Inspection on 24/06/08 for Mundy House Care Centre

This inspection was carried out on 24th June 2008.

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

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

Other inspections for this house

Mundy House Care Centre 03/03/10

Mundy House Care Centre 06/04/09

Mundy House Care Centre 30/07/07

Mundy House Care Centre 06/01/07

Mundy House Care Centre 28/06/06

Mundy House Care Centre 02/02/06

Mundy House Care Centre 16/06/05

Mundy House Care Centre 05/03/05

Mundy House Care Centre 15/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Mundy House Care Centre Church Road Basildon Essex SS14 2EY Lead Inspector Mrs Bernadette Little Unannounced Inspection 24th June 2008 08:30 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 Mundy House Care Centre DS0000018098.V367059.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. Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mundy House Care Centre Address Church Road Basildon Essex SS14 2EY 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) 01268 520607 mundy.house@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Manager post vacant Care Home 65 Category(ies) of Dementia (3), Old age, not falling within any registration, with number other category (65) of places Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Personal care to be provided for older people aged over 65 years. Personal care can be provided for up to a maximum of three service users with dementia. The total number of service users for whom personal care can be provided shall not exceed 65. 30th July 2007 Date of last inspection 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, which can be 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. The range of fees for accommodation is £444.57 - £ 600.00 per week. Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The site visit was undertaken by two inspectors over a ten hour period as part of the routine key inspection of Mundy House. Time was spent with the residents at various times during the day and observations of interactions and non-verbal communications were noted during the day and these are reflected as part of the report. The manager submitted an Annual Quality Assurance Assessment as required prior to the site visit. This is required to detail their assessment of what they do well, what could be done better and what needs improving. This information was considered as part of the inspection process and reflected as part of the report. Prior to the site visit, the manager was sent a variety of surveys to distribute and that asked questions that were relevant for each group, such as for residents, relatives, staff, care managers and healthcare professionals. A survey for a care manager was received from a relative. It was advised at the site visit that the surveys had not been sent to the relevant professionals and so no information was available from these sources A number of staff were spoken with throughout the day. A tour of the premises was undertaken and records, policies and procedures were sampled. The manager and operations manager was also present for the most part of the site inspection. The outcomes of the site visit were fed back in detail and discussed with the manager and operations manager and opportunity was given for clarification where necessary. The assistance provided by all of those involved in this inspection was greatly appreciated. What the service does well: One resident spoken with said “this is the best place I’ve been to so far, its great here, and all the staff know my name.” Residents are formally assessed prior to admission so that care staff are able to meet the needs of the prospective person. Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 6 Rapport between staff and residents was observed to be positive. A comment about the staff in a survey was “there are a couple that seem to have limitless patience and nothing is too much trouble, a pity this doesn’t happen throughout” and other person said, “Carers are all very kind”. Visitors to the home are made to feel welcome. Food provided to residents is of good quality and comments from residents relating to meals provided were positive. There was a varied menu and various alternatives are available if required. Residents spoken with during the inspection were satisfied with the home environment and their personal space. There is a safe system in place to safeguard individual’s monies. What has improved since the last inspection? What they could do better: Every resident needs to have an individual plan of care in place on admission that includes all their care needs and preferences and clearly shows staff how these are to meet on a day to day basis. These care plan need to have up to date risk assessments to help staff keep residents’ safe and well. Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 7 The manager needs to continuously monitor staffing levels and deployment to make sure that residents’ needs can be met by the staff on duty. A survey question on how the home could improve noted “ more staff at teatime and nights”. Staff need to have proper induction training so they can know about the needs of residents and how to meet them. A comment from a survey stated “ the staff do their very best and it is appreciated, they can’t improve without the backing of senior management.” There needs to be much more attention given to improving parts of the premises and keeping the standard of decoration at a reasonable level to ensure all residents live in nice surroundings. A survey included the view “the bedrooms need to be decorated”. Attention should also be given to the positioning of call bells so that residents have every opportunity to call for assistance when they need it. Dignity should be better considered with appropriate locks fitted to toilet doors. 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. The summary of this inspection report can be made available in other formats on request. Mundy House Care Centre DS0000018098.V367059.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 Mundy House Care Centre DS0000018098.V367059.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People thinking of living at Mundy House can generally expect a full assessment of their needs prior to admission to ensure these can be met. EVIDENCE: Surveys from people who use the service indicated that they felt they had received enough information about the home before they moved in. A service user guide and statement of purpose were readily available. The service user guide told people about the availability of inspection reports, included recent views from customer surveys, and provided a good range of relevant information, including how to make a complaint. It had limited information on the relevant qualifications of the care staff. The statement of purpose had some good detail about Mundy House in parts but other parts of the document were general to all the organisation’s homes. It could give people clearer information on the qualifications of staff working at Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 10 the home, explain more clearly that the home does not provide nursing care and tell people about reviews of their plan of care. Assessment records were reviewed for four recently admitted residents to look at whether the manager had carefully considered all the person’s needs so they could be sure they could be met by Mundy House. All files sampled showed that a senior care staff member of Mundy House had undertaken preadmission assessments, although in two cases there was limited personal detail information recorded and one was undertaken on the same day as admission. Formal assessments had been included regarding dependency levels, moving and handling, skin/pressure area viability, nutrition and continence. It was also noted that an assessment of the person’s needs undertaken by social services was available to provide a wider range of information to enable staff at Mundy House to assess if they could meet the person’s needs. There was no evidence to show that written confirmation is provided to the individual to confirm that, based on their assessment, the home can meet the person’s needs. The service user guide stated that everybody will be provided with a contract. The contract, or statement of terms and conditions, tells people what facilities and services they can expect and what their responsibilities are while they live at Mundy House. In their Annual Quality Assurance Assessment completed in February 2008, the manager said that one of the ways they had improved in the past twelve months was that contracts were now being distributed to residents. Two service user surveys stated that they had received a contract, while two people had not and one person said they had discussed this twice but nothing had happened. Files sampled showed that while a contract was available for the person’s care between the funding authority and the organisation, residents did not have direct information on their terms and conditions from Mundy House. Mundy House offers intermediate care for up to nine people in a separate unit. This is additional support for people who need it for specific time periods. At the time of this site visit Mundy House was providing intermediate care for eight people. Mundy House Care Centre DS0000018098.V367059.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. 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 using available evidence including a visit to this service. Although there are generally positive care outcomes for residents, shortfalls in care planning, risk assessing and some aspects of medication management means that residents cannot be assured that their needs will always be met. EVIDENCE: In the Annual Quality Assurance Assessment the manager stated that according to assessment, they complete a detailed plan of care identifying all needs required by the individual and that they now had a detailed care plan for every individual. Care files for six residents were reviewed to see if the home document all the person’s needs and how staff are to meet them in day to day practice, and in a way the is safe and takes the person’s preferences into account. We included people on short or long term stays at Mundy House. It was disappointing to note that there was no care plan or risk assessment/ safe working practice assessments in place for one resident who had been in the home for a few days. The person’s assessment said they had severe short term memory loss, so at times would be unable to make their needs known to Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 12 staff if required. As a result of this the manager was issued with an Immediate Requirement. It was noted positively from the daily care notes that attention had been sought for the person’s healthcare needs and there had been visits by both the GP and the District Nurse. There were also records available of the person’s intake of fluids and nutrition, which is again good practice. Care notes about how the residents spent their day and the support provided by staff varied in quality and were not always recorded daily. Some needed to provide more detail, for example for one person the only recording for two days was the word ‘wandering’. There was concern expressed to the manager that where care staff had reported a resident in pain and documented this, the action taken to address this by senior care staff was not appropriately timely. Care plans were in place for the other people sampled and contained some good information/practice in parts, including for example people being weighed regularly and fluid and nutrition charts being maintained to help monitoring where poor appetite and a history of weight loss was known. Other aspects did not reflect fully individual’s needs in respect of their health and welfare, identify changes or risks that may have potential adverse affects on this and how this impacts on their daily life. Examples included where one person who had a formal diagnosis of dementia had no care plan specifically relating to their dementia and how this impacts on their daily life and those around them, for another person no full falls risk assessment and no update to the initial assessment following a recent serious fall, and no explanation of why bedrails were in place for another person. Also noted was a resident who had a pressure sore, and while a care plan was in place it did not refer to day to day management by staff or any intervention by the district nurse, which was later confirmed with a district nurse on site. The manager advised that the current review of all the care plans would be completed by the end of July 2008. Senior care staff have been allocated to participate in this but not all have had appropriate training. All four resident surveys received indicated that they usually received both the care and support and medical support they needed. However, one comment was “I keep asking for fingernails to be cut and cleaned” another comment was “..do not always follow through with what they say they will do..”. Residents spoken with during the site visit and who were able to clearly express a view were satisfied with the level of care and support provided to them. Another survey noted “They look after (resident’s) needs more than we could if (they) were at home, that is day and night..” Residents spoken with confirmed that they feel their privacy and dignity is respected and one person said “staff always knock at the door”. A carer was observed to adjust a resident’s clothing for them to cover them and promote their dignity. Staff were also noted to speak to residents by name and with respect. However, it was noted that one staff member called out loudly to another in the main hallway “ are you free to toilet (resident’s name) now”, this practice should be reconsidered as it is not dignified for the resident Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 13 concerned. Other issues are noted in this report referring to this include ensuring toilet doors have locks, offering able residents the opportunity to sign their own care plans, providing people with a reasonably decorated living environment and where appropriate the opportunity to lock their room when they leave it. A pharmacist inspector inspected the practices and procedures for the safe use and handling of medication. All areas where medicines are stored were secure but the temperature in all areas was above the recommended maximum of 25C, this was despite there being an air cooler unit in the ground floor storage room. The temperature of this room is monitored and recorded each day and shows it is consistently at or above this maximum. The temperatures in the other areas, The Lodge and ICU are not monitored or recorded but were above this on the day of the inspection. The failure to store medication at the proper temperatures puts residents at risk of receiving medication that may be ineffective. Controlled drugs were being stored in a separate cupboard but this was not one that complies with the relevant Regulations. Records of controlled drugs were adequate but there is a need to zero the recorded balance in the register when such medicines are disposed of. Records were kept of medicines received into the home and of those disposed of, but there were some medicines held back which had been recorded as being disposed of ten days earlier. There are regular stock counts to reconcile medication in use with the records and this should continue as good practice, but not all medication could be reconciled correctly. In some cases the amount of medication found was more then there should have been and in others there was less. There were a few gaps in the records made when medicines were given and so it was not always clear whether the residents had their medicines or not. In a few cases a medicine which should not be given at the same time as other medicines, is recorded as being given at the same time; although care staff confirmed that it was given at the right time. Some of the hand-written medication charts did not clearly indicate the month and year of use. This raises questions about the accuracy of the records made when medicines were given to residents. Only suitably trained staff give medicines and the standard of training is good. We observed medicines being given to residents by two care staff at lunchtime and this was done with due regard to people’s dignity and personal choice. Mundy House Care Centre DS0000018098.V367059.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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 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. Residents can expect opportunities for social activities and to exercise choice in areas of daily life, including meals, that are in some ways more readily available to more able residents. EVIDENCE: The opportunity for residents to have relevant activities and social interactions was reviewed. Residents spoken with and able to exercise choice and independence were satisfied with the activities available or the choice not to participate in them. One person said “I can do as I like, read the paper, sit in the garden, go to my room to watch television, I don’t join in the activities as they don’t appeal to me, although the list is up if you want to read it and pick something”. Another person said “I can do as I please, make tea or a sandwich and do as I please. I can go and join in activities but prefer to stay to stay up here”. Residents spoken with said their visitors were welcomed into home. An activity program was displayed that included nail care sessions, one to one reminiscence sessions, bingo, quiz, crafts and movement and stretch sessions. The activity coordinator was on duty and the Annual Quality Assurance Assessment advised of an increase of 15 hours in their post. Residents were Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 15 taken into the garden, some residents were taken out for a shopping trip, a ball game was played, a black-and-white film was shown in the afternoon in one of the lounges. They now have a bimonthly outside entertainers coming in and outside trips are also planned. There was a weekly religious service in the home every Sunday. One person said they would like a visit from a representative of their own faith and were unaware this could be arranged as stated in the service user guide. Care plans to support effective meeting of peoples social care needs were limited in detail. Three of four resident surveys received said there are only sometimes activities arranged by the home that they can take part in. There was less evidence of opportunities for more highly dependent residents or for those living with dementia or communication difficulties. However, some good quality interactions were observed between staff and residents including those in the small higher dependency lounge. One survey said “residents need taking out more. Some, without relatives tell me they never go out, that’s very sad”. Residents confirmed they were able to make choices about where to spend their time, what and where to eat, what to wear and times for going to bed or getting up. Staff spoken with were less clear on the active choices available to less able residents and how these were supported. Residents are asked for their food choices the day before. Where memory loss is an issue for some people this may not promote positive decision-making. Clearer information for people on the choices available is also an area that could be developed such as having large print/pictorial formats for menus and activities available. Residents spoken with were satisfied with the food provided at Mundy House. One person said “there is plenty, you can have what you like”. Another person said “the food is quite nice, there is plenty of it and it is hot enough”. Information in resident surveys showed that most people usually enjoyed the food and one person commented “the food is very good, well prepared and a very friendly kitchen staff”. A member of the kitchen staff was particularly observed to speak to residents with respect at the end of the lunchtime meal, asking them if they were finished before removing their plates and asking if they had enjoyed their meal or had had enough. Residents in the main lounge ate in pleasant surroundings and with nicely set tables and supported by two care staff and appropriate equipment. They did not have jugs of juice available on the table at lunchtime and this should be considered, particularly for those residents who would be able to manage this to respect choice and independence. Some residents were observed to have their meal in the small lounge, they were well supported by two care staff. Drinks were noted to be offered during the day and recorded for a resident cared for in bed. This was considered particularly as it was an issue raised in a recent complaint. Some residents had drinks close by them while in one lounge the jug of drink was at the far end of the room. Some staff worked Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 16 harder than others to encourage residents to take fluids, particularly as it was an especially hot day. During the afternoon drinks round in the main lounge a staff member was observed to ask residents if they would like a cup of tea and if they would like sugar in it, which is positive and respects individuality. The choice to have coffee could be routinely offered to people who may sometimes feel like a change. Mundy House Care Centre DS0000018098.V367059.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. 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. Residents can expect to be listened to and to be safeguarded by staff knowledge and responsive systems. EVIDENCE: Information on making complaints was displayed in the foyer near to the visitors signing in book. It was recommended that this be produced in a larger font to be clearer and more accessible, and to have clearer information on peoples right to contact the local authority and up-to-date contact details. Two completed resident surveys said that they would not know how to make a complaint. A number of thank you cards and letters were displayed. These were mainly from people who had received respite care or from relatives of residents who are no longer at the home thanking staff for the care given. The Annual Quality Assurance Assessment stated that complaints received by the home are taken very seriously, thoroughly investigated, responded to promptly and there is an open door policy for family or resident to raise any concerns. A complaint folder was available that showed one completed complaint investigation and one currently being investigated. Records showed that the first issue related to inappropriate refusal to admit to a resident, had been Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 18 responded to promptly and appropriate action taken. The second more recent complaint was advised as currently being investigated by the manager of another home. It alleged that a resident had been left in their room without being taken out for social interaction since their admission, that relatives were unable to get assistance for a residents personal care when needed as they were told this would require hoisting, and that staff refused to take the resident into the garden as this would mean a member of staff would have to stay with them. A further complaint had been investigated and some aspects of it referred to the safeguarding team, from whom no outcome has yet been received. The commission was aware of this complaint that related to access to the call bell, food and drink for a person cared for in bed, high staff turnover and a failure to respond effectively to concerns raised. Three separate safeguarding issues had been referred to the safeguarding team and are currently being investigated. One related to financial abuse, one related to inappropriate administration of medication at the third to poor care and hygiene including the call bell, food and drink being left out of residents reach. The commission will monitor the outcomes of these investigations and consider if it needs to take any further action. The manager and operations manager had acted appropriately in reporting issues above known to them and in taking appropriate action to safeguard residents, including suspension of staff. They were clearly aware of appropriate procedures for managing safeguarding referrals from their recent experience of using these, and a current copy of the local guidance was available. A new system for managing residents finances had been introduced. New procedures had been introduced in relation to auditing and storage of returned medications. Observation of the day of this site visit showed that people cared for in bed were regularly given drinks and staff interventions. It is recommended that a review of access to call bells and staffing levels is undertaken, along with monitoring of care staff interventions for people cared for in bed by senior carers each shift is implemented to ensure good quality care outcomes at all times. The staff training matrix showed that the majority of staff had attended training on protecting and safeguarding vulnerable adults. Protecting vulnerable adults was discussed with three staff, including one who had not yet had the training. All were aware of different types of abuse and stated that they would report any concerns immediately to their manager, or a higher person in the organisation if this was necessary. Mundy House Care Centre DS0000018098.V367059.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Mundy House will find an environment that is clean and has plenty of communal space but where the décor is tired and shabby and their dignity and privacy may not always be respected. EVIDENCE: In the Annual Quality Assurance Assessment the manager said that there had been some redecoration and this was seen in the entrance hall and corridors, which had been re-carpeted, and that this would continue. The manager also acknowledged that the standard of decoration in the home is an area where they could improve and identified also that new furniture is to be provided in the lounge and dining room. Two resident/relative surveys noted that there is a need for further and more timely decoration/refurbishment of the home. The recent appointment of a maintenance person is expected to improve this. Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 20 It was noted that the décor in one downstairs toilet area was very shabby with wallpaper missing or peeling off the wall. One toilet cubicle that faced onto a corridor did not have a lock fitted on the door. This does not respect the privacy or dignity of the people living at Mundy House. Bathrooms were not particularly homely. Assisted bathing facilities were available but there is no shower facility available throughout the home should this be a preference for any resident. Minutes of a residents meeting show that this has been requested but no action has been taken to respond to this. The change noted at the last inspection of using one large downstairs room as a separate dining room continues to be a good arrangement, allowing better supervision of residents. Residents in different areas of the home, such as The Lodge confirmed that they have ample communal space. Residents in the intermediate care unit have their own dining room and lounge upstairs. During the day, residents were seen to access and use the garden, which had recently been upgraded and a resident said they liked to “sit and read the paper there”. Residents spoken with said they were satisfied with their rooms describing them as ‘comfy’ or ‘nice’. Many bedrooms were personalised and had the resident’s choice of pictures, photographs and small pieces of furniture to make them feel more familiar and homely. Some rooms needed decorating and refurbishing to some degree to make them more a pleasant place for people to spend their time. Resident rooms viewed showed the people could lock their bedroom door while using their room, which is positive. However, only a limited number of residents had active choice of having a key to lock their door while they were ‘out’ to support their right to privacy and dignity. Due to where beds were positioned in some bedrooms, people would be unable to call for assistance from their bed if they needed it, because the call bell points/extension cords were inaccessible. This was an issue identified in a recent complaint made about the care at Mundy House and needs to be addressed. Some people also had no access to turn on a light from, or before getting out of, bed should they wish to and to possibly prevent trips and falls. Additionally, it was noted that residents do not have access to call bells in the downstairs lounges, should they need to call for assistance for themselves or others. It was noted on different occasions, that while staff supervise these areas much of the time, there were several periods during the day when there were no staff present. Staff spoken with confirmed this occurs and advised that they would be supporting people with personal care, or on their break etc. Some odours were noted in the home on arrival but these were not present throughout the rest of the day. The Annual Quality Assurance Assessment states that the housekeeper has a well maintained cleaning structure and the premises were observed to clean. Mundy House Care Centre DS0000018098.V367059.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. 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 using available evidence including a visit to this service. Residents can expect a level of staffing/staff deployment that could on occasions restrict the ability of the service to fully deliver person centred care and to ensure that peoples’ needs can be met. EVIDENCE: Staff spoken with confirmed the manager’s information that the current staffing levels are a minimum of nine staff each day, including two senior care staff, for the current number of residents (fifty). While dependency levels are assessed at admission, the manager said they do not use these on which to base, and vary, staffing levels to ensure they are adequate to meet resident needs. The manager stated that more half the current residents require the assistance of two staff for all their care and transfers, including all the people in the intermediate care unit. Care staff spoken with said there were times when they were unable to supervise residents and also that they had little time for one to one interaction with them. Two staff are allocated to the intermediate care unit, one to The Lodge and the other four cover the downstairs lounges. Seniors were seen to spend much of their time administering medication, dealing with visiting professionals etc, particularly during the morning when there was no management support. A survey comment was “some carers don’t have enough time for the residents. If a resident is not under their remit they Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 22 have held back about seeing to their personal needs and I find this quite distressing. Another comment was “most of the staff are excellent and very caring. Things do sometimes go wrong when they are under pressure, i.e. short staffed at weekends etc.” Three resident surveys indicated that staff were usually, but not always, available when they needed them. One person said they were sometimes available and added the comment “sometimes ..there are no staff available, they have all gone to a meeting or they are all on a tea break.” Two people also said that staff may or may not listen and act on what is said, “do not always follow through.” The last inspection report required that staffing numbers be sufficient to meet the needs of residents . Generally staffing levels were considered adequate, but were clearly stretched at times of breaks and ‘busy’ times such as getting people up in the morning and just before and after meals where people needed assistance with using the toilet or getting from one room to another and so were not adequate to meet resident at all times. One staff member said that when they are short staffed it is not right that they end up getting the last resident up at 11am. The manager and operations manager advised that there were high sickness levels at the home that needed and would be addressed, as while agency staff are brought in, there may be a delay before they can get to the home for that shift. Staffing levels need to be regularly reviewed to reflect resident dependency levels so that residents’ needs can be met. Residents spoken with privately commented positively about the staff with comments such as the staff are really nice here. The dataset information in the Annual Quality Assurance Assessment shows that of the 32 permanent care staff employed four have achieved NVQ level 2 or above and 10 staff are working towards this. The manager states one of their plans for improvement in the next 12 months is for at least 50 of the care team to have either achieved or enrolled in NVQ level 2. Recruitment files were reviewed for four staff recruited since the last inspection to consider if the home had undertaken the appropriate checks and reference in a timely manner to safeguard residents. The files were well organised. One contained all required documents, two did not contain a photograph of the person to confirm identity and the other did not contain a full employment history with recorded dates, so that the manager could be sure where the person had worked and when. This is an outstanding issue from the last inspection and does not comply with the information in the Annual Quality Assurance Assessment that all checks are undertaken before employment is commenced. Original criminal records bureau checks were not on file. However, information was available confirming that these had been done for each individual and a Povafirst check was also available. Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 23 The statement of purpose and Annual Quality Assurance Assessment stated they have a robust induction programme that is completed by all new staff. Induction training is necessary when staff start working at the home to help them to understand all areas of peoples’ care needs and other aspects that will enable them to care well and safely for people. While the manager confirmed that the organisation do now have an induction programme based on Skills for Care Standards, no evidence of induction was available for two staff selected and the induction had not been properly implemented on the third person’s file. It is positive that the manager confirmed that all new staff would now have a supernumerary period for two weeks where they shadow an experienced member of staff to learn about their role and standard of practice required from them at Mundy House. The statement of purpose provided limited information on the qualifications of staff working at the home to show interested people whether staff had the training necessary to provide appropriate care and promote resident well being. The manager provided a matrix that shows the majority of care staff had had training on all the basic subjects such as fire safety, moving and handling, food hygiene, health and safety, protecting vulnerable people, infection control, nutrition and dementia awareness, and that updates are routinely provided. Training on other aspects was also noted for various staff including in relation to first aid, bedrail safety, customer care, safe handling of medication and managing challenging behaviour. Certificates were found on six staff files sampled that confirmed the information in the training matrix. Mundy House Care Centre DS0000018098.V367059.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A period of stability is needed to develop and strengthen all aspects of the management systems to ensure residents’ best interests are met. EVIDENCE: Mundy House has seen a period of unsettled management. This was commented on in a resident survey when asked if they knew who to speak to if they not happy. The appointed manager was on suspension and the deputy manager was covering the role of manager and is referred to in this report as the manager. The manager advised that they had 20 years experience in care environments and had completed NVQ level 4 and were awaiting verification. The manager advised that they have had a lot to learn and deal with initially, and remain in a temporary role and so have not caught up with everything, for Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 25 example quality assurance surveys and staff inductions, but are ‘getting there’ and had had good support from the organisation. The manager stated that the organisations’ quality assurance was not in use at Mundy House and they had not yet undertaken any survey of residents, relatives and professionals to gather their views on the service to see how it could be improved or what worked well. However, they confirmed that this will be undertaken. There are also plans for any member of staff are seen not to be working to a high standard to be mentored by a senior member of the team until they feel that they are experienced and knowledgeable working within their remit, as a way of supporting quality in practice. The Annual Quality Assurance Assessment confirms that changes in menus and activity coordinator hours had taken place following resident comments. A new system to manage resident finances had been introduced following the safeguarding investigation into the theft of residents’ money. Individual money wallets were no longer maintained. Instead, a cash float was made available so that residents had access to their cash as they require, although this is restricted evenings and weekends as only the manager and the administrator have access to the key. Receipts were provided for all money received from relatives and were available for all money paid out on behalf of residents for example for hairdressing or chiropody. All money paid in was deposited in a single bank account that paid interest, which the manager advised was appropriately allocated to each resident. Details records were maintained on computer, receipts were issued by the administrator for each outgoing and these were kept in individual wallets for each resident. The system audits/ reconciles the accounts balances and identifies if these do not reconcile. The system is constantly also accessible to head office for monitoring purposes. A system was in place for staff to have one to one supervision meetings to look at any issues staff had, identify training needs etc and so support them to provide a good quality of care to meet people’s needs effectively. Supervision had not been provided routinely on the staff files sampled and was provided by staff who had not had training in how to do this properly. It was discussed with the manager that the records showed a one sided agenda that did not show that the sessions were supporting staff to their best potential. The Annual Quality Assurance Assessment stated that the manager carried out quality audits on a monthly basis to ensure a good service is being delivered. In discussion this was confirmed at being 19 audits over the service including for example accidents, medication, and the premises. Records examined show that appropriate maintenance checks were carried out and a range of certificates relating to Health and Safety were examined, including the lift, call bell system, legionella, fire equipment, hoist and gas installation. Records showed that regular checks were carried out on the hot and cold water temperatures. A record showed monthly fire drills and an improvement was noted whereby all attendees of the drills were recorded. Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 26 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 2 2 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 2 X X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)d Requirement The home must confirm in writing to each prospective resident that, based on their assessment, they are able to meet the person’s needs in respect of their health and welfare so that people can be reassured their needs will be met. Care planning at the home must identify, and be effective in meeting all residents’ assessed needs and give staff clear instructions on how to apply these in daily practice to ensure that residents get the care they need and in the way they prefer. Risk assessments must be devised for all areas of assessed risk so that risks to residents can be minimised and health and well being promoted. Residents must be protected by having medication stored under suitable environmental conditions and in line with DS0000018098.V367059.R01.S.doc Timescale for action 01/08/08 2. OP7 15(1) 01/08/08 3. OP8 13(4) 01/08/08 4. OP9 13(2) 01/08/08 Mundy House Care Centre Version 5.2 Page 28 current legislation. Previous timescale of 30/08/07 not met. 5. OP9 13(2) Records of medicines received, administered to residents and disposed of must be accurate and complete. This will show residents receive the medication prescribed fro them. Previous timescale of 30/08/07 not met. 6. OP19 23(2) To respect residents’ right to live in a pleasant and wellmaintained environment, the premises must be refurbished and redecorated in a timely manner. Staff must be employed in sufficient numbers to meet the needs of the people who live at the home. This is an outstanding requirement. 8. OP29 19&sch.2 &4 People must only be employed at 01/08/08 the home once all of the checks as required by regulation have been carried out so as to ensure that they are fit and suitable to care for older people. This requirement is outstanding in part. 9. OP30 18(1) (c) staff working at the home must receive the training and support they need, including induction training so as to fulfil their roles according to their job descriptions and meeting the needs of the people who live at the home. DS0000018098.V367059.R01.S.doc 01/08/08 01/10/08 7. OP27 18 01/08/08 01/08/08 Mundy House Care Centre Version 5.2 Page 29 This requirement is outstanding in part 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 OP1 Good Practice Recommendations So that people wishing to use the service have access to all relevant information to help them make a choice about living there, the statement of purpose and service user guide should include more/clearer detail as identified in this report. So that people have all the available information, all residents should be given a statement of terms and conditions on their admission, telling them what care and services they can expect during their stay at Mundy House and what their responsibilities are. So that residents’ dignity is protected staff should not discuss the person’s needs in communal areas. The availability off suitable pastimes and meaningful activities should continue to develop for all people residing at the care home so that their social care needs are met and to ensure they have stimulation to promote their wellbeing. Information should be made available to residents in a way that they may best understand, for example with menus and activity plans so that people have the best opportunities to make choices. So that residents retain as much independence and choice as possible staff should ensure they are provided with choice at all opportunity, including for example to choose and pour their own drinks at lunchtime or to have DS0000018098.V367059.R01.S.doc Version 5.2 Page 30 2. OP2 3. 4 OP10 OP12 5. OP14 6. OP14 Mundy House Care Centre alternatives offered as routine at other times. 7. OP16 So that people know how to raise concerns the complaints procedure should be produced in a way that is easy to see and understand and should have up to date information. So that residents’ needs and preferences are met, the registered provider should consider providing a user friendly shower facility as requested by a resident. To respect residents’ dignity and privacy, all toilet and bathroom doors should be fitted with appropriate locks. A minimum of 50 of care staff should achieve NVQ 2 training to support them to develop their knowledge and better care for residents. A permanent manager should be appointed and registered with the commission to ensure effective and consistent management of the home for the people living there. So that the views of people using the service can be obtained and used to improve it, the registered provider’s quality assurance system should be fully implemented in the home and stakeholders views sought more robustly. To support staff and monitor effective practice all staff working at the home should receive regular supervision. 8. OP21 9. 10. OP21 OP28 11. OP31 12. OP33 13. OP36 Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Mundy House Care Centre DS0000018098.V367059.R01.S.doc Version 5.2 Page 32 - 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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