Inspection on 06/04/09 for Mundy House Care Centre

This inspection was carried out on 6th April 2009.

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

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

Other inspections for this house

Mundy House Care Centre 03/03/10

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 19/06/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Mundy House Care Centre Church Road Basildon Essex SS14 2EY Lead Inspector Mrs Bernadette Little Unannounced Inspection 6th April 2009 11:20 DS0000018098.V374906.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) 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. www.cqc.org.uk Internet address Mundy House Care Centre DS0000018098.V374906.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.V374906.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. 24th June 2008 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 £453.11 to £666.50 per week. Mundy House Care Centre DS0000018098.V374906.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. Since the last key inspection and in response to a safeguarding concern raised and other information made available to the Commission, a random unannounced inspection of Mundy House was undertaken on Sunday, 1st February 2009. This inspection identified ineffective management of the service including inadequate staffing levels to meet residents’ needs, shortfalls in the planning of residents’ care and concerns regarding the management of medication for which an immediate requirement notice was issued. A subsequent unannounced random inspection by the specialist pharmacist inspector on 12th February 2009 demonstrated further non-compliance with safe medication management. Southern Cross responded promptly to the inspection reports and advised of systems they had put in place to address the shortfalls. The planned unannounced key inspection of Mundy House was brought forward. This site visit was undertaken by two inspectors over a nine hour period as part of the routine key inspection of Mundy House. A specialist of pharmacist inspector was also present for part of the day to review medication. There were 38 people living at Mundy House at the time of this site visit. 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 project manager submitted an AQAA (AQAA) as required prior to the site visit and their prompt response in providing the information is appreciated. This is required to detail their assessment of what they do well, what has improved, and what needs improving and how they plan to do this. This information was considered as part of the inspection process and reflected as part of the report. Prior to the site visit, the project manager was sent a variety of surveys to distribute and that asked questions that were relevant for each group, such as for residents, staff, care managers and healthcare professionals. No completed surveys had been received at the time of writing this report. 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 project manager, support manager and operations manager were present for the most part of the site inspection. The outcomes of the site visit were fed back in detail and discussed with the managers and opportunity was given for Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 6 clarification where necessary. The assistance provided by all of those involved in this inspection is appreciated. There remain a number of requirements that have not been met since the last inspection, which is a concern. However as recent improvements are noted, the registered person will be given opportunity to demonstrate further and sustained improvement and this will be monitored. Should these requirements and shortfalls as identified within the main text of this report not be addressed by the registered person, the Care Quality Commission may consider taking legal action. What the service does well: The majority of residents spoken with were satisfied with the meals served. Some resident bedrooms were personalised and very homely. What has improved since the last inspection? What they could do better: There needs to be a period of stable and effective management at Mundy House to support and sustain a clear sense of direction with robust operational systems that ensure positive care outcomes for the people who live there. This includes effective monitoring of all aspects of the service and compliance with the requirements of this report. Further development is required to ensure that care records are more detailed, recording staff interventions and actual delivery of care to individual residents. The home environment needs to be furnished and equipped to meet the needs of those people who live at the home and provide them with a pleasant and safe place to live. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 7 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. Mundy House Care Centre DS0000018098.V374906.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.V374906.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 and 6 People using the 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 thinking of living at Mundy House can expect to have an assessment of their needs to make sure that the service can meet them but may benefit from having more enough information on which to base their decision to live there. EVIDENCE: A copy of the current Service User Guide and Statement of Purpose was provided on request. A Statement of Purpose and Service Users Guide was readily available detailing the aims and objectives of the home and the service and facilities provided. On inspection of the Statement of Purpose this makes reference to a “nursing needs assessment”, “named nurse”, “registered nursing care contribution” and “determining nurse”. This is not appropriate as Mundy House is a residential care home and not a nursing home and requires reviewing. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 10 One resident spoken with could not remember whether or not they had been provided with a copy of the Service Users Guide. The project manager advised that both documents are also available on audiocassette and can be printed in a larger format for those people who have sensory needs. The file for the most recently admitted resident, as advised by the project manager, was reviewed to assess the quality of the information obtained by the home prior to admission of the resident to ensure they could meet the person’s needs. There was no photograph available on this person’s file to support identification. A copy of the assessment by the placing authority of the person’s needs was available as was an admission assessment undertaken by staff at Mundy House, evidenced as being prior to admission. It contained relevant information about the person’s needs. Formal assessments were also completed relating to dependency, dementia, moving and handling, pressure area risk assessment, nutritional assessment and continence. There was no evidence on the person’s file to say whether they or their representative had visited the home prior to admission or whether this opportunity had been offered. The resident confirmed that they had not visited but said that this did not cause them any concern. The administrator confirmed there was no evidence available to demonstrate that the management team had confirmed in writing to the person that, based on the pre-admission assessment, their needs could be met at Mundy House. This is an outstanding requirement from the last key inspection. A copy of the person’s contract was held on the computer and placed on the resident’s file at the time of the site visit. In their AQAA, the project manager advises that resident contracts are being drawn up promptly after admission. Good practice would indicate that the person or their representative would have access to their contract on admission to ensure they understood and agreed the detail. A copy of the pre-admission assessment for another resident admitted some months previously was requested as part of the review of care plans. The project manager advised that they had been unable to find this and so had rewritten it very recently, based on the information provided in the placing authority assessment. Mundy House has an Intermediate Care Unit that offered additional support for up to nine people who needed it for specific time periods. At the time of the last key inspection eight people were accommodated in that unit. At the time of this key inspection, the Intermediate Care Unit was unoccupied. The project manager advised that they did not know why this was as there was no reason that they could not admit residents to this unit. Mundy House Care Centre DS0000018098.V374906.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While some improvements were noted, shortfalls in care planning and risk assessment were highlighted which could have an adverse affect on outcomes for residents and their wellbeing. EVIDENCE: There is a formal care planning system in place to help staff identify the care needs of individual service users and to specify how these are to be met by care staff. The care planning format is comprehensive and remains unchanged from previous inspections to the home and includes formal assessment tools relating to dependency, manual handling, pressure area care, nutrition, falls and continence. As part of this inspection, the care files for 7 people were inspected (2 in full and 5 partially inspected in relation to individual’s specific care needs/ healthcare needs). These showed that although there has been some Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 12 improvement since our last visit on 1/2/09, further development in care planning and risk assessing is required, so as to ensure the care needs of individual people are clearly recorded and staff have the most up to date information to ensure appropriate levels of care delivery are undertaken. For example the placing authority assessment for one person recorded them as having Parkinson’s disease and having an allergy to nuts which could be life threatening. Records showed no plan of care was devised in relation to the individual’s Parkinson’s disease and how this affected the person’s ability to undertake activities of daily living. Although there was a plan of care pertaining to the person’s allergy, no risk assessment was devised. Where people are at risk of poor dietary intake and/or weight loss, it was positive to note that in the past 2 weeks, the management team of the home have devised a new weekly weight, monitoring record. Whilst we recognise this, it is clear from records examined that where individual care plans have specifically recorded that people should be weighed weekly this has not always been undertaken until recently. Additionally, records relating to daily nutritional and fluid intake were not always completed and out of 5 peoples’ records examined, gaps and inconsistencies in recording were noted in all. Records relating to the latter were also examined by a member of the management team and they concurred with our findings. The care files for 2 people recorded them as being at “high risk” of falls. Records showed that a care plan and risk assessment was devised in relation to falls and a manual handling risk assessment tool compiled, recording the person being at low, medium, high or very high risk. However, on one person’s care file it was noted that a comprehensive 4 page manual handling assessment had been completed, yet they were deemed low risk and no manual handling assessment was completed for those people recorded as being at high risk. When discussed with the management team, no rationale could be provided as to why a comprehensive assessment had not been completed, however we were advised that it should have been in place. Daily care records varied in content, with some being detailed and informative and providing a clear picture as to how people have spent their day, including staff’s interventions. Other records provided little information and focussed mainly on tasks e.g. “personal care given”. The daily care records for one person recorded on 2 occasions that blood had been found on their underwear, yet there was no information documented within their care file, professional visitors record and/or staff communication book to evidence staff interventions or steps taken to seek advice from a healthcare professional. The management team of the home were advised to ensure that for those people who exhibit challenging or inappropriate behaviours and where a challenging behaviour record is to be maintained, information recorded within daily care records should be transferred to the appropriate documentation. Of Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 13 those records inspected daily care records and behaviour monitoring records did not always concur. The care record for one person stated that their cigarettes and lighter were held by the home for safe keeping, although the resident told us they had their own tobacco. The record did not show that the person had not been consulted or demonstrate their agreement to this restriction. On inspection of individuals’ professional visitors record, this showed that people have access to a range of healthcare professionals and services e.g. GP, Optician, District Nurses, Community Psychiatric Nurse and Dentist etc. As part of the inspection process, a SOFI (Short Observational Framework for Inspection) observation was undertaken during the morning in one of the lounge areas. This involved us observing 4 people who use services for a continuous period of 1 hour and recording their experiences at regular intervals. This included observing their state of wellbeing, how they interact with staff and other people who use the services. As stated at the random inspection to the home on 1/2/09, staff were again observed to go about their duties, however there were few occasions whereby staff interacted with residents. It was noted at this inspection that staff were busy with routines of the home e.g. undertaking the tea round, completing paperwork, however little time was afforded to residents. The most verbal interactions that took place with individual residents were from the operations manager and another member of the management team. This was positive as residents became animated and engaged. Once this interaction was completed, several residents digressed back to staring into space, closing their eyes and talking to themselves. One resident was observed to place their head in their hands and to rock gently. It was positive to note that the lounge area was staffed throughout the time of the SOFI observation. Interactions by staff in the afternoon were observed to be more positive and residents were seen to welcome this. One staff member was observed to give a resident time, support and encouragement to transfer from wheelchair to chair and to speak to them in a positive and respectful way. From discussions with staff it is clear that staff have a basic understanding and awareness of peoples’ care needs, however the main focus of support provided is predominantly task based. This was discussed at feedback with the operations manager, project manager and another manager and all concurred with our observations, stating they had witnessed this themselves but felt in order to change staff attitudes and practices, this would require more time. A pharmacist inspector examined the practices and procedures for the safe handling, use and recording of medicines. This has improved over previous inspections. The home has good, up to date, policies and procedures for the safe handling and use of medicines to protect residents. Facilities provided for Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 14 the storage of medicines are secure and temperature controlled. This ensures that people receive medicines of good quality and prevents unauthorised access. We noted that the record of the temperature of the medicines room on the ground floor had not been made for the last 4 days. The home’s own policy states “the temperature of the room must be monitored on a daily basis”; and the temperatures of the fridges used to store medicines is not recorded as the maximum/minimum reading despite the home’s policy that “The temperature of the medicines refrigerator should be monitored on daily basis using a maximum/minimum thermometer”. We expect this to be managed by the home without the need to make a requirement. We looked at records kept of the receipt and disposal of medicines and the records made when medicines are given to people. These were in good order with few discrepancies. Most of the omissions we found had already been picked up by the home’s own audit procedures that have recently been introduced. This demonstrates that people receive the medicines provided for them. A medicine for some people which should be given at least 30 minutes before food, drink or other medication had not been given on the morning of the inspection. We expect this to be managed by the home without the need to make a requirement on this occasion to protect these people from harm. Medication is given to residents by suitably trained staff and this is backed up by training and supervision records. We watched some medicines being given to people at breakfast time and this was done well with due regard to their privacy, dignity and personal choice. Requirements made on previous inspections have been met. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. While some residents experienced improving opportunities others may not receive the necessary consideration and support to operate choices and satisfy their individual emotional or social needs and preferences. EVIDENCE: An activities co-ordinator is employed at Mundy House for 30 hours per week, Monday to Friday, however we were advised that these hours are flexible to cover evenings, weekends and special events. A copy of the weeks activity programme was displayed within lounge areas and on notice boards. The activity programme is provided in both a written and pictorial format. On inspection of 4 weeks activity programme, this showed that people living at Mundy House are able to participate within a varied range of activities. These include hairdresser, bingo, games, manicures, ‘sweet memories’ mobile shop, quiz, reminiscence, 1-1, arts and crafts (including seasonal projects e.g. Easter Bonnets), sing-a-long, music, religious observance etc. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 16 On inspection of the activities folder, this showed that a recreational record is compiled for individual residents detailing activities undertaken. Records also showed that a ‘Map of Life’ had been completed detailing their personal preferences, likes and dislikes, life history and those people important to them in their life. Of those care files case tracked, information relating to individuals social care needs was seen to be limited and not person centred. Records show for those people who have limited communication and/or poor cognitive ability, there is a lack of social stimulation. As part of the inspection process a SOFI observation was undertaken during the morning in one of the lounge areas for a period of 1 hour. This showed that although the activities co-ordinator was not present within the home, staff made no attempt to engage people in social stimulation. One of the senior managers noted that residents were dozing and not engaged in an activity or task. They took the initiative and instigated a ball game of which 10 residents joined in. The atmosphere and mood within the lounge changed instantly and residents became lively and engrossed in the activity. A member of staff was then given the task of instigating a game of skittles with residents, however they appeared half-hearted in their attempt to engage residents and people seemed to lose the momentum and motivation to continue. When discussed with the operations manager and project manager we were advised that the organisation’s policy is that all staff, are responsible for providing social activities to people who live at Mundy House and not just the role of the activity co-ordinator. People spoken with advised they are given the choice as to whether or not they participate in activities. People spoken with stated, “the activities are OK”, “you’re lucky if some people talk to you” and “staff do there best, but it’s hard with so many different people”. There is an open visiting policy whereby visitors to the home can visit at any reasonable time and a visitor spoken with confirmed this. There is a rolling 4 week menu in place and this showed that people within the home are provided with a varied choice of meals each day. People can choose where they wish to eat their meals e.g. in the dining room, in the lounge or in the comfort and privacy of their own room. Lounge areas were observed to have jugs of juice readily available for people. During the morning we observed the ‘mid morning tea round’. No residents were asked if they wanted a drink or given the choice of tea, coffee or a cold drink. Through discussions with a member of staff we were advised, “we’ve tried and tried, nobody likes coffee, only tea”. This is inaccurate as another member of staff advised that some residents do like coffee and in the afternoon, one person was seen to be drinking coffee. Although biscuits were Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 17 provided for people with their drink, on inspection of some care files for those people who are at risk of poor dietary intake and/or weight loss, these made reference to people being offered snacks throughout the day. There was no evidence to show that snacks are provided, other than biscuits with the morning and afternoon ‘tea round’. The teatime meal was observed within the main dining area. Tables were observed to be attractively laid with tablecloths, condiments, placemats and serviettes. The meal was provided in a timely manner and where people required support and assistance by staff to eat their meal, this was provided with dignity and sensitivity. A menu depicting the choices available was not displayed, however staff were observed to advise residents of the specific choices available. After the meal people were provided with a drink, however the only choice available was tea. Comments from people spoken with on the day of the site visit relating to the quality of meals provided were varied and included, “the meals are OK, it depends who’s cooking”, “sometimes good, sometimes not so good”, “no comment”, “they’re not bad” and “the food is OK”. Other people commented that the food choice they pick one day is not necessarily that which arrives the next day, but that the food itself is generally satisfactory. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the 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 be listened to and be better safeguarded by improving staffing levels and planned training. EVIDENCE: Southern Cross have a detailed complaints procedure with clear timescales for responses and investigation. Clear and basic information on how to make a complaint was displayed in the entrance foyer. It contained contact details for the Commission as well as the names and telephone numbers of the Southern Cross staff relevant to Mundy House. It did not explain that social services have a role in investigating complaints about the care provided, so that people have the full range of information available to them. The Commission had been made aware of two complaints made directly to social services by relatives. The AQAA identified that Mundy House had received nine complaints in the past twelve months, all had been responded to within 28 days, seven had been upheld and one was currently being investigated. Some of the complaints had been made by social workers. The record of complaints was reviewed and concurred with the information provided although the formal outcome was not always clear. Responses to complainants included apologies and confirmation of actions taken to address the concerns raised. These included issues relating to the premises including Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 19 poor decoration, facilities such as WC or wash basin not functioning, no aerial available to a resident who would like to watch the television in their room, the need for covers for additional radiators to ensure residents’ health and safety, a resident not being taken to the toilet when requested as staff were too busy/unavailable, not requesting a medication review as agreed and appropriate monitoring of health care needs and weight management. The project manager and operations manager confirmed that complaints will have clearly recorded outcomes, will be reviewed as part of the new monthly audit and will also continue to be monitored as part of the monthly regulation 26 visit and report. Residents and a relative spoken with said they would feel able to raise any concerns they had directly with the staff or with social services. 40 of the staff are recorded as having attended customer care training which would support them in listening to residents. A number of cards and letters of thanks and compliment were displayed in the main foyer. The AQAA stated that four safeguarding referrals had been made in the past twelve months. Three of these were ongoing and considered at the time of the last key inspection. One relating to financial abuse was upheld and appropriate actions taken, including the introduction of a new financial management system. One related to inappropriate administration of medication and the other to care practices and the call bell and food and drink being left out of residents reach. Formal outcomes and conclusions to these are awaited from the safeguarding team. A current copy of the local guidance on safeguarding was available. The more recent safeguarding referral included concerns of inadequate staffing at weekends leading to inadequate care outcomes for residents, verbal abuse of a resident, inappropriate medication management and lack of access to call bells and drinks for residents. This was reported by a visitor rather than by staff, which is a concern. This investigation remains ongoing although some aspects have already been upheld. The anonymous information received by the Commission advising of inadequate staffing levels at weekends leading to inadequate care outcomes for residents was confirmed during the random inspection of Mundy House in February 2009. Improvement to staffing levels and resulting staff availability to residents to meet care needs was noted at this site visit. Training information provided showed that 98 of staff at the home had been provided with safeguarding training in the past 12 months, to support them to recognise abuse and take appropriate actions to safeguard vulnerable people. Records evidenced that this training was covered with new staff as part of their initial induction. Staff spoken with were able to identify types of abuse and showed confidence in reporting it, either to the manager, higher in the organisation or to social services if this was appropriate. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 20 The anonymous information received by the Commission advised that some residents did not receive best care as staff were unable to manage challenging behaviour and so tended to avoid them and ignore the impact this had on other residents. Observation of practice at both the random and key inspection did show opportunities where staff could be more pro-active in supporting residents in this situation. Training information provided showed that 38 of staff (13 of 30 care staff) had been provided with training on managing behaviour that challenges in the past 12 months. The project manager advised that more staff may have had this training but as they do not have evidence of it, they will record it as not having occurred. Records provided by the operations manager demonstrated that several local training sessions on challenging behaviour are planned in the very near future and they confirmed that staff from Mundy House would be attending. This would equip staff with better understanding and skills to enable them to support residents more effectively. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 25 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The continuing lack of effective and timely action to update and refurbish the areas of Mundy House does not demonstrate respect for the people who live there nor provide them with a pleasant living environment. EVIDENCE: There are two separate lounges downstairs, a seating area in the foyer as well as a large dining room. Both the Lodge and the intermediate care unit have their own separate lounge/dining rooms. Access to the call bells to enable residents to summon assistance in the downstairs lounges has not improved although this was identified in the last key inspection report, raised in both complaint and safeguarding concerns and also noted in the random inspection report. It was also again noted that there is not easy access to call bells or a Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 22 light switch that can be reached from bed in some resident bedrooms, which does not support good falls prevention management. Some resident’s bedrooms were really well personalised. Two residents confirmed that they found their rooms very comfortable and “nice”. A resident said they had their own ornaments and photographs, which was “very important” to them. The decoration in a number of resident bedrooms as well as some communal areas remains in need of attention, with torn wallpaper, stained walls, and falling down curtains. This is an outstanding requirement from the key inspection report of June 2008 and action in relation to this is not considered sufficiently timely. Furniture in many bedrooms and in some communal areas is damaged and marked. The window in the lounge in the Lodge was cracked. The project manager advised that a decorator has now been employed to deal with the communal areas and some work was seen to have commenced. The project manager advised that decoration of the other areas, including residents’ bedrooms, is undertaken by the maintenance person when they can fit this in around their other tasks. They acknowledged that they could do better in redecorating bedrooms once they become vacant, an issue found to be upheld in a recent complaint. The project manager’s AQAA states that their plans for improvement in the next 12 months is to continue the redecoration programme and to purchase new furniture for both communal areas and resident bedrooms. It is recommended that the opportunity currently presented by the vacant intermediate care unit be used effectively to ensure timely attention to the decoration in resident bedrooms. Following a recommendation made at the last key inspection, locks were noted to be fitted to all bathroom and toilet doors. However, one of the toilets on the upstairs landing was out of order and the lock on the other toilet door was broken. This does not respect people’s privacy and dignity. The home was generally clean. One of the two washing machines in the laundry was out of order and discussion with staff and inspection of the monthly regulation 26 reports indicate that this has been outstanding for the past two months, resulting in washing piling up which is not good infection control practice. The laundry was in need of a deep clean and to have for example the broken tiles replaced on the walls to ensure all surfaces were impermeable so they can be kept clean. This also applied to the upstairs sluice room where numerous tiles were missing from the walls. The sluice room doors were not kept locked and while this was reported to the project manager during the morning, both doors were again seen to be wide open during the afternoon. Boxes of latex gloves were easily available to residents. While staff need easy access to these, they present a potential choking risk to confused people. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 23 An unpleasant odour was noted in one resident bedroom where the carpet was badly stained. The project manager confirmed that new flooring is on order and to be fitted imminently. Another resident was visited in their room at 4.35pm. There was a strong unpleasant order in this room and the person’s almost untouched lunch and dessert was on the table in front of them. The project manager confirmed this would be addressed immediately. Information from two separate residents’ care records show that they complained about or refused personal care as the water was “ freezing and too cold. The staff communication book details that there was an issue with the home’s main boiler and there were also some difficulties with the back up boiler. The Commission had not been notified. The management team advised they were unaware of the issue with the water, would follow it up and inform the Commission without delay. The project manager advised that the estates manager from Southern Cross would be visiting Mundy House in the very near future to audit the premises so that an action plan can be produced and implemented. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the 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 of Mundy House can expect to be cared for by adequate numbers of care staff who are increasingly able to meet their needs through more effective management support and training. EVIDENCE: At this site visit the project manager stated that current minimum staffing levels are seven care staff including one senior during day shifts and three carers plus one senior at night. This allowed two staff to be deployed to each of the downstairs lounges, one staff to be in The Lodge, one staff to be available as a floater and the senior to undertake medication rounds, leading the shift and other tasks such as communication with relatives, health professionals etc. Inspection of recent rotas provided demonstrated that this level was generally met and regularly increased. A number of staff were spoken with and all confirmed that staffing levels had improved routinely in the last few weeks, that staff were no longer under stress and pressure from working short staffed and excessive hours to provide cover and that this was better for residents. Residents and a relative spoken with confirmed adequate staffing levels and that they do not wait long periods for staff support. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 25 The home has vacancies for senior care staff and the manager confirmed they are actively recruiting. Records demonstrate that two staff from another local Southern Cross home are providing regular cover at Mundy House, which supports consistency of care for residents rather than using different agency staff. The rota was not an accurate reflection of the staff on duty at the time of the site visit. The new deputy manager was not on duty and advised as currently not working in that role. However both the project manager and the supporting manager said they had each covered the shift and additionally another staff member came on site, making a total of nine care staff. The hours worked by the project manager and supporting manager were not recorded on the rota to evidence sufficient hours to support effective management of the home. The AQAA states that 8 of 32 care staff have achieved NVQ Level 2. The project manager advised that three have achieved NVQ Level 3 and that all staff will now be expected to sign up for either NVQ Level 2 or 3 training. Files were reviewed for two recently recruited staff to assess if appropriate references and checks had been undertaken to ensure that prospective staff are suitable people to care for the residents at Mundy House. Both contained photographs, applications, references, evidence of identity and timely Pova First checks. The project manager confirmed the finding that there were gaps in employment history that had not been suitably explored and recorded. Recruitment files were not available for the staff from another Southern Cross home working at Mundy House, but these were brought from the other home in a matter of minutes. They also contained appropriate references and checks as noted above. All four of the files contained a copy of the front page of an application for a criminal record bureau check, but no actual criminal records bureau check. The managers advised that these are maintained at head office, with e-mailed confirmation of the relevant details send to the home that should have been printed off and placed each person’s file. The project managers AQAA states that three staff have received induction training to Skills for Care standards and that as a planned improvement, all new staff that do not hold NVQ level 2 will commence 12 weeks Skills for Care induction training. At the site visit, the documents to support this had been printed off and were available. Files reviewed for two recently employed staff showed they had had commenced Skills for Care induction training with certificates that evidenced an initial three-day training course that was part of the 12 week training programme. It included safeguarding, the care needs of older people and the duty of care, person centred care to promote the rights and dignity of older people, effective communication and health and safety in daily practice. The Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 26 files also contained evidence of additional training in for example fire safety, food hygiene, dementia awareness and nutrition awareness. The training records for two longer serving members of staff were reviewed and compared to the training matrix. These confirmed evidence that staff had had the training recorded and included moving and handling, food hygiene, fire training, health and safety, infection control, safeguarding, pressure area care, safeguarding, customer care, safe use of bedrails, dementia care and management of behaviour that challenges. The project manager’s AQAA identifies that further planned areas for improvement are to hold monthly staff meetings, to recruit a bank staff system, and to ensure that all staff are aware of their roles and responsibilities. A staff member spoken with confirmed improvements in the home and recognised the need to build up staff morale and a teamwork approach. Another staff member spoken with noted improvements within the staff team’s morale and approach to working together and also improved communication and support from the management team. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 25, 36, 37 and 38 People using the 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 a new management approach that in many aspects promotes their best interests, but where the affects of a period of management instability and some management systems may not best safeguard them. EVIDENCE: The last key inspection noted that Mundy House had had a period of unsettled management. There have been further changes in the management team, with the acting manager no longer actively in post and two more recently appointed deputy managers also not in post. The Commission had not been formally notified of the manager changes, or the appointment of the first project manager or the current project manager at the end of March 2009 and this Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 28 information is awaited. A new operations manager also came into post in February 2009. The current project manager advised that they will remain as manager of Mundy House, with the support of a registered manager from a local Southern Cross home, until the appointment of an experienced manager and deputy manager at Mundy House. The project managers prompt completion and return of the AQAA and dataset information was appreciated. Notices were seen displayed in the home advising of a planned residents meeting for later that week. The project manager confirmed that she would be attending. Some residents spoken with were aware of the meeting, and felt they would be able to raise their dissatisfaction with the menu and be listened to. The project manager advised that they have been unable to find an analysis and report following the last residents’ survey of October 2008. Since coming into post, she had prepared and sent out surveys to relatives and these will be followed this week by those for residents, healthcare professionals and staff, to seek views from people using the service. The project manager confirmed that a copy of the report of this quality assurance exercise would be sent to the commission in due course. The project manager also advised of the implementation of one very detailed monthly audit tool to replace the 19 previous advised audits, and which will follow national minimum standards as a guide and review all aspects of the service. Monthly visits and reports as required by regulation have been completed since the new operations manager came in to post. It is of concern however that issues raised in the last key inspection report and concerns identified following the safeguarding referral and the random inspections undertaken by the Commission for Social Care Inspection had not been identified by the Southern Cross’s monitoring systems and appropriate action taken in a more timely manner to ensure better quality care outcomes for people using the service. A warning letter was issued to Southern Cross informing them that unless improvements were made, the Commission would seek to take legal action. Southern Cross has provided improvement plans and responses to the requirements and concerns raised, are now providing extra management support to the home to ensure effective monitoring of newly implemented systems. In light of this and noted improvement and plans at this site visit, and following management review of the service, the Commission will not to take legal action at this time but will continue to monitor the service. At Mundy House, Southern Cross operate a cash float system for looking after residents’ money. This entails the money being deposited in a single bank account that pays interest that is then allocated appropriately to each person. The cash float allows residents access to cash as they require and individual receipts are provided/maintained for money received or paid out on behalf of residents, for example for hairdressing or chiropody. The system is Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 29 computerised and audits/reconciles the account balances and can be monitored at all times by head office to ensure accuracy and safeguard residents. The project manager confirmed that the planned supervision matrix needed to be reviewed and updated to include all staff. They also confirmed that all staff had not been receiving regular supervision, that this was definitely an area for improvement that would now be implemented and monitored. There was evidence on files sampled of recent group supervision that addressed issues raised during the random inspections and Southern Cross’s response actions. This included a subsequent audit of the care files and drew staff attention to failings where residents’ personal care records were not kept up-to-date or person centred, the implementation of the key worker system, the retraining of seniors in medication with competence assessments and accountability, attitudes of senior care staff to care staff and the need to work as a team, also issues in relation to health and safety, acknowledgement of receipt of the falls policy and review of training needs. A large number of personal records relating to residents were found in a broken and open filing cabinet in an upstairs lounge and also in an unlocked store cupboard accessed from an upstairs landing. This does not respect peoples’ right to privacy nor comply with the legislation in relation to data protection. It does not ensure that information relevant to residents’ care is readily available to staff supporting them. This was drawn to the immediate attention of the project manager who later advised that new secure filing cabinets would be obtained immediately. Management of health and safety was reviewed and satisfactory apart from those issues identified in the section on environment. Evidence was available of inspection of the fire alarm, emergency lighting, call bell, gas installation and passenger lift. Records were available of regular checks of the emergency lighting and fire alarm. Records were maintained relating to fire drills and showed that all staff had attended regular fire drills and practices to support the safety of all at the home. Training statistics demonstrate that in the past 12 months, 96 of all staff have attended training on health and safety, 98 attended training on control of substances hazardous to health, 98 attended fire safety training and 96 attended infection control training. Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 30 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 1 x 2 x x 3 x 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 2 x 3 1 1 3 Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 31 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. Previous timescale of 01/08/08. This is an outstanding requirement. 2. OP7 15(1) 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. Previous timescale of 01/08/08 not met. This is an outstanding requirement. 3. OP8 13(4) Risk assessments must be devised for all areas of assessed risk so that risks to residents can DS0000018098.V374906.R01.S.doc Timescale for action 15/04/09 01/05/09 01/05/09 Mundy House Care Centre Version 5.2 Page 32 be minimised and health and well being promoted. Previous timescale of 01/08/08 not met. This is an outstanding requirement. 4. OP8 17(2) Where a person is at risk of losing weight maintain records of nutrition that include weight gain and loss and demonstrate appropriate action is taken. 01/05/09 5. OP12 16(2)(m)& People residing at the care home (n) must have their social care needs met to ensure they are stimulated and do not become bored. 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 and a detailed programme with clear timescales to be sent to the Commission. Previous timescale of 01/10/08. This is an outstanding requirement. 01/05/09 6. OP19 01/06/09 7. OP19 23(2) To promote their safety and well being, residents must have suitable access to a call bell system in all areas of the home used by them. To ensure appropriate laundry services and management of infection control, equipment and premises must be kept well maintained and in good repair. 15/04/09 8. OP26 23(2) 01/05/09 9. OP29 19&sch.2 &4 People must only be employed at 15/05/09 the home once all of the checks as required by regulation have been carried out so as to ensure DS0000018098.V374906.R01.S.doc Version 5.2 Page 33 Mundy House Care Centre that they are fit and suitable to care for older people. Previous timescale of 01/08/08 not met in part (This refers to a full employment history and evidence of satisfactory Criminal Record Bureau checks being available). This is an outstanding requirement. 10. OP31 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. To promote resident best 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. To promote residents’ rights to privacy, all records pertaining to them must be securely stored. 01/06/09 11. OP33 24 & 26 01/06/09 12. OP37 17(1) 15/04/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP2 Good Practice Recommendations 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 DS0000018098.V374906.R01.S.doc Version 5.2 Page 34 Mundy House Care Centre conditions on their admission, telling them what care and services they can expect during their stay at Mundy House and what their responsibilities are. 3. OP3 Records should be retained to demonstrate that the home has undertaken their own assessment of the persons needs prior to their admission. It is recommended that relevant information regarding resident health and well-being be cross-referenced, for example from daily care records to evidence appropriate management of peoples health and welfare. All doors to WCs need to be fitted with effective and working locks to demonstrate respect for peoples right to privacy and dignity. To show respect for peoples right to exercise choice and control, records must be maintained of any limitations placed upon them and demonstrate their agreement. 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 alternatives offered as routine at other times. The complaints procedures should provide clearer information on the role of Social Care (Social Services) in investigating complaints. All 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 meet the needs of residents at Mundy House. To promote resident safety, door to sluice rooms should be kept locked and potential hazards such as latex gloves should be safely stored. To promote resident safety and falls prevention management, residents should have access to switch on a light from their bed. A review should be undertaken of the hot water system to ensure that it is adequate to meet residents’ needs. 4. OP8 5. OP10 6. OP14 7. OP15 8. OP16 9. OP18 10. OP19 11. OP19 12. OP21 Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 35 13. OP21 So that residents’ needs and preferences are met, the registered provider should consider providing a user friendly shower facility as requested by a resident. A minimum of 50 of care staff should achieve NVQ 2 training to support them to develop their knowledge and better care for residents. 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. A copy of the report of the advised current audit be sent to the Commission. To support staff and monitor effective practice all staff working at the home should receive regular supervision. 14. OP28 15. OP33 16. OP36 Mundy House Care Centre DS0000018098.V374906.R01.S.doc Version 5.2 Page 36 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: 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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