Inspection on 04/09/06 for Mountford House

This inspection was carried out on 4th September 2006.

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

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

Other inspections for this house

Mountford House 13/08/07

Mountford House 20/10/05

Mountford House 04/05/05

Mountford House 18/01/05

Mountford House 16/08/04

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 Mountford House Cyril Road Truro Cornwall TR1 3TB Lead Inspector Richard Coates Key Unannounced Inspection 4th September 2006 09:15 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 Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mountford House Address Cyril Road Truro Cornwall TR1 3TB 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) 01872 274097 01872 223990 mountford.home@cornwallcare.org Cornwall Care Limited Miss Diane Jayne Hicks Care Home 37 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (8), Old age, not falling within any other category (23), Physical disability (6) Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. Service users to include up to 23 adults of old age (OP) Service users to include up to 6 adults aged 50 years and over with a physical disability (PD) Service users to include up to 12 adults aged over 65 years with dementia (DE[E]) Service users to include up to 8 adults aged over 65 with a mental illness (MD[E]) To accommodate one named service user for respite provision under 65 years of age, in the category (PD) Total number of service users not to exceed a maximum of 37 Date of last inspection 20th October 2005 Brief Description of the Service: Mountford House is one of eighteen homes owned by Cornwall Care Ltd. It is registered to accommodate thirty-seven older people in need of personal care and who are over retirement age. The Registered Manager is Diane Hicks. Mountford House is a large purpose built care home situated just outside Truro. It is close to local facilities and has good transport links to the local town. Mountford House core services are: - The residential home provides long term care to service users who are in need of personal care and are over retirement age. - A 6 bedded rehabilitation unit. Health professionals refer service users who because of their physical health need a period of rehabilitation before they can return to their own homes. Mountford House accommodation is essentially on one floor and consists of four wings. Each wing has a its own lounge, bedrooms and bathing facilities. One wing has a small sitting room for smokers. All rooms have call bells. Meals are prepared in a well-equipped kitchen on the lower ground floor and served in a central dining room on the ground floor. All parts of the home are accessible to service users. A patio area at the front is accessible to all who use the home. There is limited parking. The provider gave the charges at September 2006 as from £293.25 to £490.00. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a planned unannounced key inspection. The purpose of the inspection was to follow up the provider’s compliance with the requirements and recommendations set in the last inspection report dated 20 October 2005, and to focus on the key national minimum standards as identified by the commission. The inspector was on the premises during two days. A commission business services manager joined the inspector for the first day as part of her induction. The methods used were discussion with the manager, staff, residents, and their relatives and visitors, inspection of records and documents, observation of the daily life of the home and inspection of the premises. The manager submitted a pre-inspection questionnaire. The inspector is grateful to the Registered Manager, staff and residents for their assistance in completing the inspection. What the service does well: Service users and their representatives stated that Mountford House provides good quality care and accommodation. Residents made positive statements about the skills and caring qualities of the staff. Residents felt that they could follow their preferred routine and pattern of daily life. They reported that their health needs are monitored and appropriate professional advice and assistance are obtained when necessary. Staff record needs assessments for prospective residents and draw up care plans with the resident and their representatives. There were some good examples of detailed care planning. Residents can take part in a mix of organised group activities and individual activities with staff. Residents felt their visitors were welcomed to the home. Residents and staff felt able to approach the registered manager with any concerns and issues. The home provides homely accessible accommodation mostly on one level. There is a pleasant accessible patio outside. There are a number of staff who have worked at the home for some years. Staff and residents have got to know each other well. Staff receive regular supervision and were satisfied with the support and supervision that they receive. Cornwall Care has a structured training programme and supports and encourages staff in their training and development so that residents and their representatives can have confidence in a well trained and supervised staff team. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 8 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 Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 9 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): 3 and 6 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The needs of service users are assessed so that they can be assured that the home can provide the care required. EVIDENCE: Managers complete needs assessments for prospective residents and obtain assessments from the commissioning authority. Cornwall Care Ltd has a standard format for assessment and care planning which, when completed in sufficient detail, covers all the issues specified in the standard. The three residents’ records case tracked in detail contained written needs assessments. Commissioning information from health and adult social care was also on file, although the level of information provided was rather limited. Two of the home’s assessments stated who was present, providing evidence that the prospective resident and their family were involved in the assessment. Intermediate care is provided in the rehabilitation unit. Residents are admitted here for short stays with the aim of improving their functioning and confidence Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 10 before returning home. This is a separate unit on the lower ground floor. The multi-disciplinary staff team includes occupational therapy and physiotherapy input. Rehabilitation care staff follow each resident’s individual plan of care to provide a programme of rehabilitation. One resident’s record was sampled and evidenced that the therapists undertake detailed assessments in consultation with the resident and draw up an individual plan. This plan sets clear objectives for the rehabilitation programme. The residents currently staying on the unit made positive comments about the quality of the accommodation and the support that they were receiving. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Written care plans direct and inform staff about how to meet the residents’ health and personal care needs, but care plans lack consistency in quality and the level of detailed direction for staff. The health and well being of residents are monitored and addressed so that their healthcare needs are met. The arrangements for the management of medicines do not fully protect service users. EVIDENCE: All the residents case tracked had written care plans. Cornwall Care Ltd has a standard single format for assessment and care planning. Staff here also draw up a ‘Care Profile’ - a summary of the care plan used as a working document. Two of the three care plans case tracked directed and informed care staff in detail in meeting the health, personal and social care needs of residents. These were good examples of individual care planning. However, one care plan case tracked did not provide adequate directions and information for staff on meeting the complex care needs of the resident. The written directions for Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 12 staff did not reflect changes in the resident’s care needs as identified in other parts of the record. Two of the records had evidence of regular reviews. Each resident has a key worker. The Personal Routines and Preferences records detail residents’ lifestyle preferences and choices, their dietary preferences and needs, and their religious beliefs. The level of information in the records is variable. Care staff confirmed that they are involved in the care planning and reviewing residents’ care needs. All residents case tracked had a moving and handling assessment. Falls risk assessments are included as a small part of the moving and handling assessment. Where a resident is at risk of falling, the home completes a separate falls risk assessment to direct staff in reducing the risk and safeguarding the resident. Recent accident records were analysed. There has not been a high level of falls. Care staff do not complete a record every day for each resident. There are significant gaps between entries in the running records. This level of recording does not provide an adequate record of the residents’ wellbeing, activities undertaken, dietary intake, visitors, and other events. Additionally, these records may not reflect all the activities that go on in the home. Staff keep separate records in respect of bathing, and other specific individual health and care needs. Residents are all registered with local GP practices. Residents and their representatives felt that their health care needs were well-monitored and prompt attention obtained when required. Resident records detailed medical contacts for each resident, although one record sampled was not accurately recorded on the format used. The community nurses visit the home regularly. An assistant manager reported that two residents currently have pressure areas being treated by the community nurses. A second assistant manager discussed how the home met the care needs of one resident who has a specific healthcare need, as an example of how the home monitored and addressed health needs. Residents were very positive about the kindness and caring qualities of the staff. They felt that their privacy and dignity were respected and had confidence in the staff when they were being assisted with care. Relatives and visitors expressed satisfaction with the standard of care provided and the caring qualities of the staff. Residents on the rehabilitation unit felt involved in their care plans and stated that they were being supported effectively to make good progress with their care plan. The Registered Manager monitors staff attention to privacy and dignity by being present around the home and seeking feedback from residents and visitors. The home uses the Boots monitored dosage system. Cornwall Care has a corporate policy and procedure on the handling of medicines which includes guidance on the use of homely remedies. Medicines for the care home are Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 13 stored in the assistant managers’ office. A locked trolley holds the medicines which are not suitable for including in the monitored dosage system cassettes. Replacement stocks of medicines and the monitored dosage system cassettes are stored in a locked cupboard which is not a secure medicines cupboard. Controlled drugs are not stored in a controlled drugs cabinet, but a second locked container secured inside the cupboard. The cupboard and trolley were tidy and well organised. There is a small medicines refrigerator and the temperature is checked daily. There did not appear to be a signed consent to the administration of medicines on each resident’s file. One resident currently administers her own medication. The home had recently returned to administering lactulose to each resident from their own supply after a short period of using each resident’s bottle in turn over the month as a community supply for all residents prescribed lactulose. This latter practice reduces the number of sticky bottles in the trolley at any one time, but is not acceptable as medicines are the personal property of each individual. Identified staff, who have completed training, have responsibility for the administration of medicines. The administration records in the care home were generally well maintained. Amendments to the records were appropriately referenced, dated and signed. However, the administration records for the rehabilitation unit were not satisfactory. Residents on this unit are admitted for short stays. The staff write the medicine administration records by hand as the computer printed version provided by the monitored dosage system is not available. A second member of staff is not checking and countersigning these records. The medicine administration records do not tally with the stocks of medicines held because of an error generated by the current timing of writing out each record and the pattern of administration. There is a controlled drug register for the care home and the rehabilitation unit. This was generally correctly completed and signed and witnessed. However, the record for a controlled drug for a resident in the rehabilitation unit was incomplete. No member of staff appeared to have detected this or taken any action. The arrangements for storage of medicines in the rehabilitation unit are also unsatisfactory. Current medicines are stored in a small locked container which is not a medicines cabinet. The supply of medicines for the next month is stored in the drawer of a filing cabinet. Although legislation does not require a medicines cabinet of the standard specification in care homes which do not provide nursing, it is recommended that the provider review these storage arrangements urgently. A record of medicines returned to the pharmacist is kept as a duplicate book. The pharmacist had visited recently following the change to the monitored dosage system. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 14 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, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents are supported to follow a lifestyle which accords as far as possible with their own choices and preferences. The diet provided is varied and nutritious with attention to individual preferences. EVIDENCE: Residents felt that they had control over their daily lives and choices in their routines and patterns of daily living. There is an activities co-ordinator. The home provides some regular programmed activities including games, keep fit, hairdressing and manicure sessions. There are regular religious services and visits from a range of denominations. The home shares a people carrier with another home and arranges regular outings. Residents discussed their interests and activities with the inspector. Individual interests are recorded in service user admission information and care plans. The Registered Manager stated that staff look to promote active care, occupation and wellbeing. Residents are supported to continue their own preferred individual activities and interests. Staff were engaged in various activities with residents during the inspection. The home has recently acquired two new cats and these provide a source of interest and diversion for residents and staff. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 15 There is a flexible visiting policy and residents choose where they meet their guests. Residents felt that their visitors were made welcome. Visitors confirmed that the home’s visiting arrangements suited them. Staff make them welcome and offer them a cup of tea. The Registered Manager stated that she does not act as appointee for any residents for their benefits or manage any savings. Residents’ finances are generally managed with informal assistance from relatives or through Power of Attorney arrangements. Residents can bring in possessions and furniture by agreement with the provider. This was clearly evidenced in some residents’ rooms. Cornwall Care Ltd has made available to residents the ‘Care Aware’ advocacy service. The manager has introduced Cornwall Care Ltd’s ‘appetite for life’ initiative to ensure that a varied and appealing diet is provided to residents in a relaxed atmosphere. Breakfast is served flexibly according to individual preferences. The choices include cereal, toast, fruit, prunes, a cooked breakfast and drinks. There are two or three main choices each day at lunch, with further individual choices available. The home is currently providing diabetic diets, but no other special individual diets. Residents’ food and drink preferences are recorded. Residents made positive comments about the quality of food provided although there was some feeling that the menu choices for tea were rather unimaginative. They can choose to have their meals in their room or in the dining area. Lunch was a relaxed and sociable occasion with staff providing appropriate support. Residents enjoyed a glass of wine or a non-alcoholic drink with their choice of meal. Hot and cold drinks are served between meals. It was not possible to inspect the kitchen in detail as it was closed for essential maintenance on the second day of the inspection. Residents enjoyed a hot pasty or a salad for lunch on that day and this appeared to be appreciated. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 16 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 and 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a satisfactory complaints procedure that would ensure that complaints are listened to and acted upon. There are arrangements to protect service users from abuse. EVIDENCE: Cornwall Care Ltd has a corporate complaints procedure which complies with the standard. Mountford House and the commission have not received any complaints since the last inspection. Residents told the inspector that they had not needed to complain, but they were confident that the managers and staff were approachable and would deal with any issues raised. There is a complaints and compliments record. Cornwall Care Ltd has a corporate adult protection policy which has been recently amended to comply with local multi-agency guidance. The manager has a copy of ‘No Secrets’, the Department of Health guidance, and a copy of the Cornwall multi-agency adult protection guidance. The manager should ensure that staff are aware of the multi-agency guidance. Cornwall Care Ltd provides training in adult protection at induction and during NVQ training. Staff have not attended the multi-agency alerter’s training, although this is planned for the future. The provider needs to review the provision of refresher training in adult protection. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home is generally well presented but some areas require attention to ensure that residents live in a well-maintained environment. Hygiene practices were mostly satisfactory but some areas of the home were not completely clean and hygienic. EVIDENCE: Mountford is a purpose built care home in a residential area close to Truro centre. The main entrance is accessed up a sloped path and there is a small threshold. There is a moderately sized car park in the rear. The main residential areas of the home are on a single level with the rehabilitation day unit, main kitchen, laundry and training rooms on a lower ground floor. There is a passenger lift between the floors. The home accommodates residents with mobility difficulties and visual impairments; all areas of the home are accessible to residents. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 18 Cornwall Care Ltd has a programme of continuing maintenance. The front aspect of the home has been recently refurbished and is very well presented. However, a significant amount of the woodwork and window frames to the rear and sides of the building are in very poor condition. This is causing problems inside the window frames and sills in some rooms. The communal areas are comfortably furnished and generally decorated to a good standard. The blue wing shows signs of needing redecoration in some areas. The communal areas are generally clean and homely, but a number of armchairs did not appear to have been vacuumed or wiped clean recently. The dining room is a pleasant shared space with good quality furniture. There is a patio area accessible for residents at the front of the home with seating. The grassed areas to the rear and side have steeply sloping sides and are not accessible or safe for residents. At the time of the inspection the grass was long and unkempt and there were weeds growing on the paths and brambles trailing from shrubs and across pathways. There is a bathroom on each wing. Three have assisted baths; one has a level entry shower. The bathroom facilities were decorated to a good standard and were clean with the exception of the shower room where the drop down shower seat and hand basin were not clean. There are toilets on each wing and these were clean and hygienic. The residents’ rooms are single and four have an en suite facility. Most residents’ rooms were decorated to a good or reasonable standard and were personalised. Some rooms are beginning to need redecoration. All rooms inspected had clean fresh bedding. Residents stated they were ‘happy’ with their accommodation and facilities. Although basic cleaning was being carried out and floors were clean, many residents’ rooms had layers of dust at higher levels on light fittings, lampshades, the tops of wardrobes and pictures. A number of hand basins, surrounds and tiled splash backs were not clean. Some of the furnishings, both the fitted wardrobes and sink units, and freestanding furniture are showing their age. Curtains in some rooms were not hung properly; the curtain rails appear rather aged. There is a lack of storage space. A number of dripping taps were noted in hand basins. There were noticeable odours in some areas of the home. An assistant manager reported that domestic staff cleans affected areas and carpets regularly. Staff reported that there is a maintenance book for logging jobs that need to be done and the general assistant completes these promptly. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 19 The laundry complies with the standard. There are two industrial grade washing machines and two tumbler dryers. Staff reported that the equipment was in good working order. Good practice guides are displayed on the wall and COSHH information was available in the office. Soiled laundry is moved to the laundry in sealed bags and there is a laundry chute from the main floor to the laundry. Hand washing facilities are situated around the home with liquid hand wash and disposable towels. There were also supplies of gloves and aprons throughout the home. Following a recommendation in the last inspection report, one of the four sluicing areas has been generally improved to make it easier to keep clean. However, the original aged sluicing toilets and sluicing sinks remain. The wings lack modern enclosed sterilising sluices, which are safe and effective for cleaning the daily high number of commode bowls. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 20 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, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Recruitment procedures support and protect the service users. Staff are trained and competent to meet the needs of residents. The staffing levels are generally satisfactory but have not consistently ensured that the needs of residents are met. EVIDENCE: Residents commented that they felt staffing levels were sufficient. The roster for the care home detailed four care staff in the morning and three care staff in the afternoon, adequate general assistants and catering staff, and an assistant manager during the waking day. At night there are 2 waking staff and a manager on call. There have been some occasions recently when, due to sickness and annual leave, only three care assistants have been on duty during the morning. This is not a satisfactory level of staffing for the home. The rehabilitation unit has a rehabilitation co-ordinator and rehabilitation care staff. There is a minimum of one member of care staff at all times during the day with the coordinator. An occupational therapist and a physiotherapist provide professional assessment, care planning and guidance. Service users spend their evenings and nights in the care home – their rooms are on blue wing. The go down to the rehabilitation unit between 7.00am and 8.00am and return in the early evening. There have been a number of occasions recently when a low staffing level in the home has resulted in no care assistant being available for the rehabilitation unit. As a result the residents on the unit have had to Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 21 return to the care home for the afternoon, and the rehabilitation unit has been unable to function. The majority of care assistants have attended the ‘Promoting Independence’ course and trained to NVQ2. The rehabilitation coordinator supervises the rehabilitation care assistants. Residents were positive about the skills, kindness and qualities of the staff team. Posts are advertised through the Job Centre and local press. Cornwall Care Ltd has standard corporate recruitment procedures. Two managers interview applicants using standard set questions. The records of a recently recruited member of staff showed that the required employment checks had been properly completed. Staff records for established staff contained the required documents and information. Staff receive a statement of terms and conditions of employment. Cornwall Care Ltd provides a structured corporate training programme for staff. Training records showed that staff had completed training, or were due to attend required training, in moving and handling, dementia care, food hygiene and health and safety. The provider was engaged in ensuring that all staff had up to date moving and handling. Recently appointed staff had begun their inductions. Staff were satisfied with the training they received to do their jobs. Over 70 staff are qualified to NVQ care level 2. The Cornwall Care Ltd training structure ensures that all new staff are registered promptly for their NVQ level 2. Staff training records were well ordered and up to date. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The provider has recently appointed an experienced and qualified manager who is determined to ensure that it meets its stated purpose and objectives, and provides the highest quality care. The health and safety of residents and staff are promoted, but improved attention to detail is required in some areas. EVIDENCE: The Registered Manager is Miss Diane Hicks and she was appointed relatively recently. Miss Hicks exceeds the experience requirement for Registered Manager and has a professional social care qualification. There are four deputy managers; one post was vacant at the time of the inspection. There are clear lines of accountability from the manager through the deputy managers, who each have specific areas of responsibility, and supervise one of the wings and Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 23 staff. Staff were positive about the support and supervision that they received from the manager. Cornwall Care Ltd has corporate policies for the management of service users’ monies and the home provides safekeeping for small amounts of money. Families and representatives pay in cash on behalf of the residents. Each resident has a record detailing payments in and out, and a running balance. Each resident’s balance is not held as an individual amount of cash – for 40 residents this would amount to a large sum for the home to hold. The cash is held in a specific bank account with a float available for daily transactions. A separate cash book details all payments in and out of the cash float. The provider has been advised to ensure that proper dated receipts are retained for all transactions on behalf of residents in order to complete the audit trail. This involves, for example retaining a copy of the newspaper bill which details each individual resident’s expenditure. Cornwall Care Ltd has previously sought the views of residents and their representatives, and other stakeholders through questionnaires. The Registered Manager stated that the annual quality assurance survey this year is being carried out by an external organisation. The surveys will be distributed to residents and all other stakeholders with a stamped envelope so that they can be returned directly to the external organisation for analysis. The staff records showed that all staff receive regular supervision sessions, although one record sampled showed no annual appraisal and there was a gap in supervision dates. Staff generally receive annual appraisals. Each assistant manager is responsible for supervising the staff on an identified wing of the home or the night staff team. Staff stated that informal and formal supervision supported them to do their jobs well. Cornwall Care Ltd has comprehensive policies for health and safety. The pre-inspection questionnaire detailed required maintenance and safety records. A sample were checked against the original records and found to be accurate. Staff have attended required health and safety training. Staff reported that Cornwall Care Ltd promotes safe working and manages health and safety well. The records showed weekly tests of the fire alarm system and the emergency lighting and regular fire training for daytime staff. There is a written fire plan/procedure. This was not dated. The Registered Manager needs to review if it is the current accurate fire procedure. The home’s fire risk assessment has been completed. The Registered Manager has been asked in this report to confirm if the fire service has seen the risk assessment and provided feedback. The records of fire training for night staff do not demonstrate that night staff have received regular training in fire procedures. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 24 Some health and safety issues were noted. There was no standard oxygen hazard notice on the door of the garage where oxygen cylinders are stored, although there was a sign warning of the presence of oxygen. Some cupboards required by the fire procedure to be kept locked, were open with keys left in them. The power cables to some pressure mats were not safely stowed but were looped in areas where the resident would be mobilising. Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 2 Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13 Requirement The registered person must make arrangements for the safe keeping, safe administration and accurate recording of medicines in the rehabilitation unit. The registered person must continue the programme of replacing the remaining windows and external woodwork. The registered person must ensure that all parts of the home are kept clean, hygienic and free from odours. The registered person must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Night staff must receive regular training in fire procedures. A standard hazard notice, as issued by the supplier or from the dispensing pharmacist, must be displayed where oxygen is stored. Timescale for action 03/10/06 2. OP19 23 30/09/07 3 OP19 23 03/10/06 05/09/06 4 OP27 18 5 6 OP38 OP38 23 23 28/02/07 03/10/06 Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 28 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 Refer to Standard OP26 OP7 Good Practice Recommendations The registered person should review the sluice facilities and develop a plan for updating and improving them. Care plans should set out in detail the action required by care staff to meet all aspects of the health, personal and social care needs of each service user. Care staff should complete regular daily records for each service user. A second person should check and countersign hand written medicine administration records. The registered person should review the fitness for purpose of the home’s main storage cupboard for medicines. The registered person should consult with residents and staff over the menu choices for tea. The registered person should review the need for refresher training in adult protection to staff. Curtains in residents’ rooms should be hung correctly and should be easy for residents to draw back and forth. Records of the management of service users’ money held for safekeeping should provide a complete audit trail. The Registered Manager should write to the commission and confirm if the fire service have inspected the home’s fire risk assessment and detail any feedback the fire service provided. Power leads to pressure mats should be placed well away from areas where the resident mobilises. 3 4 5 6 7 8 9 10 OP7 OP9 OP9 OP15 OP18 OP19 OP35 OP38 11 OP38 Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Mountford House DS0000009158.V303459.R01.S.doc Version 5.2 Page 30 - 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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