Inspection on 24/07/06 for Mountwood Care Home

This inspection was carried out on 24th July 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

Mountwood Care Home 08/11/07

Mountwood Care Home 20/12/05

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Mountwood Care Home 11 Millway Road Andover Hampshire SP10 3EU Lead Inspector Tim Inkson Unannounced Inspection 24th July 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Mountwood Care Home DS0000065933.V297065.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. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mountwood Care Home Address 11 Millway Road Andover Hampshire SP10 3EU 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) 020 7929 3444 01264 363081 mountwood@ashbourne.co.uk Ashbourne (Eton) Limited To Be Confirmed Care Home 49 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (49), of places Physical disability over 65 years of age (49) Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 service user whose date of birth is 09/01/1949 can be admitted under the age of 65 years. 20th December 2005 Date of last inspection Brief Description of the Service: Mountwood Care Home provides is located near the town centre of Andover. It can accommodate up to 49 service users in the categories old age and dementia, requiring nursing care. The home has a dementia Care Unit with 11 bedrooms, a dining room and sitting room. The home has recently undergone a number of changes of owner in recent years and the current registered provider is the Southern Cross group of homes. Potential residents are given a brochure about the home and a copy of the home’s “Service Users Guide” that provides information about the services and facilities provided by the home. A copy of the home’s Statement of Purpose and Service Users Guide are available in the entrance hall to the home. There is a notice on display in the home informing anyone who may be interested of the availability of the Commission for Social Care most recent report about the home. Copies of reports of previous inspections of the home are available in the entrance hall of the home. The home’s manager at the time of this fieldwork visit said that he told potential residents and their relatives about the Commission for Social Care Inspection (CSCI) website and encouraged them to look at reports on the site. At the time of the fieldwork visit to the home on 13th June 2006, the home’s fees ranged from £430 to £630 per week. This did not include the cost of hairdressing; newspapers; chiropody and dry cleaning. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This fieldwork visit was unannounced and took place on 24th July 2006, starting at 09:15 and finishing at 17:20 hours. The process included viewing the accommodation including bedrooms, communal/shared areas and the home’s kitchen and laundry. Documents and records were examined and staff working practices was observed where this was possible without being intrusive. Residents, visitors and staff were spoken to in order to obtain their perceptions of the service that the home provided. At the time of the inspection the home was accommodating 43 residents and of these 7 were male and 36 were female and their ages ranged from 42 to 96 years. No resident was from a minority ethnic group. The home’s proposed manager was present throughout the visit and was available to provide assistance and information when required. Other matters that influenced this report included a pre-inspection questionnaire with documentation completed and provided by the proposed manager. Also information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 20th December 2005, such as statutory monthly reports made to the home for the owner and notices received about incidents that had occurred. What the service does well: Detailed information was obtained and recorded by the home about the help that residents required both before and after they moved into the home. This helped to ensure that the care and support they received was planned properly and their needs were met. Potential risks to residents’ welfare were identified and documented and plans put into place to eliminate as far as possible any harm that individuals could suffer. The home liaised with specialist healthcare professionals to that ensure that residents’ healthcare needs were managed appropriately. The friendly and caring attitude of the staff was appreciated by residents and relatives. Residents were able to participate in a range of social and other activities that were organised by the home. Individuals that were bedfast were given one to one attention and equipment was available to enable stimulating activities to be provided for residents with enduring mental health problems. The home promoted the right of residents to make choices for themselves and exercise personal autonomy as far as was reasonably possible, including dealing with their own finances. The food that the home provided was enjoyed by residents. Although he had only worked in the home for 5 months, staff, residents and visitors to the home valued the personal qualities and abilities of the proposed manager. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 6 Internal communication in the home was being improved through the establishment of regular meetings for both staff and residents. Management systems and procedures in the home worked well including, dealing with complaints, quality monitoring, and health and safety. There was a strong commitment to staff training and development to ensure that staff were able to fulfil their roles and responsibilities and meet residents needs. 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were procedures in place to ensure that the home identified the assistance and support that potential residents needed before they moved into the home. EVIDENCE: The home had written policies and procedures concerned with the admission of new residents to the home and these referred to the importance of ascertaining the help required by potential residents before they moved into the home. The home’s Service Users Guide stated the following: “Prior to admission the Home carries out a detailed assessment often in conjunction with other health and/or care professionals, to ensure that the staff are able to meet your care needs and that any appropriate equipment is in place…………….We avoid unplanned admissions where possible”. A sample of the records of 4 residents was examined including those concerned with identifying the help and care that people needed. There was evidence from these documents that the admissions to the home of the individuals concerned had all been planned with staff with the appropriate Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 9 knowledge and skills visiting potential residents and identifying the help and support that they needed before they moved into the home and a draft care plan was prepared. It was also evident from the records examined that potential residents were contacted before they moved into the home informing them that the home could meet their assessed needs. The home’s pre-admission assessments and pre-admission draft care plans were complemented by more thorough and comprehensive assessments of a resident’s needs when they actually moved into the home and replaced by more detailed and permanent care plans following admission to the home (see next section). There was documentary evidence that assessments of residents needs were reviewed regularly and revised as necessary when an individual’s circumstances had changed. The home does not provide intermediate care. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had systems in place to ensure; the personal and healthcare needs of residents were met and medication was managed safely and effectively. Among other things staff working practice ensured that residents’ privacy and dignity was promoted. EVIDENCE: The home’s Service Users Guide stated the following: “Staff will draw up a care profile with your involvement, which will detail how all your care needs and lifestyle choices will be met. We encourage you to include your views and to agree to sign the plan wherever possible. Your family/friends may also be involved…..This care profile will be kept under review and revised … on a monthly basis….” A sample of the care plans of 4 residents was examined. Among the sample was an individual who had an enduring mental health problem (i.e. dementia) and someone that had a pressure sore. The documents were detailed and the plans were based on the assessments the home carried out in order to identify what help individuals needed (see pages 9 and 10). Assessments included a range of potential risks to residents e.g. pressure sores; falls; nutrition; moving and handling; malnutrition; bed Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 11 rails; etc. Where a pressure sore assessment indicated that an individual was at risk it was noted that the corresponding plan of care for the person concerned referred to the use a pressure relieving aid. The plans examined set out clearly the actions staff had to take and what specialist equipment was needed to provide the support and assistance each person required. There was evidence from documentation that wherever possible individuals and/or their representatives had been involved in developing the plans and agreed with the contents. Where care plans referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place e.g. pressure relieving aid; Zimmer frame; hoist; soft diet/pureed meal; etc. Records indicated that care plans were reviewed at least monthly and daily notes referred to the actions taken by staff to provide the needs set out in those plans. Staff spoken to knew the needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. Comments from residents and relatives about the abilities of staff the care and support that the home provided and the use of care plans included: • “I am a bit independent, if I need them to do it they will cut up my food They turn me every two hours -They use a hoist to move me -They give me a bed bath quiet often -The staff are lovely, I can’t fault them - My daughter read my care plan”. • “If I need help they give it, I only have to ask. I don’t need much help, but they do massage my legs, they are very kind -, they always have time for you. • “We are very happy, he is well looked after and his needs are met. I only have to mention something and it is sorted - I come to review his care plan as he cannot speak himself”. Seven comment cards were received from relatives of residents accommodated in the home and six of them indicated that they were satisfied with the care that the home provided. Comments included: • “Staff are very kind and caring to residents”. • “The care is good with staff occasionally bringing small gifts, which make my mother feel special and cared for”. Discussion with residents indicated that the home was sensitive to the specific needs of individuals and sought the specialist help and support of outside agencies where required. One resident who was admitted to the home because her carer who was her partner had died, said, “I have had bereavement counselling it was arranged by J” Records examined also indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Residents said that they saw and received treatment from among others, doctors, podiatrists and opticians and when required arrangements to attend outpatient clinics were made by the home. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 12 • “I had a bed chest and they called the doctor in to see me and I had antibiotics. I see the chiropodist about every 6 weeks”. There was evidence that home made referrals to and arranged specialist support when required e.g. tissue viability nurse, occupational therapist, speech and language therapist. There was documentary evidence that when an individual had a wound/pressure sore that specific plans to include regular turning and the use of pressure relieving aids were implemented. This was confirmed in discussion with residents (see above). Charts recording the turning “regime/programme” were kept in the room of the persons concerned and the wound healing process was monitored and recorded. Individuals’ health was monitored routinely and regularly e.g. blood pressure and weight. The home had a small 11-bed dementia care unit. The registered provider/owner was a large national organisation and it employed its own specialist consultant in “dementia care”, who was able to provide advice, guidance about how to manage the care and meet the particular needs of residents with enduring mental health problems. The home had written policies and procedures concerned with the management and administration of medication. Medication was kept in locked and secured medicine trolleys and cupboards and where required in a medical refrigerators. Controlled drugs when required could be stored securely in an appropriate lockable metal cabinet. The home operated a monitored dosage system. A local pharmacist provided most prescribed medication every seven days in cassette/dosette boxes for each person concerned. Other medicines that could not be put into cassette boxes because they could spoil, such as liquids or those that were to be taken only when required were dispensed from their original containers. The only staff in the home that dispensed and were responsible for the management and administration of medication on a day-to-day basis were registered nurses. The home’s proposed manager said that the deputy manager had delegated responsibility for ensuring that the home’s system was effective and safe. Good practice noted during the fieldwork visit included: • Recording the temperature of the refrigerator used for storing some medication • Dating of containers of certain medications when they were opened because of limited shelf lives i.e. eye-drops and thyroxin • Sample copies of the signatures of the Registered General Nurses that dispensed medication • Some sedative medication was treated as if it was Controlled Drug • A file was being maintained of all medical alerts received by the home The home strongly promoted the independence of residents and those residents assessed as being able and who wished to were encouraged to keep, Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 13 and take their own medication. At the time of the fieldwork visit however no resident was managing his or her own medication. The home’s proposed manager had recently completed an audit of the medication system and had identified the need for an up to date reference guide i.e. the British national Formulary and had subsequently ordered two copies. The copy available in the home was two years old. Records were kept of the ordering, receipt, and administration of medicines and these were accurate and up to date. There was no record being kept of the disposal of medicines apart from controlled drugs. It was noted that there was large bin in the treatment room that contained a large quantity of unused and unwanted medicines that would be collected by a specialist registered contractor but there was no record the contents of the bin. The home’s written procedures required such a record to be kept and the proposed manager said that he had assumed that a record was being maintained. He said that appropriate records would be started immediately and they would include the content of the bin. The home’s Service Users Guide included information about its philosophy of care including among other things the promotion of service privacy and dignity. Most residents were accommodated in singe rooms and they said they appreciated the privacy that these afforded, and particularly those that had the benefit of en-suite WCs. Those spoken to also said staff usually knocked before entering their rooms and this practice was observed during the inspection visit. Residents and relatives spoken to described the staff as respectful and polite. Comments about these matters included the following: • “Everyone is nice, so polite - I have a room of my own, with its own toilet facilities” • “They are polite and treat me with respect and preserve my modesty up to a point. Most of them knock on the door before they come in - The best thing is that I am left alone and no one bothers me as I have lived on my own for so long.” Care plans examined included reference among other things actions that would promote residents’ privacy and dignity e.g. • “Elimination: - ensure privacy and dignity i.e. close curtains, shut door, use screen”. Staff spoken to well acutely aware of the importance of such matters as well as other fundamental principles that underpin social and health care and one said, “D prefers female carers and we make sure that that happens. She needs 2 carers to mobilise and we try to encourage her to walk”. . Mountwood Care Home DS0000065933.V297065.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 using available evidence including a visit to this service. The home organised a range of social activities that provided stimulation and it also promoted residents self-determination, enabling residents to exercise choice about all aspects of their daily life. Residents were able to maintain links with relatives and representatives. The dietary needs of residents were well catered for with a balanced and varied selection of food available that met their tastes and choices. EVIDENCE: The home employed an activities organiser and there was a publicised programme of regular events in which residents could participate. A notice board in the hallway of the home was displaying information about visiting entertainers and also readily available was a newsletter published by the organisation that owned the home. Some residents spoken to said that they were able to enjoy the activities that were arranged, and others indicated that they preferred their own company.. The home’s communal area that was known as the sun lounge had specialist equipment installed i.e. lights and a projector, that could be used to stimulate the senses of individuals with dementia who were unable to join more traditional group activities such as quizzes, bingo and board games. The activities organiser described her experience and role in the home: Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 15 “I have been on Age Concern courses and other courses about therapies. I work 5 days a week. The activities programme is on display. We have a music for health workshop every 2 weeks, a lot of outside entertainment comes in and we have trips out to pubs, garden centres and boats trips – a narrow boat on the Basingstoke canal and one down at Southampton at Hythe. We do a lot of physical things. Games, board games, group-work. I do orientation to stimulate residents with dementia. Once or twice a week I use sensory materials, projector with lights and music and hand massage. For individuals in bed I do one-to-one facials and nail-care. We have residents meetings, which I hold. I love it, I look forward to coming to work. I am going to the pub now with a resident. Comments about activities included: • “She does my nails for me”. • “If there is anything going I join in although I am getting lazy and I sit a lot. I sat in the garden this morning before the sun came up and it was lovely and I enjoy sitting here in the porch it is wonderful. They go out a lot to town and so on and I go” • “He always comes down if there is musical entertainment and he is taken out”. Residents spoken to confirmed that they could exercise choice in all aspects of life in the home. One individual said, “When I first came her they said you can go where you want in the grounds. There are no restrictions where you go and how you go. Everyone does as they want. I get up at 7:30 and if I want help they will give it to me”. Other comments from residents about life in the home included: • “I choose to stay in my room all the time. I went out and had lunch in a pub today - I go on trips out. The best thing is that I am left alone and no one bothers me as I have lived on my own for so long”. • “There are no restrictions on visiting. There are no restrictions on other things like the time the lights have to be off and so on. Details of the leisure interests and individuals preferred lifestyle were recorded in their care plans. During this fieldwork visit a number of visiting relatives were seen and some were spoken to. One said, “Visiting arrangements are open, anytime day or night. They always ring me if anything happens to my son.”. Residents spoken to said that they were able to maintain contact with their families and friends: • “Visitors can come at any time.” • “My brother and his wife visit on Saturdays and my other brother on Sundays. There are no restrictions on visiting”. Although most residents handed over the responsibility of the management of their finances to relatives or representatives, a number of individuals continued to control their own financial affairs. Residents were able to bring personal items into the home including furniture and several individuals had taken trouble to personalise their bedrooms. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 16 It was noted that care plans were kept in a nurses’ station but the proposed manager indicated that when all documentation was in the format of the new owners that these could be kept in residents’ own accommodation. Other sensitive information about residents was kept securely either in the manager’s office or administrators office. The home had written policies and procedures about the control of records and access to personal files. There was information in the entrance hall of the home about a number of organisations that could provide independent advice, information or advocacy services for residents and/or their relatives. Residents were generally complimentary about the food provided and confirmed that they had 3 meals a day and could have snacks and drinks at other times. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided with a selection of choices every day. In addition special diets and individual preferences and needs were catered for e.g. soft and pureed meals and diabetics. Fresh ingredients were used in the preparation of meals and the ready availability of fluids was noted. The ingredients for pureed meals were prepared separately. Residents could choose where to eat and many preferred to eat in their rooms and they were able to select the meal that they wanted from a menu that was made available to them the day before. The menu for the day was on display in the entrance hall to the home. Comments about the food provided from residents and relatives included the following: • “The food is not bad at all, I have been spoilt. They come round the day before and ask us what we want. You can always ask for more. I sometimes go down in the sun lounge for my lunch” • “The food is pretty good”. • “He has pureed food and it looks like an artist’s palette”. • “As far as I am concerned the food is OK. You will never please everyone. It suits me. You ask for it and you get it”. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 17 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 using available evidence including a visit to this service. The home had a clear and satisfactory complaints procedure to address the concerns of residents and relatives/representatives. Robust procedures were in place to protect service users from the risk of abuse. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. All residents and relatives spoken to were confident about raising any concerns with the home’s manager. • “I have nothing to complain about if I did I would complain to N or my oldest daughter would deal with it”. • “I have had to complain to N and it was dealt with OK”. • “ I only have to mention something and it is sorted”. The home kept records of complaints that detailed the issue, and set out any agreed action to remedy the matter and the outcome. There had been one complaint made to the home since the proposed manager took up post some 5 months before this fieldwork visit. It was it is apparent from the record and correspondence that was seen that the matter was responded to appropriately and within the expected timescale and action was taken to rectify the problem the complainant identified. The home’s proposed manager also said, “I encourage people to complain, but some relatives have said that they don’t want to cause a fuss or get a reputation. I walk around the home every morning when I come to work and see everyone and ask them if everything is alright”. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 18 The home had written procedures available with adult protection. These were intended to provide guidance and ensure as far as reasonably possible that the risk of residents suffering harm was prevented. Staff spoken to said that they received training about protecting vulnerable adults and an examination of staff training records confirmed this. Staff spoken to were also able to demonstrate an awareness of the different types of abuse and the action they would take if they suspected or knew that it had occurred. Where subsequent to an assessment it was considered necessary for a resident’s safety to use bed rails written permission/consent was obtained. The home’s proposed manager had been proactive about adult protection when on one occasion there had been concern expressed to him that decisions made by a senior member of staff had resulted in a resident being left for too long and unnecessarily in soiled clothing. The member of staff concerned had been suspended and the proposed manager had also contacted the local social services adult protection co-ordinator about the matter. The member of staff had resigned before the home’s disciplinary process had been completed. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. The home’s environment was safe and well maintained. There was an infection control policy and procedures in place and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: The exterior and interior of the premises, its décor, furnishings, fittings and equipment were in reasonable repair. A schedule of capital expenditure and a maintenance programme for 2006 were seen and both indicated that the organisation that owned the home was investing in both the building, and its contents e.g. all carpets in the ground floor corridors and communal rooms were due to be replaced in early August 2006. The organisation that owned the home also had an estates division/department that organised and arranged major maintenance, repair and redecoration of the home. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 20 The home employed maintenance personnel to undertake minor repairs and redecoration and one bedroom on the first floor of the home was being redecorated at the time of the fieldwork visit. There was some discussion about the redecoration of the home’s dementia care unit and the proposed manager said that he had spoken to the dementia care consultant employed by the organisation to ensure that the colour scheme would be appropriate and could help residents orientate themselves e.g. the careful use of colours and doors of WC’s and bathrooms made easily distinguishable. The organisation/company that owned the home had a designated fire safety officer who had visited the home on 2nd February 2006. There was a fire risk assessment in place and records and discussion with residents and staff indicated that fire safety was treated seriously by the home. The local environmental health officer had visited the home on 24th February 2006, and had examined the homes food hygiene procedures and corresponding records and had identified a number of matters of concern. The proposed manager had subsequently implemented an action plan and all the matters of concern had been addressed. He had also commenced monthly audits of the kitchen as part of the home’s quality monitoring system. The home had comprehensive procedures in place concerned with infection control and these referred to among other things, effective hand cleaning and the use of protective clothing. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers (that were full and working) and paper towels. Protective clothing was readily available in convenient locations and staff were observed using gloves and aprons appropriately. The home was clean and odour free at the time of the fieldwork visit and residents and visitors spoken to were all positive about these aspects. • “It is kept spotless, if there is a speck of dust they go mad”. • “I think that the home is kept clean, they clean my room every day”. • “The cleanliness and décor of the place seems fine” One comment card received from a relative before this fieldwork visit indicated that there was a problem with an extractor fan in a communal WC. This had been repaired by the time the fieldwork visit took place. There were sluice disinfectors available on both floors of the home. The home’s laundry although cramped and quite small for the size of the home and number of residents accommodated, was appropriately sited and equipped. Effective procedures were in place for the management of soiled laundry items. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 21 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 good. This judgement has been made using available evidence including a visit to this service. There was an appropriate and satisfactory level and mix of staff that ensured the needs of residents were met. The home had clear staff recruitment, training and development procedures that ensured that service users were protected and supported. EVIDENCE: The total number of staff employed to work in the home at the time of the fieldwork visit was 45, this included 11 registered nurses and 22 health care assistants and of the latter 5 had a qualification equivalent to a National Vocational Qualification level 2 in care (i.e.22 ). The registered manager said some recent resignations had resulted in a number of health care assistants with relevant qualifications being reduced. He intended to promote staff training and development and all that all the remaining heath care assistants had been registered to start NVQ training. He also said that the home had recently recruited 4 new staff from overseas with suitable experience and qualifications that were deemed equivalent to NVQ level 3 in care. Most staff, residents and relatives (including the views expressed in comment cards) indicated that the staffing levels in the home were sufficient and most service users also expressed confidence in the abilities and competence of the staff to meet their needs. Comments from residents and relatives about the sufficiency and competence of staff included the following: • “The staff are lovely, I can’t fault them. Sometimes they are busy at weekends, but we don’t go short. If there are new staff they get someone to shadow them”. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 22 “Some of the new staff don’t seem to know what they are doing I sometimes feel unsafe as they don’t know how to hold me. They are always short staffed. They come and say can you wait a bit because I am seeing to someone”. • “It is very good, I don’t find anything wrong with it. Everyone is nice and so polite and everyone tries hard. They always have time for you - I have been a nurse and I think that they could do with a little more help, everyone wants things at the same time”. • “Staffing levels are appropriate for the number of residents we have at the moment”. • “Staffing has been difficult as quite a few left but we coped well with it. Most of the time we have enough, it depends on the day and what is happening some days there is more going on than others”. • “There always seems to be someone around to help me and to lift him when needed. I have no problems with the abilities of the staff”. Out of 7 comment cards received from relatives, 4 indicated that they believed there were sufficient staff on duty at all times. At the time of the fieldwork visit the care staff rota setting out the minimum number and skill mix deployed in the home was as follows: 0700 – 1300 2 7 9 1300 – 1900 2 6 8 1900 - 0700 2 3 5 • Registered nurses Health care assistants Total Apart from registered nurses and health care assistants the home employed other staff and these comprised. Administrator Activities organiser Kitchen assistants Housekeeper Cleaners Laundry assistants Chefs Maintenance personnel Records were examined of 3 staff that had been employed to work in the home since the last fieldwork visit to the establishment on 20h December 2005. All statutorily required information and checks had been obtained and conducted before they had started work in the home. In addition the record of one registered nurse that had been employed in the home for some 2 years was checked and her professional registration with the Nursing and Midwifery Council was in date. All new health care assistants were provided with a copy of the General Social Care Council’s code of practice. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 23 All new staff received comprehensive induction and health care assistants completed a programme that satisfied the requirements of the training body for the social care workforce i.e. Skills for Care (previously the Training Organisation for Personal Social Services [TOPSS]). Staff training needs were identified through appraisals and individual supervision sessions and on the day of the fieldwork visit the proposed manager met with 2 staff to appraise their performance. The home had a training programme for all staff with several topics for them to attend every month. There was evidence from staff training records that were examined that a large number of staff had recently attended training in subjects that were essential to ensure that the home was able to promote residents’ welfare e.g. basic food hygiene, adult protection. Other subjects on the training programme ensured that staff acquired the necessary skills and knowledge to be able to meet the complex needs of residents e.g. pressure sore prevention, dementia care, infection control, first aid, and nutrition. Training resources that the home had available included videos and workbooks e.g. “care planning and risk assessment for people with dementia”. The home also accessed training sessions organised by Hampshire Social Services Department for care providers in the independent sector. Staff comments about their induction and further training opportunities included: • “I am about to have an appraisal with N I had the last one about 4 months ago. For updating I use professional journals, we use the expertise of medical representatives when they come to the home and recently I have done research on the internet and I am going to do a talk to other staff about pressure relieving aids. I want to learn more. I am going on a course next week about young disabled people as we have one resident under 60 years of age - N is very good he is keen to get us on training -. I feel that I can progress more”. • “I am starting my NVQ level 3 -For my induction I had a week with someone supervising me. It was all a bit rushed but I completed an induction book. • We have in house training in, fire, health and safety and moving and handling. We have things to read and videos to watch - N is setting up some dementia care training. I have been reading up on it for some time”. • “I have NVQ level 2 and 3 and I have just done a first aid course - We have regular dementia care training every 6 months and I had POVA training about 6/8 months ago”. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 24 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 good. This judgement has been made using available evidence including a visit to this service. The home’s manager provided effective leadership There were systems and procedures in place for monitoring and maintaining the quality of the service provided and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The home’s proposed manager was a registered nurse and he had been in post for some five months. His previous experience included managing a care home that provided nursing for a group of residents that were mostly young adults with very complex needs. He said that he was due to start a course in August at a local technical college for the registered manager’s award. It was evident from documentation provided prior to the fieldwork visit and also seen during the visit that the proposed manager had initiated a lot of changes and was clearly providing direction for the home’s staff team. His Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 25 intention to improve internal communication was evident from the implementation of a range of regular meetings involving both staff and residents some of which had occurred and other that were due to take place. He had made a visit to the home at night to meet with night staff as well as ensure that staff practice during at time of the day was as required and he said that he was entirely satisfied with his findings. As a result of discussion with the proposed manager and also from observing him in conversation with staff, relatives and residents, he presented as; knowledgeable; proactive; open and enthusiastic; sensitive to the needs of both residents and staff; and concerned with the quality of the service the home provided. Comments from staff, residents and relatives about him were all positive and included the following: • “N is very nice, very approachable and understanding if you have personal problems. He has made a lot of changes and does try. He has also restarted a lot of things that lapsed with the previous manage” • “Without sounding too creepy, N is very good, he has the interests of the home first, he is keen to get us on training. He is very approachable. If there is an issue he will get it sorted and done”. • “N is very nice, easy to get on with and very fair”. • “I like N, he has coped well as there have been so many changes”. • “N is great, very good”. • “N has not been here that long. He is polite and he will take time to speak to me”. • “N – I get on with him, he sorted out a lot of problems for my son”. The organisation that owned the home had procedures in place for monitoring the quality of the service that it provided and they included monthly audits of various aspects such as, the kitchen and the system for managing medication. The home’s manager also had to complete a detailed report each month that was validated by his line manager. On display in the entrance hall of the home were the results of stakeholders survey for 23rd June 2006 and the perceptions of the participants were mainly positive. A range of meetings took place in the home enabling staff and residents to influence the service provided. One resident said that she had attended a meeting and requested that a shower was installed, as she was unable to use an assisted bath. The manager said that he had arranged to have 2 level access showers installed in the near future. The home had a large number of comprehensive policies and procedures and there was a notice in the entrance hall to the home stating that they were readily available and accessible to anyone who wanted to see them. Staff viewed these procedures as helpful and there was evidence that were regularly reviewed and updated. “Policies and procedures are guidelines, we have to read them and sign to confirm we have”. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 26 “ I have read some policies and procedures they are very useful, and it is so everyone does the same”. At the time of the visit it was noted that advice from the Department of Heath about care for older people during a heat wave was prominently displayed at a nurses’ station and staff had signed it to say that they had read the contents. The home looked after no money for or on behalf of any residents. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; boilers; fire safety equipment alarms, emergency lighting; and portable electrical equipment. There were contracts in place for the disposal of clinical and household waste and pest control. Staff said that they attended regular and compulsory fire and other health and safety training and residents said that the home’s fire alarm system was checked regularly. There was a fire risk assessment for the premises and regular risk assessments of the premises were undertaken. Guards covered all radiators in the home and all windows above the ground floor were fitted with restrictors. The home had 2 staff trained as accredited manual handling trainers and there were hoists, and other equipment in the home to promote safe working practices. Among other health and safety procedures noted in the home were the following: • A record of hourly observations of resident during the night • Records of accidents were kept and a quarterly analysis was made of falls suffered by residents. • The efficacy of bed rails; wheelchairs; thermostatic valves and window restrictors were checked and recorded every month. • A poster with advice on the safe use of bedrails was on display in the home’s treatment room. During the fieldwork visit it was noted that a resident had bruising to her left eye. The injury was noted in the daily record that complemented her plan of care and also in a separate accident record. Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 27 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 3 Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action 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 Standard Good Practice Recommendations Mountwood Care Home DS0000065933.V297065.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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