Inspection on 18/04/07 for The Mount

This inspection was carried out on 18th April 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Mount 30/04/09

The Mount 17/04/08

The Mount 19/12/05

The Mount 07/09/05

The Mount 03/11/04

The Mount 21/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Mount 6 Liverpool Road, North Burscough Nr Ormskirk Lancashire L40 5TP Lead Inspector Mrs Lynn Mitton Unannounced Inspection 18th April 2007 10:00 The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Mount Address 6 Liverpool Road, North Burscough Nr Ormskirk Lancashire L40 5TP 01704 893907 01704 896181 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) Social Services Directorate Miss Karen Smith Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Date of last inspection 19th December 2005 Brief Description of the Service: The Mount is owned and run by Lancashire County Council and provides respite and short term care for a maximum of four people over 18 years of age with learning disabilities. The Mount is on a busy main road and is in walking distance of local amenities and public transport. The home is a dormer bungalow and there are 4 single bedrooms. There is a lounge/dining room and conservatory area communal space. There are facilities such as a ramp, disabled toilet and other aids to help service users remain as independent as possible. A large, well maintained and secure garden to the rear of The Mount gives additional space when the weather is good. The Local Authority usually funds service users. Service users fees for the cost per night to stay at The Croft are £9.24. There was information available to potential service users and their families advising them of the service and giving them details about the type of service they could expect. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection, including a visit to the home, took place on 18-04-2007 over 7 hours. A tour of the premises took place. The registered manager, one service user and two support staff were also spoken to. Throughout the report there are various references to the “tracking process”, this is a method whereby the inspector focuses on a small representative group of staff member and service users. Records pertaining to these people were examined. Policies and practices were also looked at. There were 3 service users staying at The Mount at the time of the inspection. The Commission received 3 comment cards from a relative/visitor service users to the home. Comments and findings of these surveys are referred to throughout this report. The inspector conducted the inspection with one of the support staff on duty and the registered manager. During the inspection a number of records, policies and procedures were also viewed. What the service does well: What has improved since the last inspection? The complaints procedure is available on DVD and video. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA2 & YA5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Needs assessments were not in place to identify the care needs of service users so that care staff have a clear understanding of how they could support them. Up to date contracts were not in place to explain what service users could expect, how much it cost, and what was expected of them in order for them to stay at The Mount. EVIDENCE: There was no evidence that an assessment of need for the service user case tracked had been completed. The funding authority had completed assessments. The inspector was advised that service users were now going to the home for tea and overnight visits prior to their respite stay at The Mount. The inspector was advised that service users contracts had previously been in place, but that these were now out of date. No evidence could be found of a contract for the service user case tracked. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA6, YA7 & YA9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information on care plans did not ensure that support staff could meet service users needs in a thorough and consistent way. The risk assessment and management framework did not fully support service users in taking responsible risks. EVIDENCE: Two service users care plans was examined. These documents contained some information about the level of support needed for staff to ensure continuity of care. This information was inconsistent and not in enough detail. The inspector and staff on duty and registered manager discussed at length the format, content and detail of these plans and how they should be improved. There was no photograph for one service user. Daily records were seen and their content was not always appropriate. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 10 A number of risk assessments were seen on the care plans case tracked. The inspector and registered manager discussed how these documents should include information explaining, once the risk had been identified, how it would be managed, and what action (in detail) was to be put in place to reduce the risk to an acceptable level. Service users brought personal allowances for their stay at The Mount. These were usually managed with the support of the care staff. Monies spent by service users during their stay were accounted for. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA12, YA13, YA15, YA16 & YA17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was run to make sure that service users had opportunities to enjoy their stay and to fulfil their potential. Service users were able to make day-today decisions about their lives. Individual dietary needs were catered for and a nutritious diet was provided. EVIDENCE: Service users had some access to their local community; and activities accessed within the local community at evenings and weekends during their stay at The Mount. Public or staff transport must be used, as the home does not have its own vehicle, although the inspector was advised it was hoped that a people carrier vehicle with a back lift may soon become available to the home for a 6 month trial period at evenings and weekends. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 12 Most service users continued to attend their day care centre during the day whilst staying at The Mount. Family and friends may visit The Mount at any reasonable time, although usually families maintain contact by phone. The inspector spoke to the staff members on duty about how service users would be treat with dignity and respect. There was a payphone available for service users in the foyer. The inspector was advised that no service users requested to attend a place of worship, but that they would be supported to do so should they request it. A record was made of meals served to service users. Not all meals served to service users had been recorded. The inspector was advised menus for the home were decided on a daily basis, dependent on the number of service users at the home and their preferences. Any specialised dietary requirements would be accommodated, this included use of halal meat, diabetic and soft diets. The Mount did not have a cook. Care staff prepare meals and service users were encouraged to participate in the preparation and planning of meals to the best of their ability. The inspector noted that there was reference on one service users care plan case tracked, about food needing to be served cut into small pieces to promote eating independently. There were no records of diabetic meals served. The inspector was advised that there were no service users who required food prepared or cooked in order to meet their cultural needs. The inspector noted that the homes dining table was not tall enough to accommodate service users in wheelchairs. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA18, YA19 & YA20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users personal care and health needs were not being recorded clearly. The management of medication did not fully protect people living at the home. EVIDENCE: Care staff were seen to encourage service users to be as independent as possible regarding their personal care. Information regarding the personal support each person required was not always recorded in sufficient detail on the care plan. Routines regarding personal care should be based on each service users needs and abilities. The service user case tracked had some health information recorded on the care plan. This included medical history, medication, pain assessment, continence, nutrition, sleep, and communication. The information seen had not been dated. The development of this document was discussed at length with the registered manager at the time of the inspection. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 14 Policies and practices for managing and administering medication in short break services were in place, dated February 2006. Service users had their medication administered by care staff; however, consent for this had not been sought. Administration records seen were completed correctly. A medication fridge was in place. All staff were undertaking training to ensure that they administered medication safely, and it was hoped that this would be completed by the end of June 2007. Medications for service users staying at The Mount were seen and these were clearly labelled by the dispensing pharmacist. Although the medication administration records were handwritten, they were seen signed by 2 members of staff on administration. A photograph was seen on one service users medication administration record, but not the other. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA22 & YA23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies, procedures and training in the “safeguarding adults” did not fully protect people living at the home. EVIDENCE: There had been no complaint since the last inspection. The complaints policy was seen and had been reviewed in September 2006. The inspector advised that all staff sign to say they have read and understood policies such as these. There was no evidence visible regarding how to make a complaint for service users or any other visitors to the home. The inspector noted that the complaints procedure is available on video and dvd. The protection of vulnerable adults guidance was seen this had not been reviewed recently because it made reference to the NCSC. There was staff guidance entitled “What to do if you suspect abuse of a vulnerable adult has taken place”. Staff had not recently undertaken prevention of abuse training. POVA 1st training was outstanding for all the staff team. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA24 & YA30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of décor and furnishings provided a comfortable and homely environment for service users. EVIDENCE: The inspector conducted a tour of the home, and noted that the bath and shower facilities were suitable for wheelchair users. There was a fixed and mobile hoist in place. There were 4 single bedrooms that were tastefully decorated. A lounge/dining area and conservatory were available as communal space. Staff bedroom/office accommodation was in the dormer area. A large secure garden was well maintained. The home was clean, odour free and appeared well maintained. Suitable laundry facilities were in place. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 17 Storage space was an issue, service users equipment, for example, mobility aids and bed rails had to be stored in each bedroom. It was noted that bedrails were being used for 2 service users – risk assessments were in place and bumpers were also being used. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA32, YA34, YA35 & YA36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. 30 of care staff had completed NVQ training; Staff spoken to and observed by the inspector demonstrated an understanding of the needs of the service users. There was no evidence that staff had been recruited and trained in a way that protected people living at the home. EVIDENCE: The inspector was advised by the registered manager that out of the care staff team of 10, 3 care staff members had completed their NVQ level 3 or NVQ2 training. There were no staff personnel files available to the inspector, so it was not possible to ascertain if care staff had been recruited in accordance with care home regulations. No 1:1 staff supervision records were available to the inspector. Team meetings had taken place spasmodically. The last minutes seen were dated The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 19 February 2007; the previous records were dated April 2006. There was no training matrix available to ascertain if staff had been undertaking regular training to ensure they could meet the needs of people living at the home. The inspector observed service users being supported by experienced staff. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): YA37, YA39 & YA43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users were not formally consulted about the running of the home. EVIDENCE: The inspector was advised that the registered manager has been in post since 2005 and that recent training undertaken by her included Person Centred Leadership and Administration of Medication. The registered manager was due to undertake further in-house training in the next few weeks. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 21 Service users and their families were not formally consulted about the running of the home. The inspector noted a number of safety certificates issued with regard to the routine maintenance and safety of The Mount. The inspector advised that call point two must also be routinely checked. Due to records not being available it was not possible to ascertain that staff training had been undertaken regarding safe working practices. Health and safety policies and procedures were seen, staff should be signing to say they’ve read and understood pertinent policies, but not all staff had done so. All fire doors were being wedged open on the inspector’s arrival. Records indicated that emergency lighting was last tested in December 2005. The inspector advised that the local fire officer be asked to visit The Mount. Risk assessments were in place, for example for the use of bed rails, however, one had not been reviewed since March 2005. The inspector advised that the risk assessment format did not explain how the risk decision had been arrived at, and that this document format should be reviewed. The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 1 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 1 X X 2 X The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14(1) Requirement The registered person must have a copy of the assessment in order to ascertain that the home can meet their needs. The registered person shall produce terms and conditions in respect of accommodation to be provided including the amount and method of payment of fees. Written care plans describing how each service users needs are to be met must be in place. The registered person shall make arrangements for the recording, handling, safe keeping, administration and disposal of medication. Documentary evidence as described in Schedule 2 of the Care Home Regulations must be kept at the home and be available to the inspector. The registered person shall ensure that persons employed at the care home shall receive training appropriate to the work they are to perform. The registered person must provide evidence of consultation with residents regarding the DS0000040694.V332295.R01.S.doc Timescale for action 30/11/07 2 YA5 5(1)(b) 30/11/07 3 4 YA6 YA20 15(1) 13(2) 28/09/07 28/09/07 5 YA34 Schedule 2 19 18 (1)(c) 28/09/07 6 YA35 30/11/07 7 YA39 24 (3) 30/11/07 The Mount Version 5.2 Page 24 quality if care provided at the home. 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 YA6 YA7 Good Practice Recommendations A photograph should be kept of each service user. Any activities in which service users participate are so far as reasonably practicable free from avoidable risks and risks to service users health and safety are identified and so far as possible eliminated. The registered person should promote and make proper provision for the health and welfare of service users. Make and promote proper arrangements for the health and welfare of service users. The complaint policies and practices should be in accordance with this legislation. The registered person should ensure that by staff training or other measures, to prevent residents from harm, abuse or being placed at risk or harm or abuse. The registered person should ensure that persons employed at the care home shall receive training appropriate to the work they are to perform. The registered person should ensure that persons employed at the care home shall receive training appropriate to the work they are to perform. In this regulation this relates to 1:1 supervision and team meetings. Risks to service users health and safety are identified and so far as possible eliminated. 3 4 5 6 7 8 YA18 YA19 YA22 YA23 YA32 YA36 9 YA42 The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Mount DS0000040694.V332295.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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