Inspection on 06/10/08 for Mount Vernon Terrace Care Home

This inspection was carried out on 6th October 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mount Vernon Terrace Care Home 07/04/09

Mount Vernon Terrace Care Home 22/11/07

Mount Vernon Terrace Care Home 22/11/06

Mount Vernon Terrace Care Home 17/02/06

Mount Vernon Terrace Care Home 22/02/05

Mount Vernon Terrace Care Home 01/12/04

Mount Vernon Terrace Care Home 26/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOME ADULTS 18-65 Mount Vernon Terrace Care Home 23-25 Waverley Street Arboretum Nottingham NG7 4DX Lead Inspector Linda Hirst & Lyn Dyer Unannounced Inspection 6th October 2008 10:00 Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 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 Vernon Terrace Care Home DS0000002236.V372729.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 Adults 18-65. 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 Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mount Vernon Terrace Care Home Address 23-25 Waverley Street Arboretum Nottingham NG7 4DX 0115 978 4345 0115 978 3822 harun.holmes@ntlworld.com 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) Mr Ahmed Rashid Holmes Mr Ahmed Rashid Holmes Halima Holmes Care Home 16 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (16) of places Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2007 Brief Description of the Service: Mount Vernon Terrace consists of two large houses in a Victorian terrace in a residential area of Nottingham City. The home is registered to provide care and support for up to 16 people who have a mental disorder (excluding Dementia and Learning Disability). The accommodation spans three floors, (including a basement with a games room and a smoking area.) There is no vertical lift or other adaptations for people with disabilities at the service and because of this the home may not be suitable for people who have mobility difficulties. There are ten single and three double bedrooms available. Only one of these has en suite facilities. The tramline stops directly outside the home and offers easy transport into the city centre. The home does not have a car park, and the parking restrictions in the area can make it difficult to visit the home by car. The weekly accommodation charges are £329.83; the fees do not include cigarettes, hairdressing or chiropody. A copy of the most recent inspection report is available in the home, and the manager told us that people who want to live at the service are given a copy of the service user guide. Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who live at the home and their views on the service provided. This process considers the provider’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire about how well their service provides for the needs of the people who live there and how they can and intend to improve their service. We received this back from the manager in good time and although the form could have been more detailed in some areas, it helped us to plan our visit and to decide what areas to look at. We also reviewed all of the information we have received about the home since we last visited and we considered this in planning the visit and deciding what areas to look at. The main method of inspection we use is called ‘case tracking’ which involves us choosing three people who live at the service and looking at the quality of the care they receive by speaking to them, observation, reading their records and asking staff about their needs. English is the first language of all of the service users living at the home at the moment, but some people are from minority ethnic groups. We case tracked one person to make sure their Equality and Diversity needs have been assessed and are being met at the service. The staff team come from a wide variety of backgrounds and experiences and some speak languages other than English, which would be an advantage for people from a Bangladeshi background who want to live at the service. We spoke with two members of staff and three people who live at the service to form an opinion about the quality of the service being provided to people living at the home. We read documents as part of this visit and medication was inspected to form an opinion about the health and safety of people who live at the service. During the course of our visit we began to find evidence a continued breach of regulations concerning the safety of medicines and we issued a code B notice under The Police and Criminal Evidence Act 1984 to enable us to take evidence with a view to assessing the findings in relation to enforcement action. Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 6 We also had to issue an immediate requirement about medication practice. We issue these when we find that the people who live at the service’s health and safety is at risk and where the outcome for them is poor. We expect the owners to put these matters right within 48 hours and to tell us quickly what they will do, and how they will make sure the people who live at the service are safe and receiving good care. The owners will be expected to work with us to provide evidence of further improvement to make sure they meet the requirements and provide good quality care to the people living at the home. What the service does well: What has improved since the last inspection? We found that the people who live at the service are having regular checks on their health to make sure that they are well and healthy. Several rooms have been redecorated and the carpet on the stairs has been replaced. The smoker’s room was being decorated in response to requests from people living at the home and a new bath has been fitted on the second Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 7 floor. The damp has been investigated but unfortunately it has not been resolved in all areas and needs further attention. The manager has arranged for there to be collections of clinical waste to minimise the risk of infections spreading between staff and other people living at the home. We found that improvements have been made to the staff files we looked at and people have a fully completed application form now so that the manager can be certain that they are suitable to work at the home. We also found that the staff have had a lot of training since we last visited the home and we found that they engage well with the people who live at the service. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 8 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. Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who want to live at the service have their needs assessed before admission and can be assured that these can be met at the service. EVIDENCE: The manager told us in his Annual Quality Assurance Assessment that he makes sure that people who live at the service have their needs and aspirations “thoroughly” assessed to be sure that these can be met before they come to stay at the home. We looked at the care plan for the last person who was admitted to the service and found clear evidence that the person was assessed by their care manager before being admitted to the home. The care plan complied by the service has not been fully written yet, but there is detailed information about the person on the file which would enable staff to help and support the person with their needs. The people we spoke with told us that they remember being assessed by their social worker before being admitted to the service, one commented that they had “lots,” of assessments. Staff we spoke with confirmed that they read all of Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 11 the assessments, they told us, and “the assessments contain lots of information on the resident’s history, mental health and care needs.” They told us that the manager then uses this information to write the initial care plan. Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: We looked at the care plans for the people we case tracked to make sure these reflect their needs and detail the help and support they need. The mental health needs of the person are detailed and there is clear advice to staff about the signs to look for which may show that people are becoming unwell. In addition, their social, recreational, emotional and behaviour needs are assessed along with their capacity to make decisions. The religious and cultural needs of people from minority ethnic groups are recorded, and staff encourage people to plan, prepare and cook food which is culturally appropriate or preferred. The plans we saw are up to date and are reviewed a minimum of every six months. We saw evidence that people have been involved in developing their care plans. Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 13 We found that the plans are person centred and contain good details about the personal preferences of the people living at the service. Some people have declined certain treatments and the staff have recorded their assessment of the person’s capacity to refuse following the code of practice in relation to the Mental Capacity Act 2005. This is good practice. Residents’ meetings are held regularly; we looked at the minutes of these and found that the manager responds to people’s requests (E.g. more day trips, redecorating the games room.) Risk assessments were seen in every file, and a wide range of risks are assessed which cover various aspects relating to people’s mental and physical health, their past and present history. Highlighted risks are covered within care plans and are also followed up at Care Programme Approach reviews which representatives from the service attend. A person living at the service told us that they don’t know much about their care plan, but they said they don’t need help with personal care. Another told us, “I am happy with the way staff support me. I can do what I like and can go where I like when I like but I am prevented from doing a lot of things as my benefits have not been sorted out yet.” When we asked the manager about this, there are reasons for these circumstances and the manager agreed to talk to the person about these issues. Staff we spoke with told us, “service users always get involved in their own care plan and staff sit and speak to them when reviewing the plans. Service users are able to make their own decisions and they are listened to.” Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live at the service are able to make choices about their life style, and social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: The manager told us in his Annual Quality Assurance Assessment that people are encouraged to go out and be part of the local community, with staff accompanying those who may need support, physically or emotionally. He told us that more day trips have been provided, “in response to service users’ requests.” We looked at the care plans and found that these identify people’s likes, dislikes and preferences in terms of their social, recreational and cultural Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 15 needs. We saw evidence that people have been out on a trip to Skegness and have cooked meals with the staff. We saw people coming and going as they wished during the day, and it is clear that no restrictions are imposed on people. The people we spoke with told us, “I am interested in going to college once I am settled in and I hope the staff will help me to do this. I am very interested in painting and decorating but I don’t think I could get a job because of my mental health.” Another person told us they like to go out shopping. The person has visited a variety of towns to do this and told is that staff would go as well if needed. “I would love to be able to go out into the countryside every now and again. We went to Skegness in the summer and that was great.” Staff told us, “we took them to Skegness in June which we paid for and we also took them to the Goose Fair. We also escort residents into town sometimes if they wish to go shopping and want us to go with them. We have a games room with a pool table and other games and residents tend to use it a lot and staff go there with residents too.” The manager told us in his Annual Quality Assurance Assessment that they support people in maintaining good contact with family and friends and make any visitors feel welcome should they come to the home. We did not see any visitors coming to the service during our visit, people we spoke with told us, “I would also like to go and see my family but can’t go until I have the money to clean myself up and take my own cigarettes.” There are reasons for this which are outside of the control of the service, but the manager expressed a willingness to loan the person money to facilitate family contact. Staff we spoke with told us, “residents have a right to make their own choices and this includes choices around relationships, sexual or otherwise. If a relationship developed between residents then staff would respect this as people are free to do this.” They did say however, that they would inform the relevant people such as the social worker or CPN if the relationship has implications for their mental health. It is recommended that the policy on sexuality be looked at and clarified, especially in terms of the people’s right to confidentiality and privacy but with due consideration of Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People who live at the service told us they feel there is flexibility at the service around their personal routines, “I am free to do what I like in the home and to go to bed and get up when I like.” Staff told us, “residents are free to come and go as they like and they all go to bed at various times and get up in the morning at various times; there are no Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 16 restrictions on this.” Another person told us, “the residents are able to do what they want, wear what they want and they have a right to their own choices.” We observed lunch and found that the staff interact well with the people who live at the service. There is a daily menu on a large board in the dining area and this shows there is a range of food available for breakfast, one lunchtime choice and a choice of two different sandwiches in the evening. Although there is not a choice at lunch, we observed people being given separate orders of vegetables and being given the choice of gravy and they condiments to use if they wished. The lunch itself was well presented and looked appetising. People were given plenty to eat. Drinking water is not freely available in the dining area for people to take their medication or just to drink with their lunch. Enabling people to make their own drinks and snacks would be good practice. The care plans highlight people’s food likes and dislikes (including their cultural preferences.) People who live at the service told us, “the food is good and there is plenty of it but I would like to be able to get myself a cup of tea when I like and maybe make a snack for myself. I would love to have some nice curries sometimes.” Another person told us, “I enjoy the food.” Staff we spoke with told us that people who live at the service can choose when they have their meals and they said that cultural preferences regarding food are respected. They told us, “(a named person) is supported to cook food in the kitchen that meets their cultural needs.” Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People receive support and treatment for their physical and mental health needs, but the arrangements for medication are unsafe and people are not receiving their medicines as prescribed by their Doctor. EVIDENCE: The manager told us in his Annual Quality Assurance Assessment that staff prompt people to wash and change their clothes and they assist those who need help with their personal hygiene. The people we case tracked do not need any help with this area of need, although the plans do consider issues such as personal hygiene and continence. Staff we spoke with told us that some of the people living at the service have needs around their continence, “we have a clinical waste bin now to dispose of the soiled items. We always have protective gloves available to wear when we assist with continence issues.” Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 18 One person told us they do not have soap, deodorant or toothpaste, this was brought to the manager’s attention who said that they would lend the person money for these items. There was no evidence that staff are routinely checking with people whether they have toiletries and this is advisable. The manager told us in his Annual Quality Assurance Assessment that the service has improved by arranging for annual health checks for people who live at the service. We found that the care plans give staff clear guidance about the mental health needs of each person and how this affects them, along with the symptoms of worsening mental health. We found clear evidence in the care plans that people have their health care needs assessed. We saw information on a person’s specific physical health needs in their care plan which had been downloaded from the Internet. This gives clear information about the signs which indicate the person’s condition may be worsening. We found evidence in daily records that people have been taken to see the Doctor very promptly if there are any concerns about their physical health. However we found that one person who consistently refuses medication for a physical health problem has no timescale identified in their care plan to guide staff about when to discuss the refusal of the medication with their Doctor. People living at the service told us, “I have no complaints about being able to see a doctor but I would like to be able to see the dentist eventually,” another told us if they are ill the staff will take them to see the Doctor or ask one to come to the service. We passed on the comments about the dental care to the manager for them to take action. Staff we spoke with told us that the optician comes to the home regularly to see people and if a person has a hospital appointment the staff remind them. Social workers tend to be very involved in supporting the residents and in supporting us too. The manager told us in his Annual Quality Assurance Assessment that the service supports people with their medication, he also said all staff have training on the safe administration of Medication. The manager told us in his Annual Quality Assurance Assessment that the service keeps medication records up to date and signed. We found evidence in the staff files to show that staff have received training on the safe administration of medicines. We looked at the storage of medication and found that this could be more secure by providing a facility, which is designed for the purpose. A record of Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 19 the temperature of the room where medication is stored is supposed to be written down every day but we found this has not been done consistently. We watched the staff giving out medication and found that they routinely pop tablets out of the blister pack and into their hand to administer them. This is not only unhygienic but it could result in transmissible infections being passed between staff and people living at the service. We also witnessed staff routinely signing the Medication Administration Record before administering the medication. We found that a medication which has been prescribed only once a day has been signed as given more than this, and when we discussed the issue with the manager he said this is because the person requests the medication more often. There was a failure to understand the importance of only giving the medication as prescribed by the Doctor. We found gaps on the Medication Administration Record for three people without an explanation as to why the medicine had been omitted. We found medication missing from several blister packs and there were extra signatures to indicate medication has been given over the prescribed amount or at nonprescribed times. Two people had tablets remaining in their blister pack, although the Medication Administration Record had been signed to indicate the medicines had been given. We also found that there was no record of stock carried forward from medication in boxes so the signatures on the Medication Administration Record did not tally with the tablets, which remained at the home making auditing impossible. People we spoke with told us, “the staff know when I need to take my medication and they help me with this.” The staff we spoke with said, “I know there have been issues during the morning with you finding inaccuracies with the medication. There has been a new system recently and some staff don’t understand the new system, although they are quite comfortable with it.” We left an immediate requirement at the service about the safety of medicines. We have not received a response to this requirement. Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live at the service have access to a robust complaints procedure but the safeguarding arrangements are not robust enough to ensure that staff will take the correct action to protect people from harm or abuse. EVIDENCE: The manager told us in his Annual Quality Assurance Assessment that an easily accessible complaints procedure is in place. Forms are available for people to pick up and fill in if they wish to make a complaint. He told us that staff would assist any person who is unable to fill in the form. We found that the service displays the complaints procedure in the service and that it meets legal requirements. We looked at the complaints record but none have been recorded. We have not been notified of any complaints directly since our last visit to the service. There is a record of concerns and we looked at these, there are two reported, which are about communal living and the tensions, which can be caused by this. There is a record of action taken about concerns and of the outcome. People we spoke with told us, “I would not make a complaint as I wouldn’t want to be seen as a tittle tattle but if I really needed to I could approach the manager and something would be done.” Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 21 The manager told us in his Annual Quality Assurance Assessment that all staff have received safeguarding training and they intend to update this training in the coming year. We found that the safeguarding policy for the service states that if a person does not want a safeguarding issue reported it does not have to be. This is in conflict with “No Secrets,” and the local safeguarding procedures. We found that the service does not have a copy of the updated procedures; these can be downloaded from www.nottsadultprotection.org. We have not been alerted to any safeguarding referrals since our last inspection, and the service have told us that none have been made. People living at the service told us, “I feel safe here, I didnt feel safe at night before coming here but I do now.” Staff we spoke with were not familiar with the local procedures to be followed if safeguarding issues are raised, they told us, “I would call the manager and he would deal with it.” Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The position of the home is well suited to the needs of people who live there but the accommodation is not clean and well maintained in all areas. EVIDENCE: The manager told us in his Annual Quality Assurance Assessment that they, “keep a clean and safe home, and make the home feel homely by providing a nice environment.” They say that in response to service users’ requests they have redecorated individuals rooms and certain areas of the home. They state that they have improved the efficiency of the heating, resolved the damp problem in the top floor bathroom and two additional bedrooms have been rectified and redecorated. The carpets on the two main stairways have been replaced. The areas which have been decorated and re carpeted have brightened the accommodation, but we found that although the service has taken steps to Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 23 eliminate the damp problem, these have not been fully effective and further action is needed to make sure that the damp penetration does not have any adverse effects on people’s health. The bedroom where the damp problem has been resolved needs redecorating to provide a pleasant environment. We also found there is no hot water in the second floor bathroom, and the absence of blinds at the window compromises the privacy and dignity of people living at the service. The tumble dryer is not working and the staff are drying clothes outside and in the garage area which is used by people as a smoking area. This can only be a short term solution. The manager told us in his his Annual Quality Assurance Assessment that a clinical waste bin has been provided to ensure that there is safe disposal of clinical waste and effective infection control takes place. We found some areas of the home could be cleaner and some of the bedding and other linen used by people living at the service is very old, worn and was unclean. We also found the home to be cold and draughty in parts. People living at the service told us, “The place is clean enough. I would like more clean clothes so that one set can be washed. I like a clean bed but the bed has not been changed since I moved in.” Another said, “I love my room, it is always nice. The home is often too cold though.” Staff had no comments to make on the environment. Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are supported by trained and caring staff. The recruitment practices at the service are safe and protect people from those who may be unsuitable to work with them. EVIDENCE: The manager told us in his Annual Quality Assurance Assessment that the service employs, “high quality, friendly, qualified staff,” although he told us only two of the staff working at the home have achieved National Vocational Qualification Level 2, which is well below the target of 50 . The manager highlighted this as an area they could improve upon. We found evidence on the staff training files that people have undertaken the common induction training, two people have National Vocational Qualifications, and training has been provided on Moving and Handling, First Aid, Nutrition and safeguarding training. We also found that there is a training Compact Disc for staff on the Mental Capacity Act 2005. We could not find evidence that they have undertaken training on mental health, which would be desirable given Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 25 that the people who live at the service have these needs. The manager recognises this as an area for development. Staff we spoke with confirmed that they have undertaken training on National Vocational Qualification levels 2 and 3 in health and social care, and they said they have done or will be doing a health and social care course which included training in safeguarding, infection control, moving and handling, health and safety and first aid. They said they have not done any training in mental health needs. They said that they are due to do some training in medication shortly and that they have received medication training at some point in the past. The manager told us in his Annual Quality Assurance Assessment that the service obtains CRB and POVA first checks prior to staff commencing their employment. The staff files we looked at were well organised and had evidence that all of the information and documentation required by Law has been obtained. Based on the evidence we looked at the recruitment practices at the service are safe. People living at the service told us, “the staff are always good and are very patient.” Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service is not being managed effectively and in a way, which ensures the health and wellbeing of the people living there. It therefore cannot be said to be operating in their best interests. EVIDENCE: The manager told us in his Annual Quality Assurance Assessment that the home runs, “efficiently and effectively,” but that financial issues have presented a barrier to improvement which they have tried to mitigate against. The manager states they have focused on completing an annual workforce plan for the home and conducting a new annual Quality Assurance Programme. Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 27 However we have had to set a number of requirements following this inspection about medication issues, which, if not managed correctly have serious implications for people’s health (see OP20.) This indicates that the management of medication has not been good enough and this situation must improve. We found evidence of the new internal audits, which have been introduced. This includes surveying people living at the service for their views on the care being provided. People who live at the service raise issues around their leisure interests, their understanding of other’s negative behaviour and the control of it, their opportunities to get out and about, summoning help in an emergency and having the adaptations to meet people’s needs. No action plan has yet been developed to show how the service will address the issues raised. We also saw evidence that service user meetings are held at the home, and we saw evidence that the service respond to the requests of people who live there, (E.g. the pool room is being redecorated.) The manager told us in his Annual Quality Assurance Assessment that all of the required Health and Safety checks and tests have been done at the required intervals to maintain the health and wellbeing of people living at the service. We found that the Fire Safety tests have been done regularly. A third of the staff group have undertaken infection control training. All staff should have this training. Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 1 X 3 X X 3 X Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 29 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 YA20 Regulation 13(2) Requirement There must be evidence that the temperature of the area where medication is being stored is being checked every day. You must make sure that the temperature does not exceed the recommended storage temperature. (Usually 25°C). Systems must be introduced to ensure that entries made on service users medication charts match the prescription to ensure that service users receive the appropriate medication as prescribed by their Doctor. This requirement has not been complied with. The timescale of 23/12/07 has not been met. We will extend the timescale for a final time. This must be complied with to avoid further action being taken. 2. YA20 13(2) Staff must follow the correct hygiene practices when administering medication to DS0000002236.V372729.R01.S.doc Timescale for action 20/11/08 20/11/08 Mount Vernon Terrace Care Home Version 5.2 Page 30 3. YA20 13(2) 4. YA20 13(2) people to prevent the risk of infections passing between staff and people living at the service. Staff must not sign the 20/11/08 Medication Administration Record until they have witnessed people taking their medicines to ensure there is an accurate record of when people take their medication. Medication must be given to 08/10/08 people only as prescribed by their Doctor. If medication is not given for any reason a code must be entered on the Medication Administration Record to indicate the reason why. This will give a clear indication as to whether people are taking their medication as prescribed by their Doctor. This is an immediate requirement. Medication, which is carried forward from previous stocks should be recorded so there is a clear audit trail of medication held at the service and to avoid the risk of misappropriation of medicines. This is an immediate requirement. Appropriate training must be provided for staff on the safety of medicines, and there must be clear evidence through supervision that they understand the importance of administering medication at the correct time, in the correct dose as prescribed by the person’s Doctor. The problem of damp penetration in the second floor bedroom and bathroom must be addressed to prevent people living at the service developing DS0000002236.V372729.R01.S.doc 5. YA20 13(2) 08/10/08 6. YA20 13(2) 31/01/09 7. YA24 23 (2) (b) 31/01/09 Mount Vernon Terrace Care Home Version 5.2 Page 31 health problems. This requirement has been partially complied with but the problem has not been fully resolved. The timescale of 22/1/08 has not been met. We will extend the timescale for a final time. This must be complied with to avoid further action being taken. 8. YA24 23(2)(j) There must be a supply of hot water to the bath in the second floor bathroom so people can use the facility. 1) Blinds or other window coverings must be in place in all rooms used by people living at the service to ensure their privacy and dignity. 2) You must provide clean and appropriate bedding in all bedrooms to ensure the comfort of people living at the service. The tumble dryer must be repaired or replaced to ensure people can get their clothes laundered and returned promptly. There must be evidence that all areas of the home, which are used by people living there are maintained at a comfortable temperature. 31/12/08 9. YA24 16(2)(c) 30/11/08 10. YA24 23(2)(c) 30/11/08 11. *RQN 23(2)(p) 30/11/08 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 Good Practice Recommendations DS0000002236.V372729.R01.S.doc Version 5.2 Page 32 Mount Vernon Terrace Care Home 1. Standard YA16 2. 3. 3. YA17 YA18 YA19 4. 5. YA20 YA23 6. YA23 7. 8. 9. YA24 YA32 YA35 The policy on people’s sexuality should be reviewed to make sure that it considers people’s rights to privacy and confidentiality and the Mental Capacity Act and Deprivation of Liberty Safeguards. People who live at the service should have an area where they can safely prepare drinks and snacks for themselves when they want to. Staff should routinely check with service users that they have the toiletries they need to maintain their personal hygiene. Care plans should clearly identify when a Doctor should be contacted if people consistently refuse medication prescribed for a physical illness so their health and wellbeing is promoted. More secure and appropriate storage should be provided for medication to ensure the safety of people living at the service. The safeguarding policy should be in line with “No Secrets,” and the local safeguarding procedures. It must make clear that all safeguarding issues will be reported in order to protect people living at the service. A copy of the new local safeguarding procedures should be obtained and staff should be made aware of the procedures to be followed if safeguarding issues come to light. This will protect people living at the service. The bedroom on the first floor, which had damp penetration should be redecorated to provide a pleasant environment. 50 of your staff should have achieved their National Vocational Qualification Level 2 to ensure that people living at the service are supported by competent staff. Staff should have training on mental health so that they are able to understand the needs of people who live at the service and know how to support them. Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Mount Vernon Terrace Care Home DS0000002236.V372729.R01.S.doc Version 5.2 Page 34 - 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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