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Inspection on 16/06/05 for Mundy House Care Centre

Also see our care home review for Mundy House Care Centre for more information

This inspection was carried out on 16th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Mundy House provides a homely and welcoming place for residents who need assistance with care to carry out daily activities of living. The home and garden are well maintained. Residents have a choice of meals, which, are well presented, and special diets are catered for.

What has improved since the last inspection?

Staff have improved the way in which they record information about residents who live at the home, and their needs, so as to ensure that all staff are aware of these needs and any changes. Staff work so as to ensure that residents have their medication at the correct time. Complaints are dealt with more promptly and action taken by staff to address concerns and issues that are brought to their attention by residents and / or their relatives. The provision of new bedroom furniture and futon style bedding and the replacement of carpets improved the overall environment and provide a more homely place for residents to live.

CARE HOMES FOR OLDER PEOPLE Mundy House Church Road Basildon Essex SS14 2EY Lead Inspector Carolyn Delaney Un-announced 16th June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Mundy House Address Church Road Basildon Essex SS14 2EY 01268 520607 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) info@ashbourne.co.uk Ashbourne (Eton) Limited 193-199 Bath Street Glasgow G2 4HU Mrs Claire Jane Collins CRH 65 Category(ies) of Dementia (DE) 3, Older People (OP) 65 registration, with number of places Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Dementia (3), Old age, not falling within any other category (65) Date of last inspection 5/03/2005 Brief Description of the Service: Mundy House Care Centre is a large home that was purpose built in 1965. Care and accommodation is offered for up to sixty-five older people, including up to a maximum of three service users who have a diagnosis of dementia. It is close to local shops and is on a bus route with services to Basildon and Wickford.The majority of bedrooms are situated on both floors of the main building. An additional eight bedrooms are sited in the Lodge annexe. Following recent renovations, this area can now reached through an internal walkway on the first floor. Single and double bedrooms are available and the majority offer ensuite facilities. Access to all rooms is available via passenger lift.The home has a number of communal lounge/dining areas. There is a courtyard and garden area accessible to service users. Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on 16th June 2005 between the hours of 08.45 and 19.00 by the homes lead inspector Carolyn Delaney and second inspector, Michelle Love. During the inspection residents care notes such as assessments of their needs, care plans and assessments in respect of risks of potential injury were examined. A number of residents, relatives and members of staff were spoken with during this inspection and their views and comments have been reflected within this report. Records in respect of the recruitment and training of staff were also examined. A brief tour of the premises was carried out. What the service does well: What has improved since the last inspection? Staff have improved the way in which they record information about residents who live at the home, and their needs, so as to ensure that all staff are aware of these needs and any changes. Staff work so as to ensure that residents have their medication at the correct time. Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 6 Complaints are dealt with more promptly and action taken by staff to address concerns and issues that are brought to their attention by residents and / or their relatives. The provision of new bedroom furniture and futon style bedding and the replacement of carpets improved the overall environment and provide a more homely place for residents to live. What they could do better: The records of assessments and care plans could be more detailed and include details about how residents would like to have care carried out. Staff at the home could spend more time with residents, attend to residents more promptly when they ask for assistance, and when carrying out any care they should ensure that they explain what they are about to do, especially when dealing with people who may be anxious or confused. Staffing levels at weekends are sometimes low due to unexpected sickness and this affects the care of residents living at the home. Plans should be implemented to deal with times when staffing levels are low and replacements cannot be found, such as rearranging the daily routines so that some tasks could be done later in the day when more staff are available. Staff could also do more to ensure that residents are kept safe from harm and injury, particularly when they are assisting staff to move. Information about each residents needs could be more clearly recorded so as staff are kept up to date and to ensure that residents living at the home receive the care that they require. More could be provided in the way of activities for residents living at the home and the number of hours dedicated to this could be increased. Measures should be in place to ensure that staff are managed and act in a way which does not put residents at risk of injury when moving and handling them and all staff must be aware of what constitutes abuse, and what action to take in the event of any verbal or physical abuse of residents living at the home. Checks and references for all new staff should be more robust so as to protect the residents living at the home. Please contact the provider for advice of actions taken in response to this Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 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 standard(s) 2, 3, & 5 Assessments in respect of prospective residents needs are not carried out consistently in sufficient detail so as to determine that the home can meet these needs. EVIDENCE: A qualified member of staff carries out an assessment of each residents care needs prior to the resident moving into the home. The records in respect of the assessment of residents did not always include sufficient details in respect of resident’s needs and how these needs affect their ability to carry out normal daily activities of living. For example where it was identified that one resident had a history of ‘self neglect’, it was not clear how, and where residents were identified as having mobility or nutritional needs these were not clearly identified. Improvements had been made in the recording of assessments since the previous inspection. Residents and / or their relatives are issued with contracts of terms and conditions in respect of living at the home. Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 10 Residents and relatives said that they were invited to visit the home before they make a decision was made to move in. Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 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 standard(s) 7,8 &9 Care plans and records in respect of assessing risks to residents were not recorded in sufficient detail so as to ensure that all staff were aware of each residents needs. Staff were observed to carry out moving and handling of residents in a manner, which could cause injury to residents. Staff working at the home ensure that residents receive medication as prescribed. EVIDENCE: Care plans did not include details of how resident’s care and welfare needs affected their ability to carry out daily activities or details of how staff were to assist residents with their assessed needs. Where resident’s needs had changed due to deteriorating health etc, care plans were not always updated with this information. Assessments in respect of risks to resident’s health and welfare such as the risk of developing pressure sores, injuries due to falls or the use of bedrails were not sufficiently detailed. It was not clear what actions that staff were to take in order to minimise these risks. Assessments were not always reviewed when residents needs changed. For example for one resident who spent most of the day in bed and required the assistance of staff to change her position so as to minimise the risks of Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 12 developing pressure sores, it was not recorded how often the resident was to have her position changed or how much time was spent in bed. Daily care notes did not include details of what action staff took in the event of a resident displaying aggressive behaviour, or where residents had refused meals it was not clear from records what actions staff took, such as offering alternative meals or offering food later in the day. During the inspection staff were observed on a number of occasions to move residents in an inappropriate manner, which could cause injury to both resident and staff. Residents receive their medication at appropriate times. Since the previous inspection there has been an incident where medication has gone missing from the home. Measures had been implemented so that staff check medication each shift. Records in respect of these checks were not maintained so as to evidence that this procedure occurs every day. Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 &15 The provision of meaningful occupational and leisure activities at the home are not sufficient to meet the needs of residents who live there. A choice of well cooked and well-presented meals are made available for residents living at the home, however staff do not always assist residents in an appropriate manner at mealtimes. EVIDENCE: Mundy House employs one activities coordinator for five hours per day, five days per week. One resident said that she was taken out to the library and local shops, though not on a regular basis. Residents said that the activities coordinator was ‘lovely’ but many residents also said that there ‘was not much to do during the day’. One resident enjoys gardening. He was observed to spend most of the day tending to plants in the garden. There were little other activities noted during the day of this inspection. In particular there were no activities and staff did not spend time with residents who were confused. Relatives said that they are welcomed when they visit the home. The majority of residents said that the food provided by the home was ‘very good’. Meals were seen to be served in an appealing manner and residents had a choice of meals from the menu at both lunch and suppertime. It was positive Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 14 to note that resident’s needs in respect of nutritional needs had been reviewed since the last inspection and as a result residents with difficulties in swallowing or chewing foods were now being offered ‘soft’ diet instead of ‘pureed’ meals. It was noted that staff did not interact with residents when serving and assisting them with the lunchtime meal. In one instance a member of care staff put an apron on a resident, moved her feet on her reclining chair and commenced feeding her without explaining these procedures or saying anything to her. Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Residents and relatives feel that their complaints will be dealt with appropriately. Staff working at the home do not consistently act in a manner, which ensures the protection of residents from harm or abuse. EVIDENCE: Records in respect of complaints received since the previous inspection were well maintained and complaints were investigated and responded to promptly. Residents and relatives said that they felt that for the most part that complaints were handled well. However when some issues were raised by inspectors in respect of comments made by residents and their relatives these were not well received by senior members of staff who were very defensive in their response. Staff training records, which were sampled, included details of staff training in respect of the protection of vulnerable adults. However one member of staff when questioned as to what action he would take if he witnessed a resident being verbally abused, did not demonstrate that he would act in an appropriate manner. One member of staff had been suspended recently following an allegation by another member of staff that a resident had been verbally abused. At the time of writing this report this member of staff had been re-instated following an investigation carried out by the home’s manager, whereby there was no evidence to support this allegation. This member of staff will be subject to regular supervision with an extended probation period. Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 The environment was not fully assessed during this inspection, however no issues of concern were noted throughout the day. Standards nineteen to twenty six will be assessed at the next inspection. EVIDENCE: Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 Staff are not always employed in sufficient numbers so as to meet the needs of residents living there. Staff receive training however they do not always act in a manner, which promotes the wellbeing and safety of residents living at the home. Recruitment procedures are not sufficiently robust so as to protect the welfare and safety of residents living at the home. EVIDENCE: Staff duty rotas were maintained well and staff do not regularly work excessive hours without off duty days. While staff receive training in respect of the safe moving and handling of residents a number of staff were observed to move residents in an inappropriate manner throughout the day of this inspection. During the inspection residents were left unsupervised in two of the lounge areas. On occasions residents were heard calling out for assistance and on two occasions inspectors had to ask staff to attend to residents who were calling out to use the toilet. Some relatives said that staffing levels at weekends were insufficient to meet the needs of residents living at the home. Staff rotas for the weekend prior to the inspection indicated that staffing levels were insufficient and this was discussed with the homes manager and senior staff. Criminal Record Bureau (CRB) disclosures had been sought for staff working at the home. However checks in respect of staff’s previous employment history Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 18 and references were not carried out consistently. Where staff who had never worked in a care home before were employed at the home there was no evidence that their training and / or skills needs were assessed and that the period of induction was suited to their needs. Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35,36 &38 The management of staff working at the home does not always ensure the safety and wellbeing of residents living at the home. EVIDENCE: The home’s care manger had died unexpectedly some time prior to this inspection. The homes manager said that her line manager had been very supportive, however that this event had impacted upon staff and the management of the home. During the inspection residents and relatives said that the manager was approachable and that they felt they could discuss any issues with her and felt confident that these would be addressed. The manager raised some staff management issues during this inspection. She Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 20 said that some staff did not agree with the use of a hoist for moving residents, as they felt that this was undignified and inappropriate, despite an assessment having been carried out which determined that this was the safest way to move residents. The manager had commenced disciplinary action against those members of staff involved and that this had improved things, however some members of staff were still not complying. Despite the training received by staff some were observed to act in a manner, which could potentially put residents living at the home at risk (detailed within this report). The manner in which one senior care staff addressed issues with other care staff was not appropriate. Monies held on behalf of residents were stored safely and up to date records maintained in respect of any monetary transactions. The home was well maintained and there were no safety issues in respect of the premises observed on the day of this inspection. Maintenance personnel carry out safety and routine maintenance and repairs on a regular basis. Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 2 x 2 x 3 3 x 3 Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1) (a) (b) Requirement The registered persons must ensure that service users are only admitted to the home following a detailed assessment of care and welfare needs so as to determine that the home can meet these needs. Timescale for action 15/08/05 2. OP7 15(1) (2) This with particular reference to assessing how service users needs affect their abilities in respect of daily activities of living. (Previous timescales following the last four inspections have not been met.) The registered persons must 15/08/05 ensure that each service user has a written plan of care, which identifies care and welfare needs and includes details of how these needs are to be met. (Previous timescales following the last four inspections have not been met.) The registered persons must 15/08/05 ensure that wherever it is practicable that service users are protected from harm or injury.This with reference to Version 1.30 Page 23 3. OP8 13(1) Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc 4. OP12 16(2) (m) 5. OP12 OP15 OP27 OP16 12(1) (2) 6. 22(3) 7. OP18 OP30 13(6) 8. OP27 18(1) 9. OP29 19 10. OP30 18(1) ensuring that detailed assessments in respect of the risks of falls, developing pressure sores and injuries from the use of bedrails are carried out and reviewed according to each individuals needs. (Previous timescales following the four last inspections have not been met.) The registered persons must ensure that meaningful social , leisure and occupational activities are provided which meet the needs and so far as it is practicable the wishes of residents living at the home. The registered persons must ensure that staff act in a manner which promotes the safety, independence and dignity of residents living at the home. The registered persons must ensure that all complaints and concerns are received and dealt with according to the homes policies and procedures. The registered persons must ensure that all staff act in a manner which promotes the protection of residents living at the home. The registered persons must ensure that staffing levels are maintained at all times, which meet the needs of residents living at the home. The registered persons must ensure that all of the appropriate checks in respect of the fitness of people to be employed are carried out prior to their commencing employment at the home. The registered persons must ensure that staff are trained in respect of their roles, meeting the needs of, and protecting the 15/08/05 30/07/05 30/07/05 30/07/05 30/07/05 30/07/05 30/08/05 Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 24 11. OP31 OP33 12 interests of residents living at the home. The registered persons must ensure that the home is managed so at to protect the interests of residents living there. 30/07/05 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. Refer to Standard Good Practice Recommendations Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on sea, Essex SS2 6BG 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 Mundy House I06-I56 S18098 Mundy House V228902 160605 Stage 4.doc Version 1.30 Page 26 - 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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