Inspection on 23/06/09 for The Mount

This inspection was carried out on 23rd June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Mount 30/06/08

The Mount 06/08/07

The Mount 27/11/06

The Mount 07/06/06

The Mount 24/10/05

The Mount 14/04/05

The Mount 05/10/04

The Mount 15/04/04

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Maple Lodge

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Breme

Ravenhurst

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Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Random inspection report Care homes for older people Name: Address: The Mount 226 Brettell Lane Amblecote Stourbridge West Midlands DY8 4BQ two star good service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jean Edwards Date: 2 3 0 6 2 0 0 9 Information about the care home Name of care home: Address: The Mount 226 Brettell Lane Amblecote Stourbridge West Midlands DY8 4BQ 01384265955 F/P01384265955 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Jenny Joy Green care home 18 Number of places (if applicable): Under 65 Over 65 6 18 dementia old age, not falling within any other category Conditions of registration: 0 0 The minimum age on admission for dementia category will be from 55 years The registered person may provide the following category of service only Care Home Only Code (PC) To service users of the following gender Either Whose primary care needs on admission to the home are within the following categories Old age not falling within any other category Code OP maximum number of places 18 Dementia Code DE 6 maximum number of places 6 The maximum number of service users who can be accommodated is 18 Date of last inspection Brief description of the care home The Mount is registered to provide 24-hour care and support for 18 people over the age of 65. It does not provide nursing care. The property is a large 2 storey detached Care Homes for Older People Page 2 of 16 Brief description of the care home house situated on Brettell Lane, Amblecote and is easily accessible by public transport. The home has been extended to include a previously detached bungalow. There are gardens to the front and rear and car parking facilities to the side of the house. There are 16 single and 1 double rooms with the majority having en-suite toilet and hand wash basin facilities. Shared space comprises of a dining room, lounge and conservatory. A smaller lounge is also available and may be used when people living at the home have visitors. Access to the first floor is via a lift or main stairway. The home has an assisted bath located on the 1st floor a shower room and a walk-in shower on the ground floor. Care Homes for Older People Page 3 of 16 What we found: We, the Care quality Commission (CQC) undertook this random inspection visit to monitor the safety and well being of people living at the home. The previous registered manager left in 2008 and there had been only temporary acting management arrangements in place. A new acting manager had commenced employment in the week prior to this random inspection. The responsible individual (RI) had also resigned and this post remained vacant at the time of this inspection visit. There was an acting responsible individual but an application to register this person had not been submitted to the CQC. We spent a day at the home and looked at the medication systems, care records, the systems for dealing with complaints and safeguarding people, including staff recruitment. We also looked at how people were supported and given assistance to meet their daily needs. We looked around the premises and spoke to people living at the home, staff and visitors. We looked at a sample of the medication held at the home. We noted that staff had received medication training and were generally knowledgeable. There were some areas of good practice, medication was well organised and administered to people in a timely manner, and records were maintained. Handwritten entries on Medication Administration Records (MAR) charts had in most cases been signed and witnessed by two trained staff, which demonstrated good practice and reduced the risk of errors. There were also photographs with the MAR charts, which reduced the risk of medication being given to the wrong person. A number of areas needed to be improved. There was no up to date specimen signature list for staff administering medication, the homes medication policy and procedure could not be found, and the homely remedies information was a generic statement taped into the MAR (Medication Administration Record) file, this needed to be specific for each person and must be signed by their doctor. The medication regimes in care plans had not been updated and did not contain the same information as the MAR charts. The medication room had no windows and no external ventilation. The room temperature records showed that the temperature was in excess of 25 degrees C. This was confirmed during the inspection visit. This meant that medication was not being stored in accordance with manufacturers guidelines which state medication must be stored below 25 degrees C. This concern had been previously raised and the management had failed to make suitable changes. The medication fridge was not locked and the temperatures were in excess of 8 degrees C. and the management had not taken any action to ensure that refrigerated medication was stored between 2 degrees C and 8 degrees C. Medication not stored at the recommended temperature may fail to be effective in treating the condition it is prescribed for. The records of medication received into the home and medication left over was not consistently recorded. In addition variable dosages such as one or two tablets, 5mls or 10mls were not consistently recorded. This meant that the accurate auditing of Care Homes for Older People Page 4 of 16 medication dispensed in original containers could not be easily carried out. The storage of Controlled Drugs storage no longer met legislation and the management must assess this and provide suitable storage. We looked at the care records for two people and noted that there were no care plans or written protocols for the administration of when and as required (PRN) medication. One person had been administered medication on various occasions; there were no records to indicate why this was administered and what the outcomes were. This was poor practice as staff may administer PRN medication for different reasons that would not always be a benefit to the person. Care plans were not person centred so that there was a clear record of how each persons needs were met individually. There were no care plans in place for the management of dementia. The management could show us monitoring and management strategies for people described as having agitated, aggressive or other challenging behaviours. The daily notes we saw were very basic. The recently appointed acting manager showed us evidence that she had started to audit peoples care records and had already identified some omissions and discrepancies. She told us she intended to talk to staff about accuracy of records. She had reintroduced a key worker system, which was positive. From our observations of people in the home, they looked well presented and dressed appropriately for the weather and to maintain their dignity. A relative told us, its like home from home, wish we had found this home first, staff always make us welcome. We looked at the homes systems to deal with complaints. We saw that there was a complaints procedure displayed in the home and available in the Service Users Guide. Some of the information was out of date. There were no other alternative formats for people who may not be able to read or understand written information. The acting manager told us that there were no written records of complaints since the last inspection, in June 2008. We saw a bound complaints book, commenced January 2001, which did not contain any entries but had several pages torn out. This did not demonstrate that the home was maintaining adequate records. We spoke to a relative and two people living at the home, who told us they had no complaints but could tell the staff or manager if they wanted to complain. The acting manager told us that minor concerns were not currently recorded. This did not demonstrate a proactive and robust approach to the management of complaints. The home had policies and procedures to inform staff about abuse and responsibilities for reporting suspicions or incidents. We saw that there was a programme of safeguarding training and certificates for three staff who had recently attended training. The acting manager told us that additional staff had attended this training and places for other staff had been booked. Information given to us by two members of staff who had received safeguarding training told us that they did not know what to do or where they must report allegations or suspicions of abuse. This could result in people being left at risk. The contact details should be made available to staff, relatives and people at the home so they can directly report any suspicion or witnessed incident of abuse to the lead agency. Care Homes for Older People Page 5 of 16 Information looked at in relation to safeguarding told us that the management of this service had failed to effectively record issues relating to safeguarding allegations. This meant that they were unable to assure us that they had taken action and made improvements to safeguard people living at the home. We looked briefly around the premises and we noted a number of areas of concern. There was a very worn frayed join in the carpet on the first floor corridor. The acting manager took immediate action to organise a temporary repair, whilst we were at the home. The linen cupboard on the first floor landing was unlocked and contained very hot pipe work; this area was used to air clothing. This may pose a risk to people living at the home, the management must assess this and take action to minimise the risk of harm. The premises were not being maintained to an acceptable standard. Work was needed to the untidy garden areas and the flaking exterior paintwork. The interior of the home also needed attention in a number of areas. The management must assess this and develop a programme that shows what actions are to be taken and when. The level of cleanliness and infection control was poor. There was a very stained anti slip bath mat with mould on underside in a bathroom. When the acting manager was shown this, it was thrown away. A shower chair was dirty and needed to be thoroughly cleaned. There was clean laundered linen placed on surfaces in a bathroom. This area was used by the night staff used this area to do the ironing. This did not demonstrate good infection control measures. The small laundry did not have its own supply of disposable gloves and aprons. The management should revise the laundry procedures to reflect good practice guidance in the Department of Health Essential Steps for Infection Control. An unlocked cupboard in a hallway contained various items that may pose risks to people at the home. The acting manager assured us the cupboard would be cleared and secured. Environmental Health Services inspected the kitchen in January 2009 and issued 13 legal requirements and four recommendations. The report indicated that there would be a follow up visit but the home could not confirm whether the Environment Health Officer had agreed that improvements made were satisfactory. The freezer was disorganised and needed defrosting and there were opened food items without date labels, these were thrown away during this inspection visit. The cook, who had only worked at home for few months, felt there was not really enough time for thorough cleaning in her allocated hours. The acting manager had started to audit the premises and taken some actions to improve the environment. There was no written information to confirm maintenance and repairs carried out or what was required. A new handyperson had recently been employed for all the homes, he was employed by a Director of the Company and the acting manager did not know where his personnel records were kept. The newer extension to the home was generally better maintained and provided a pleasant environment for people. Examples were an attractive quiet lounge, the main Care Homes for Older People Page 6 of 16 corridor, with lots of pictures, information and weekly activities on offer, and a display of posters, photos, old records, and light switches for sensory stimulation. Sixteen people live at this home and had a range of different needs. The acting manager was unable to tell us about the primary reason for the admission of these people. It was established that five people required the assistance of two staff to meet most of their needs. There were records that indicated that the night staff were called in the early hours of the morning to assist with people living there. Care staff had other duties in the home such as early morning and tea time catering, and incontinence laundry during the day. There were no allocated hours to ensure that there were suitable activities and social events for each person living at the home. The management must be able to demonstrate that the number of care staff on duty are skilled and trained and in sufficient numbers to meet the needs of those people using the service. There was written information, which showed that there had been considerable movement of staff between homes owned by the company. The management must be able to demonstrate that this does not negatively impact on the needs of people living at this home. The acting manager told us that her hours were usually supernumerary and that she would cover senior care shifts when the need arose. The management must be able to demonstrate that there are robust management arrangements to provide effective leadership and quality assurance monitoring to ensure the health, well being and safety of people living at the home. Three personnel files of staff recently employed were read. The files were organised with a recruitment checklist. The recruitment process was not robust and did not provide safeguards for people living at the home. The application form only requested 10 years employment history, instead of a full employment history; employment gaps had not been explored; one or no references, insufficient information to show that overseas staff were eligible to work in the UK; no job descriptions, or copies of interview questions and answers on personnel files. There was evidence of an in house induction on the staff files, some supervision records and evidence of the Skills for Care Common Induction Standards, which were in the process of being completed. The acting manager will be applying for registration; she had previously worked with older people over a number of years and had achieved a National Vocation Qualification (NVQ) level 4 Care Awards but had not commenced the Leadership and Management skills training. The acting manager had started to carry out some quality assurance checks; these included the fire systems, emergency lights, residents weights, some care files, some staff files, where she had already noted omissions and accidents. There was no evidence that quality audits had been completed previously. Unannounced visits by the management (Regulation 26) to check the management and running of the home had not taken place since February 2009. The senior management Care Homes for Older People Page 7 of 16 must assess this situation and ensure that these are carried out regularly. There have been no staff or residents meetings, these are now planned. Fire records showed that there had been no fire drills at the home since 2007 this may result in poor actions in the event of a fire putting people at risk. We also looked at accident records and Regulation 37 notifications. The acting manager had implemented an accident analysis and evaluation, which would identify trends and risks, which could be controlled or minimised. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 8 of 16 following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 16 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 10 of 16 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 To ensure there are care plans in place for the administration of when and as needed medication and staff act appropriately to monitor and inform the relevant healthcare professionals as needed. This is to safeguard the health and well being of people living at the home. 01/08/2009 2 9 13 All medication must be stored within the temperature range recommended by the manufacturer to ensure that medication does not lose potency or become contaminated. This is to ensure the health and well being of people living in the home is safeguarded. 20/07/2009 3 9 13 All medication must be 01/08/2009 receipted into the home and all Medication Administration Records must be accurately Page 11 of 16 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action completed. This is to safeguard the health and well being of people living at the home. 4 9 13 A Controlled Drugs Cabinet to ensure Controlled Drugs are appropriately stored in compliance with the Misuse of Drugs Act 1973 must be provided. This is to ensure the health and well being of people living in the home is safeguarded. 5 9 13 To ensure that all persons living at the home receive their medication as prescribed by their doctor. This is to safeguard the health and well being of people living at the home. 6 26 13 To ensure that all areas of 01/08/2009 the home are clean and meet the infection control crietria. This is to ensure the health and well being of people living in the home is safeguarded. 7 27 12 To demonstrate that the 01/08/2009 number of care staff on duty are skilled and trained and in sufficient numbers to meet all of the needs of each person using the service. This is to ensure the health Care Homes for Older People Page 12 of 16 01/09/2009 01/08/2009 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action and well being of people living in the home is safeguarded. 8 29 19 To ensure that all staff 01/08/2009 employed at the home are recruited following robust recruitment procedures, with documentary evidence to demonstrate diligent compliance with The Care Homes Regs 2001, Reg 19(1). This is to ensure the health and well being of people living in the home is safeguarded. 9 33 26 The Registered Provider or a 31/07/2009 nominated person must consistently undertake monthly unannounced quality monitoring visits as to the conduct of the home with reports available to the home and CQC in compliance with Regulation 26 of the Care Home Regulations 2001. This is to ensure that the health, well being and safety of people living at the home can be assured at all times. 10 38 13 To devise and implement a 20/07/2009 risk assessment with control measures to minimise the risks of harm to people at the home, for the large cupboard with excessively hot water pipes, on the first floor, used by staff for airing Page 13 of 16 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action laundered clothing. This is to ensure the health and well being of people living in the home is safeguarded. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 All health care risk assessments and care plans should include all of each persons assessed needs, and accurately reflect changes, which should be referred for professional advice where necessary. Carers as well as senior carers should be involved in care planning and completing daily progress records to make them more meaningful. That care plans, monitoring and management strategies should be put in place for people described as having agitated, aggressive or other challenging behaviours with ways to evaluate the effectiveness of strategies and use of PRN medication. That variable dosages such as one or two tablets, 5mls or 10mls should be consistently recorded on the MAR sheet. That there should be an up to date specimen staff signature list for the administration of medication and that staff should sign and date the homes medication policy to demonstrate their awareness and compliance. That homely remedies information should to be specific for each person and must be ratified by their doctor. It is recommendation that Patient Information Leaflets should be obtained from the pharmacist for medication dispensed in blister packs, so that staff have written guidance as to how medication should be administered, what it is used for and to be aware of possible side effects. 2 7 3 8 4 5 9 9 6 7 9 9 Care Homes for Older People Page 14 of 16 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 8 9 9 9 That the homes medication policy and procedure should be readily available. That carried forward stocks of medication are recorded on each persons MAR sheet and random audits of medication stocks should be carried out, with recorded remedial action for any discrepancies. Time for activities, with staff training to ensure appropriate social stimulation should be offered to everyone and especially to people with dementia and sensory disabilities should be made available. That records of all safeguarding investigations and any disciplinary investigations should be recorded and records kept. The telephone numbers of social service departments who support the people living at the home should be available to staff, relatives and each person so that they can report any suspected or witnessed abuse directly if needed. Assessment of how minor repairs are carried out to maintain the environment to an acceptable level should be undertaken. That references should be authenticated with a company stamp or official letterhead. That copies of qualifications claimed should be retained on file and signed by the registered person to evidence that original documents have been seen. That there should be a system to monitor overseas workers records such as the expiry dates of permits to remain and work in the UK. 10 12 11 18 12 18 13 19 14 29 15 38 It is recommended that a copy of the DoH guidance Essential Steps should be used to audit and improve infection control measures at the home. Regular fire drills at frequencies determined by the West Midland Fire Service, should be undertaken to safeguard people living at the home in the event of fire. 16 38 Care Homes for Older People Page 15 of 16 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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