Inspection on 03/03/10 for Mundy House Care Centre

This inspection was carried out on 3rd March 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mundy House Care Centre 06/04/09

Mundy House Care Centre 24/06/08

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 18/06/2010.

Key inspection report Care homes for older people Name: Address: Mundy House Care Centre Church Road Basildon Essex SS14 2EY     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Bernadette Little     Date: 0 4 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Mundy House Care Centre Church Road Basildon Essex SS14 2EY 01268520607 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): mundy.house@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 65 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Personal care can be provided for up to a maximum of three service users with dementia. Personal care to be provided for older people aged over 65 years. The total number of service users for whom personal care can be provided shall not exceed 65. Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 37 Over 65 0 65 3 0 Brief description of the care home 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 manager advised at this key inspection site visit that the current contracted fee is £453.11 per week. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service was undertaken on 6th April 2009. This routine unannounced key inspection site visit was undertaken by two inspectors over a nine and three quarter hour period on the first day. Time was spent with residents, visitors, staff, the manager and link manager and information gathered from these conversations as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. Additionally progress made against previous requirements and recommendations from the last key inspection was also inspected. In response to observed continued breaches of Regulation relating to care planning and risk assessing documents were taken as part of Code B of the Police and Criminal Evidence Act 1984. The two inspectors returned to Mundy House on 4th March 2010 to gather further information. We are now considering enforcement action. Care Homes for Older People Page 6 of 37 Additionally, a specialist pharmacist inspector reviewed medication management at the home on 23rd March 2010. The manager submitted an Annual Quality Assurance Assessment (AQAA) as required by law prior to the site visit. This is to detail their assessment of what they do well, what has improved and what they plan to do better. The AQAA contained a basic level of information that was considered as part of the inspection process. Prior to the site visit, we sent the manager a variety of surveys to distribute to residents, relatives, staff care managers and health professionals. Subsequent to the site visit, surveys were received from four residents and one staff member. The information provided and comments made are included in this report. A tour of the premises was undertaken and records, policies and procedures were sampled. The manager was present during the site visit along with the link manager and both assisted with the inspection process. The outcomes of the site visits were fed back and discussed with the manager and link manager and opportunity given for clarification were necessary. The assistance provided by all those involved in this inspection process is appreciated. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? The home has written to prospective residents to tell them that based on their assessment, the home can meet their needs. There are better opportunities for residents to be involved in social activities and stimulating occupation appropriate to their individual needs. Staff were observed to be more available to residents and to interact with them more. It was easier for residents to call for assistance when needed and cords were in place making the call bell system more accessible. The equipment in the laundry was working properly and the laundry room had been deep cleaned helping to promote better cross infection management. Recruitment files sampled showed that all the references and checks required had been undertaken to ensure that prospective staff are suitable people to work with residents and so better safeguard people living in the home. A system was in place to seek the views of residents and a very recent audit had been undertaken to enable the registered provider to monitor the quality of care provided at the home. Records were securely stored at this site visit, promoting residents right to privacy and complying with legislation. In addition to the above requirements from the last inspection report being met, a number of recommendations had also been implemented by the registered provider. These include improving the hot water system to make sure it is adequate to meet the needs of residents, arranging for the installation of a user-friendly shower facility as requested by a resident and toilet doors being fitted with effective working locks to demonstrate respect for peoples right to privacy and dignity. The statement of purpose and service user guide had been amended to include more Care Homes for Older People Page 8 of 37 information and resident files sampled contained a copy of the terms and conditions of their admission. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of living at Mundy House can expect to have an assessment of their needs to make sure that the home can meet them and will be given enough information on which to base their decision to live there. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Admissions are not made to the home until a full needs assessment has been undertaken. In addition where appropriate, supplementary information is provided by the persons Placing Authority or Primary Care Trust. Records showed that formal assessments are also completed in relation to dependency, moving and handling, pressure area care, nutrition and continence. Consideration must be given to ensuring there is evidence to show that the prospective resident and/or their representative is involved wherever possible in the pre admission assessment process as it was unclear from the records examined of their involvement and participation in the process. Care Homes for Older People Page 11 of 37 Evidence: On inspection of the care files for the three newest people admitted to Mundy House, records showed that a pre admission assessment had been completed for each person by the care manager or senior carer and prior to their admission to the home. There was evidence to show that the information recorded was informative and detailed. Records showed that arrangements and opportunity were given for the prospective person and/or their representative to visit the home prior to admission and a letter from the manager was on each persons care file confirming that the home could meet their needs. One relative spoken with at the time of the site visit confirmed they had visited the home prior to their member of familys admission and had been provided with a copy of the homes Statement of Purpose. Another relative confirmed they had not visited the home or received a copy of the homes Statement of Purpose and Service Users Guide prior to their member of family being admitted to Mundy House as they had been unaware of the move to the care home from another establishment and not notified by the Local Authority until the move had occurred. However they stated they were happy with the care and support their member of family was receiving since their admission to Mundy House and that all efforts were made by the staff team to ensure that their member of family had settled into the care home. We spoke with one of the residents case tracked and they confirmed that the admission process had been smooth. Three of four surveys received from people using the service confirmed that they had received enough information to help them decide if this home is the right place for them before they moved in. On a tour of the premises and out of 16 residents bedrooms inspected, all were noted to have a copy of the homes Service Users Guide. The statement of purpose and service user guide were not dated to show when they had last been reviewed but do have up to date information about the current manager and representative of Southern Cross. They have clearly been updated as recommended in the last inspection report and no longer contain references to nursing, as Mundy House is registered for residential care. The service user guide also tells us that it is available on audio cassette should this be more appropriate for a persons individual needs. Care Homes for Older People Page 12 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in management of risk and care planning as well as an aspect of medication recording mean that all residents cannot be assured that all of their needs will be met. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. In addition to the care plan, formal assessments are completed in relation to manual handling, nutrition, pressure area care, continence and dependency levels. Of those people case tracked, each person was observed to have a plan of care and these were devised from information undertaken as part of the pre admission assessment and from other associated information provided by other stakeholders. As part of the inspection process we looked at 5 peoples care files (3 in full and 2 in relation to specific healthcare needs). Out of 5 care files randomly sampled only 1 was seen to contain all necessary information. Records showed that compliance to meet previous regulatory requirements relating to care planning and risk assessments had not been achieved and insufficient Care Homes for Older People Page 13 of 37 Evidence: improvement found. Not all areas of assessed need were recorded within a plan of care and risk assessments were not devised for all areas of assessed risk. Where the persons care needs had changed, the plan of care and/or risk assessment had not always been updated to reflect the persons current care needs. This means that records may not be accurate or reflective of the persons current care needs and staff working within the home do not have the most up to date information. From discussions with staff it was evident that while the care and support to people living at Mundy House is intuitive, there were inconsistencies with some aspects of staffs knowledge and understanding relating to individuals specific care needs. Staff also told us that there is no system to manage reallocation of care plans to other senior staff while they are on holiday or sick leave to make sure they are reviewed and kept up to date. As a result of concerns and continued failure to comply with regulatory requirements by the given timescales as recorded within the last key inspection report of April 2009, copies of documents were taken under Code B of the Police and Criminal Evidence Act 1984 and we are now considering further enforcement action. Three of four surveys received from residents stated that they usually get the care and support they need while one person indicated they always did. Three surveys showed that people always get the medical care they need and one showed that they usually did. The survey received from a staff member told us that they are sometimes given up-to-date information about the needs of the people they support and care for, that some seniors are not thorough enough and that the way they share information about residents care needs within the home only sometimes works well. Records showed that people living at Mundy House have access to a range of healthcare professionals and services as and when required. These include District Nurse Services, GP, Optician, Dentist, attendance at hospital appointments, Parkinsons Nurse and Dietician. Of those people case tracked, professional visitors records were available outlining visits/appointments and the outcomes of interventions provided where these had been requested by staff. Staff interactions with people who live at the home were observed over a 3 hour period to be much improved and positive. Where support and assistance was provided by staff in relation to individuals personal care, this was conducted with respect and sensitivity. In addition staff presence within the lounge areas was more prevalent so as to provide support and assistance in a timely manner. People living at the care home were observed to enjoy the interactions by staff and the rapport between residents and staff was seen to be positive. Care Homes for Older People Page 14 of 37 Evidence: On a tour of the premises (first day of inspection) and from inspection of 16 peoples bedrooms, prescribed creams and ointments were easily accessible for 6 people. However when a specialist pharmacist inspector visited the home on 23rd March 2010 this issue had been addressed and no prescribed creams and ointments were found to be easily accessible. Practices and procedures for the safe use, handling and recording of medicines were examined by a pharmacist inspector on 23/03/2010. Medicines are stored securely for the protection of residents in areas which are temperature controlled to maintain the quality of medicines in use. Dedicated refrigerators are used for those medicines needing cold storage and although the temperatures of these were acceptable and are monitored and recorded, only the current temperature is recorded not the maximum or minimum the temperature has reached during the recording period as is good practice and required by the homes own policy. We expect this to be managed by the home rather then make a requirement on this occasion. We looked at the records made when medicines are received into the home, when they are given to people and when they are disposed of. In general these were in good order with very few discrepancies. The records account for medicines in use and demonstrate that people receive the medicines prescribed for them. The discrepancies found had already been picked up by the homes own audit processes and action taken to address these. This is good practice. However, we found that where people are given medicines at times different to those printed on the medication record forms, the actual time it is given is not recorded. This could mean that people receive medicines too close together. We also found this on our last inspection in April 2009, and expected this to be managed by the home. As it hasnt been we have now made a requirement about this. We looked at care plans for medication for a few people and these were in good order, listing the medication they are prescribed. We saw that appropriate risk assessments are in place where people use medicines in their rooms. Medicines are given to people by suitably trained staff and this is backed up by training and supervision records. We watched some medicines being given to people at lunchtime and this was done well with regard to their privacy, dignity and personal choice. Care Homes for Older People Page 15 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to have their social care needs met and to receive a varied diet. Evidence: An activities co-ordinator is employed at Mundy House for 35 hours per week Monday to Friday, however we were advised that these hours are flexible to cover weekends, evenings and special events. The activities co-ordinator has been in post at Mundy House for the past two and half years. The home is registered with NAPA (National Association for Providers of Activities for Older People) and the activities co-ordinator regularly meets up with other activity co-ordinators from within Southern Cross Healthcare to share ideas. A newsletter is compiled and distributed every 6-8 weeks. This includes information relating to people who have newly been admitted to Mundy House or who have left or passed away, the outcome of any fundraising events, celebrations and activities and any other business. Three of the surveys received from residents indicate that the home always arranges activities that they can take part in if they want to while one person felt that this sometimes happened. An activities programme is in place for each day and includes forthcoming events. A copy of the programme is pinned to a notice board in each of the lounge areas and this is provided in a written and pictorial format. Consideration should be given to Care Homes for Older People Page 16 of 37 Evidence: providing this in larger print for those people who have a sensory impairment. We were also advised that a copy of the programme is provided to each person within the home and this was confirmed from a tour of the premises and a copy seen in each of the resident bedrooms examined. We looked at 4 weeks activity programme and these showed that people who live at the home have the opportunity to participate in a varied schedule which includes external activities, hairdresser, sing-a-long, bingo, listening to music, arts and crafts, film mornings or afternoons, handcare, one to one, reminiscence, games, shopping, gentle exercise, ice cream van, pat dog visit, religious observance, entertainers and baking. The activities co-ordinator has a budget for materials, bingo prizes and for funding external entertainers. In addition to this fund raising events are undertaken at Mundy House and we were advised that in 2009, flat screen televisions were purchased as a result of fund raising efforts. The home has access to a mini bus on several occasions throughout a 4 week period. Copies if the current days newspapers were displayed on table in the inner hallway and so accessible to residents. The activities co-ordinator confirmed that wherever possible she meets with the resident and their representative and from this discussion an All About Me form and life history is completed. This provides useful information about the individual residents past interests, hobbies, personal preferences and provides a snap shot of their life and family composition. We were advised that a plan of care relating to the persons social care needs should be recorded within their care file however out of 3 peoples care plans examined information was only recorded for one person. Residents spoken with confirmed in general terms that they were satisfied with the range of activities provided. On the day of the site visit several activities were observed to take place in the main lounge during the morning. This included one resident having a manicure, one resident playing Connect 4, others taking turns to look at reminiscence pictures, 2 residents painting, others completing word puzzle games, others looking at magazines and the film Mamma Mia was being shown. The only negative comment provided was that some residents felt that on occasions they did not always get to see the film ending before lunch or the teatime meal, although on the day of the site visit the film was shown in its entirety. There is an open visiting policy at the home whereby visitors can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at the home are actively encouraged and supported to maintain friendships and relationships. Relatives spoken with confirmed they can visit the home at any time and are always made to feel welcome when they visit. Relatives visiting the home were observed to have a good relationship with staff and members of the management team. People spoken with who live at the home confirmed they are Care Homes for Older People Page 17 of 37 Evidence: enabled to maintain friendships with others and to see members of their family when they choose. The lunchtime meal was observed during the site visit on both the ground and first floors. At the time of our arrival the menus detailing the choices of meals available for that day were not displayed and staff spoken with were unable to tell us the choices available. In addition we spoke with 7 residents and none of these were able to state the menu choices available. The tables were nicely laid with tablecloths, condiments, glasses, vases of flowers and serviettes. People were offered a choice of drinks and these were seen to be regularly topped up. Meals provided to people were observed to be plentiful and looked appetising and where people require a pureed/soft diet this was seen to be portioned separately. In general terms positive comments were made by residents in relation to the meals provided however the main area of discord related to the vegetables. Comments included the vegetables are awful, the vegetables are attrocious, I like my vegetables to be cooked properly and the veggies are very hard. We requested a bowl of vegetables to sample and agreed that some of the vegetables were very hard and difficult to cut and chew. This was discussed with the homes link manager and they too agreed with our findings. Where people require assistance from staff to eat their meal this was undertaken with due care, respect and dignity however one member of staff was observed over a 20 minute period to not talk with the resident throughout the time they were supported. Residents in Daisy lounge were observed to wait at least 25 minutes before their meal was served as the heated trolley containing the food first goes to The Lodge, where the staff member rightly advised that they could not rush their residents in making choices and had to serve them with respect. Staff confirmed that residents in Daisy lounge always have to wait for their meal in this way and it is considered that this could be more effectively managed. A resident spoken with told us the food is great. Surveys received from residents indicated they were generally satisfied with the meals at the home and one person commented I dont know how much the chef is paid but it is not enough. We observed during the morning teabreak that residents were offered the choice of a variety of hot and cold drinks. In addition jugs of drinks were left in the communal lounge areas for people to access. Care Homes for Older People Page 18 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be listened to but cannot be reassured that there is effective management in place to ensure that they are safeguarded. Evidence: Information on the complaints procedure was clearly displayed in the entrance foyer. While it had been updated to include the name of the new manager, the recommendation from the last inspection to clarify that complaints can be taken to social services for investigation had not been included. The link manager arranged to have this amended during the site visit. The surveys received from residents told us that there is someone they can speak to if they are not happy and that they would know how to make a complaint. The managers AQAA told us that there had been five complaints received since the last inspection, none of which had been upheld. However inspection of the complaints records found this to be inaccurate. A folder was maintained where each complaint was stored separately, which is good practice. The folder contained information on six complaints received since the last inspection. Some of these did not contain records of response. The link manager arranged for these to be printed off so the files could be updated and it was clear that they had been responded to within appropriate timescales. Full records in relation to one of the complaints were not available. The manager was advised to ensure that all records relating to each complaint should be kept together to evidence effective management and a clear audit trail. Care Homes for Older People Page 19 of 37 Evidence: There was evidence on the file that four of the complaints had been upheld, at least in part. Action had been taken by the management, in full or part, in response to complaints. These related to replacing a persons armchair, informing them of relevant changes and arranging for an area of the home to receive a proper television signal. Issues in relation to the condition of the windows in The Lodge remain outstanding and action with regard to these needs to be undertaken by Southern Cross. In light of issues observed during that site visit, the report of the last key inspection contained a recommendation that staff should be provided with training on the management of behaviour that challenges and appropriate records should be kept of incidents. During this inspection, the manager told us that they did not have any residents who demonstrated aggression or challenging behaviour and so this training had not been undertaken. Inspection of the complaints records showed that one of the complaints actioned by the current manager had related to such an incident that occurred between residents. There was evidence that the current manager had taken action in response. The manager confirmed that they had not notified the Commission of this event as required by Regulation. The Commission are aware of the other complaints, two from one source and that had subsequently been investigated by social services and the adult safeguarding team. These related to a relatives concern regarding healthcare monitoring and follow up action not being undertaken and poor management of communication regarding an incident of aggression between residents. Both of these relate to a date prior to the current manager being in post, but the manager attended the safeguarding meeting and so was aware of the concern regarding communication and care management documentation. Information has been received from the safeguarding adult team that these are now closed as the management team at the time had taken steps to improve communication and care recordings. Southern Cross have a corporate policy in relation to safeguarding adults. This is detailed, identifying the responsibilities of individual roles, the procedure for notifications, actions to be taken and documentation to be maintained. It is supported by a whistleblowing policy and procedure. Staff files sampled demonstrated that staff are provided with, and sign for receipt of, both documents as part of their induction. The staff survey received confirmed that the person would know what to do if someone has concerns about the home. The managers AQAA tells us that staff receive safeguarding vulnerable adult training. The training statistics provided by the manager at the site visit indicate that 60 of Care Homes for Older People Page 20 of 37 Evidence: staff have current safeguarding training in line with Southern Crosss own policies. This is a reduction from the 98 indicated in the information provided in April 2009 at the last key inspection. The manager confirmed that Southern Cross policy is that staff attend this training annually, however they were unable to tell us why the number of staff trained in safeguarding had reduced. The three staff files reviewed confirmed that the staff had received training in safeguarding vulnerable people since their appointment within the last twelve months. Three longer serving members of staff spoken with confirmed they had attended training on safeguarding previously, were aware of what constituted abuse and said that they would report it to the care manager (deputy manager) or the homes manager. The manager told us that they had last attended training on safeguarding in 2003. The link manager also added that the manager had attended training on basic aspects of abuse as part of their induction to Mundy House. The manager stated that they had not seen the local multidisciplinary guidance on safeguarding vulnerable. When asked about their responsibilities to safeguard people and for example what they would do if a member of staff told them that they had seen another member of staff hit a resident, the manager said they would investigate, refer to the companys Operations and Compliance managers, they would complete a Regulation 37 notification and incident form, they would set up an action plan and see what they can do and set up a meeting. The manager was advised that this was cause for concern as they clearly did not show understanding of their responsibilities in relation to referring it as required to the adult safeguarding team for a decision on who would investigate, or for example in suspending staff if appropriate to protect the resident and the staff member. On arrival at the premises and ringing the bell, the door was open to us by a member of staff who let us in and walked away without asking who we were and confirming the appropriateness of our being on the premises. This does not best safeguard residents and the manager and link manager were informed of this. On admission to the premises on the second day of the site visit, we were rightly asked for our identification. Care Homes for Older People Page 21 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Mundy House cannot be reassured that they will live in a well maintained environment that suits their needs and preferences. Evidence: A partial tour of the premises was undertaken by us throughout the day of the site visit. The last inspection report contained a requirement that the premises be refurbished and redecorated to ensure that residents lived in a pleasant and well maintained environment. The managers AQAA states that the home is being redecorated to create a warm and homely environment and that a full-time decorator has been employed. Some evidence of this was seen in the decoration of the communal hall ways but that needs to continue to include several other areas of the home including the lounge in The Lodge. New carpets have been fitted in some areas. The link manager provided evidence of investment in the premises that has included new boilers being fitted to address the issue identified in the last inspection report in relation to a lack of adequate hot water for all residents. The manager told us that a new walk in shower facility, requested by a resident, is currently being fitted and will soon be ready for use. The recent residents meeting minutes show that maintenance and decoration was an Care Homes for Older People Page 22 of 37 Evidence: item on the agenda with some residents expressing frustration with the wait for issues to be attended to and lack of response to meetings such as these and complaints made. These include continuing problems with their ensuite toilet, decoration, need for new curtains, faulty radiator and drafts around the windows, cracks and lack of interest in the garden. There were also concerns expressed by residents regarding the heating in The Lodge. The minutes record the manager explaining that there are ongoing investigations into the settlement issues in The Lodge and also that redecoration was being done room by room as quickly as possible. Some residents indicated that they were satisfied with their rooms and this was confirmed by residents spoken with. A random sample of individual peoples bedrooms were inspected and these were seen to be personalised and individualised. Of 16 residents bedrooms examined 2 peoples en-suite facility were out of order. In addition one communal toilet on the first floor was also observed to be out of order. When discussed with the manager no rationale could be provided and although we requested confirmation that the registered providers estates department had been notified and evidence of the actions to be taken, no information was provided. As required in the last inspection report, the laundry has been deep cleaned and the equipment was confirmed as in full working order. A limited number of tiles remain missing from the walls. The upstairs sluice room continues to have many of the tiles missing from the walls which does not promote effective management of cross infection. The managers AQAA tells us that a fulltime maintenance person is in post to carry out required work within the home. The manager confirmed their awareness that the lock on this sluice room door did not actually work but could not provide any evidence to demonstrate that they had taken action to report it so that it could be replaced. This was also identified as being needed in the last inspection report. On the day of the site visit the premises were seen to be clean, tidy and odour free. Comments from residents also indicate that the home is generally kept fresh and clean. Care Homes for Older People Page 23 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be supported by safely recruited staff but shortfalls in the management of staffing levels and aspects of training may not promote best outcomes for residents. Evidence: There were forty eight people living at Mundy House at the time of this inspection site visit. The manager advised that minimum staffing levels required to meet the needs of the current resident group were nine care staff each day, including a minimum of two seniors each shift. Staff deployment and task allocation was organised so that staff are clear what activities and which residents they have particular responsibility for supporting with personal care. One staff member works in The Lodge and two cover the remainder of the upstairs unit, supported by one senior. There are two teams of two staff allocated to the areas downstairs who are also supported by a senior carer. The rota clearly identifies the person in charge of the shift and the manager explained that this person has responsibility for allocating staff to groups of residents and tasks each shift. The manager also advised that having two senior carers on shift supports timely administration of medication, which is positive. The manager did not initially advise us that a member of staff had not turned up for their shift that day. When this was discussed later, they confirmed that the staff member had not followed procedures by telephoning to advise of their absence and Care Homes for Older People Page 24 of 37 Evidence: that while the care manager was on site, this was to work specifically on care plans and no arrangements or actions had been taken to manage the staff shortage and provide cover on the shift. Staff worked well together as a team. While the staff shortage was not observed to have any immediate negative outcomes for residents during the site visit, minimum staffing levels must be maintained to ensure residents needs are met. The rota had not been amended to demonstrate that the staff member was absent. Additionally, the manager advised that they were unaware that they needed to record the hours worked by all staff at the home and that this included the activity coordinator, who is currently not included. Copies of recent rotas provided by the manager were subsequently reviewed and demonstrated occasions where the stated minimum staffing level was not recorded as met. The Commission had not been notified of this as required. One of the four surveys received from residents said that staff were always available when needed and that they listened and acted on what they said, the other three said this usually occurred. The staff member survey received indicated that there are sometimes enough staff to meet the individual needs of the residents and commented that while the appointment of the deputy manager has had a positive effect, fully trained and experienced senior staff are required to give confidence to residents and care staff. Observed staff interaction with residents was considered to be improved from the previous key inspection. Staff were observed to be interacting more, and more positively, with residents during this site visit and this was not just linked to tasks. Staff were heard to speak to and about residents positively and with respect. Residents spoken with were complimentary regarding the staff. A relative spoken with said the staff are really helpful and I can approach them with ease. In discussion on NVQ training the manager confirmed the information in the AQAA is accurate. This indicates that of thirty-four permanent care workers, eighteen have achieved NVQ level II or above. This is positive and above the 50 national minimum standard recommendation. Files were reviewed for two staff recruited since the manager came in to post. This was to assess if appropriate references and checks had been undertaken to ensure that prospective staff are suitable people to care for residents of Mundy House. Recruitment file processes are overseen by the homes administrator. Both files contained evidence of required information and checks obtained prior to employment Care Homes for Older People Page 25 of 37 Evidence: commencing to evidence robust recruitment procedures to safeguard residents. There was evidence of face-to-face interview by the manager and signed confirmation that staff had received Southern Crosss code of conduct, whistleblowing, safeguarding, confidentiality and safe use of bedrails policies and procedures as well as the General Social Care Council code of conduct. Both staff had previous relevant experience and qualification. A record of initial two day day induction to Mundy House was available on the file, as was a record of receipt of the Skills for Care induction log book. The record of initial training included care plans, safeguarding, whistleblowing and resident choice. Induction training ensures that staff are aware of the needs of the residents they are to care for and how to meet these. There was no evidence that the log book and full induction had been completed and signed off. Where staff advised of previous training and qualifications evidence of these were not available on the files or recorded as having been seen during interview. Both staff files evidenced that they had been provided with basic training at Mundy House including moving and handling, fire, food hygiene, health and safety, protection of vulnerable adults and control of substances hazardous to health. Additionally they had had been provided with training in relation to pressure care, nutrition awareness and safe use of bedrails. The manager provided information maintained by Southern Cross on current training statistics for the home which were compared to those provided at the last key inspection. The statistics demonstrated there had been improvement in the percentage of staff trained in line with Southern Cross policy in relation to moving and handling, pressure area care and care planning which is positive. The manager did not provide an explanation when asked as to why training levels in all other topics had reduced since the last inspection, for example fire safety from 98 to 45 , food hygiene from 98 to 43 , protection of vulnerable adults from 98 to 60 and infection control from 96 to 45 . Bedrail training was advised as booked in the following week and Southern Crosss Quality Adviser, who had recently audited the home, was to undertake documentation training later that week. Training in food hygiene was taking place at the home on the first day of the site visit and safeguarding training was planned for the next day. Care Homes for Older People Page 26 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents at Mundy House cannot be assured that the home is effectively managed to promote their best interests and well-being. Evidence: The last inspection report identified negative effects on the service produced by a long period of unsettled management. It contained a requirement that Southern Cross ensure that Mundy House is managed with sufficient skill and competence to enable the smooth running of the home and that residents needs are met. This inspection process identified that while some of the requirements from the last inspection had been met, such as keeping records securely stored and ensuring residents had access to callbells throughout the home, there has not been effective management of the service. A new manager has been appointed since the last inspection. The manager advised that they are a qualified nurse in learning disabilities and worked in this field for a number of years. The manager said that they have experience working as manager in Care Homes for Older People Page 27 of 37 Evidence: a care home for older people and also have additional more recent experience of working in another care home for older people. The manager stated that they have no training or qualifications in relation to management. They told us that they were now registered by the Commission following recent fit person interview. This was later clarified and while the interview had taken place, the process is not complete and the manager is not registered. There is evidence of inadequate management identified in this report, for example in relation to care management, safeguarding vulnerable people, maintaining records required by regulation and staff training. There was a lack of clarity as to the initial induction support provided to the manager who told us that they had had no proper induction by Southern Cross when they took on the role at Mundy House other than in relation to orientation of the premises, introduction to people and being shown the care plans. The link manager told us that they had provided informal support for a 3 to 4 week period and it was their understanding that the manager had two months supervised practice supported by a project manager as part of the managers induction. This was subsequently confirmed in writing by Southern Crosss area manager who also advised that support had been withdrawn on request of the manager and was being reintroduced following a very recent request for this. There was a lack of evidence of effective monitoring of the management and care at Mundy House by Southern Cross for a period of time and the manager told us that there had been no monthly visits undertaken by the registered provider to the home as required between April 2009 and October 2009. These monthly visits and reports would evidence that Southern Cross were making sure that they service provided to residents and the management of the home were improving in line with the concerns raised at the two previous inspections. Reports were available to show that the monthly visits required by regulation had been completed between October 2009 and December 2009 but again not during the months of January and February 2010. It is expected that these should have identified and actioned more promptly the concerns identified during this key inspection site visit. A very recent survey of residents, relatives and other stakeholders such as the GP, district nurses and social workers had been sent out to gather peoples views on the service. Five responses had already been received from relatives generally expressing satisfaction with food, activities and the care provided although one person stated dissatisfaction with the care because staff were too busy to take a resident the toilet when they asked. Surveys received from residents were also in the main satisfactory in relation to care, food and activities although some premises issues were raised. One person commented I find the staff here do a very good job of looking after the Care Homes for Older People Page 28 of 37 Evidence: residents, treating them with kindness and respect. It is also noted positively that resident meetings have been introduced and attended by the manager and the activities coordinator. These allow resident who are able a forum to express their views on how the care home is run. A computerised system is in place for looking after personal allowance money for residents who require this and is overseen by the homes administrator. The records reviewed for two randomly selected residents were found to be well maintained. Receipts were provided for money received and also where residents withdrew money for example if they were going on planned activities. The system allows continuous reconciliation of account balances that can be monitored by head office to ensure accuracy and safeguard residents. Lockable cabinets were available to store residents records safely and securely, a noted improvement from last inspection. Accident records were requested from the manager to triangulate information from other care management documents. Three separate books were provided on three separate occasions by the manager, where the stubs indicated blank spaces and reporting numbers were not consistent and so could not be relied upon. The manager confirmed that this was not a suitable way of managing records. The available accident record sheets viewed contained suitable levels of information, noted that the Commission had been notified where required and were signed by the manager. Accidents are recorded on a computerised systems so that Southern Cross can monitor for trends to help improve safety for residents. The manager was unclear as to the audit tools to be used to review care management documentation, providing inaccurate documents and then blank documents before confirming that the audits had not been undertaken monthly in line with Southern Crosss policy. The audit would help the manager to identify if care plans and risk assessments were being checked and reviewed regularly to ensure that staff had upto-date information to provide effective care and support for residents, and this was an outstanding requirement from the last inspection. The certificate of registration displayed was not accurate. The most recent certificate that had been provided by the Commission was later found on request and the link manager confirmed that arrangements would be made to have it displayed as required. The displayed certificate of Liability Insurance had recently expired. The manager stated that a new one possibly had been received but they were unclear where it was. When it was later found by the inspector in checking other records, the manager agreed to arrange to have it displayed. A random sample of inspection certificates and health and safety checks were Care Homes for Older People Page 29 of 37 Evidence: reviewed and found to be satisfactory. Current certificates were available for example in relation to gas safety and the passenger lifts. Regular checks were recorded regarding water temperatures, callbells, window restrictors, radiator safety and door closures. Separate checks were also recorded in relation to fire safety including the fire alarm and fire equipment and a record of fire drills was maintained. Care Homes for Older People Page 30 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15(1) Care planning at the home 01/05/2009 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. Previous timescale of 01/08/08 not met. This is an outstanding requirement. 2 8 13(4) Risk assessments must be 01/05/2009 devised for all areas of assessed risk so that risks to residents can be minimised. Previous timescale of 01/08/08 not met. This is an outstanding requirement. 3 8 17(2) Where a person is at risk of 01/05/2009 losing weight maintain records of nutrition that include weight gain and loss and demonstrate appropriate action is taken. To respect residents right to 01/06/2009 live in a pleasant and wellmaintained environment, the premises must be Page 31 of 37 4 19 23(2) Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action refurbished and redecorated in a timely manner and a detailed programme with clear timescales to be sent to the Commission. Previous timescale of 01/10/08. This is an outstanding requirement. 5 31 10(1) The registered person must ensure that the home is managed with sufficient skill and competence so as to ensure the smooth running of the home and that residents needs are met. 01/06/2009 6 33 24 & 26 To promote resident best 01/06/2009 interests and wellbeing the registered person must have sufficiently robust systems in place to monitor and improve the quality of care provided at the home. Care Homes for Older People Page 32 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Ensure that individuals care plans are reviewed and updated to reflect their current care needs. So that care staff have up to date information and can provide appropriate care. 06/04/2010 2 9 13 Where people are given 30/04/2010 medicines at times different to those printed on the medication record forms, the actual time it is given must be recorded. This will ensure that people do not receive medicines too close together. 3 16 22 Supply the Commission with a statement containing a summary of the complaints made regarding Mundy House in the 12 month period prior to the key inspection and any action that was taken in response to each. 26/04/2010 Care Homes for Older People Page 33 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To show that all complaints made have been investigated and appropriate action is taken to ensure the well-being of the people living at Mundy House. 4 18 13 Make arrangements so that people living at Mundy House are not put at risk of harm or abuse and ensure that people working and managing the home have appropriate knowledge and competence in relation to safeguarding. To safeguard people living at the home. 5 18 37 Notify the Commission as 26/04/2010 required of any event that occurs in the home that could affect the well being of a resident. To safeguard people living at the home. 6 27 17 An accurate duty roster must be maintained of all staff working at the home and a record of whether the roster was actually worked. To ensure there are sufficient staff to meet residents need at all times. 31/03/2010 16/04/2010 Care Homes for Older People Page 34 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 27 18 Ensure that at all times 31/03/2010 there are adequate numbers of suitably qualified and competent staff working at the home to meet residents needs. To meet residents needs and promote their health and welfare. 8 30 18 Provide staff with training that is appropriate to their role including fire safety, safeguarding of vulnerable people, food hygiene, infectioncontrol and care planning to promote competence in practice. To ensure staff are suitably competent and knowledgeable to meet residents needs and promote their health and welfare. 31/03/2010 9 33 26 Ensure that at least monthly 20/04/2010 visits and reports are completed as required by regulation and a copy of each report to be sent to the Commission monthly until further notice. So that the registered person can form an opinion of the standard of care Care Homes for Older People Page 35 of 37 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action provided in the home and take any appropriate action. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 12 18 Consider providing the activity programme in larger print. Staff should be provided with training on positive responses and the management of behaviour that challenges and appropriate records maintained, to enable them to best safeguard and meet the needs of people living at the home. Systems should be in place and implemented by staff to ensure that visitors/people admitted to the home have a right to be there so that residents are safeguarded. To promote resident safety, doors to sluice rooms should be kept locked and potential hazard such as latex gloves there should be safely stored. To promote effective management of cross infection, wall finishes in laundry and sluice room should be well maintained and readily cleanable. Keep a record on file to show that staff have completed a full induction training at Mundy House. Keep a record to show evidence of stated staff qualifications and training. 3 18 4 19 5 26 6 7 30 30 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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