal toiletries pose an 03/06/05 infection control risk, and must not be used. 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. Refer to Standard OP8 OP12 OP15 Good Practice Recommendations Staff should receive training in the management of challenging behaviours. Residents likes and dislikes, as well as preferred daily routines should be documented in all the care records. Staff should consult residents, to ensure that meals are served at times which suit their wishes and expectations. Mount Elton D53-D02 S20353 Mount Elton V222260 3 May 2005 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier 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. 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