Inspection on 30/06/08 for The Mount

This inspection was carried out on 30th June 2008.

CSCI found this care home to be providing an Good 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

The Mount 23/06/09

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

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE The Mount 226 Brettell Lane Amblecote Stourbridge West Midlands DY8 4BQ Lead Inspector Chris Lancashire Unannounced Inspection 30th June 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Mount Address 226 Brettell Lane Amblecote Stourbridge West Midlands DY8 4BQ 01384 265955 F/P01384 265955 shortysue@blueyonder.co.uk 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) Mrs Jenny Green Manager post vacant Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user identified in the variation report dated 21.11.05 may be accommodated at the home in the category DE(E). This will remain until such time that the service users placement is terminated. 6th August 2007 Date of last inspection Brief Description of the Service: 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 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 residents 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. The fees are available on application to the home. The Mount DS0000025043.V367433.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 2 stars. This means that the people who use this service experience good quality outcomes. Two inspectors carried out this inspection between 09.30 and 16.30 hours. The purpose was to assess the home’s performance against the key standards identified in the National Minimum Standards for Care Homes. We did not tell anyone at the home that we would be inspecting that day. We spoke with the owner and several members of the staff team. We also spoke with residents and relatives who were visiting the home. We looked at records, the system for keeping medication safe and some parts of the building. The day of the inspection was the first day of work for the new Regional manager for the company. She was present throughout the inspection. What the service does well: What has improved since the last inspection? Some areas of the home have been decorated and some carpets have been replaced. The owner has obtained additional slings for the hoist and is planning to purchase another hoist, so that residents are lifted safely at all times. The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 6 Care plans are more detailed and this means that staff are more informed about the care which is needed for each resident. There are better records of falls and the action which has been taken to prevent these. The complaints procedure is easier for people to understand. Staff have received further training in areas related to their job. The owners have appointed a Regional Manager for the company who will oversee the running of the home. 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 DS0000025043.V367433.R01.S.doc Version 5.2 Page 7 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 The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. Service users are provided with good information prior to moving into this home. Their needs are assessed and they are assured that these will be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were provided with copies of the Statement of Purpose and service user guide to The Mount. These contained useful information about the home. However, the Statement of Purpose needs to be updated with the current details for contacting the Commission for Social Care Inspection. We looked at files for three people who live in this home and they contained records of when people had been provided with this information. The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 9 The owner described how she would go to visit people who were considering moving into the home and would gather information from other people such as Social Services in order to assess whether the home could meet their needs. We saw records of assessments which had been carried out before admission in each of the files that we sampled. These contained details of each person’s physical and social needs and outlined the ways in which the home would meet these. We saw letters saying that the home could meet the assessed needs and offering people a place. This shows that people are provided with information so that know what the home provides and their needs are assessed to make sure that the home can provide them with suitable care. The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. Service users’ needs are set out in a care plan so that staff are able to meet each person’s needs. Service users are protected by the home’s policies and practice for the storage and administration of medication and they treated with respect by staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We saw care plans on the three files which we sampled. These contained details of each person’s health and social care needs and how they were to be met by staff. These plans had been reviewed on a monthly basis until April 2008, which is when the last manager left the home. The regional manager assured us that now that she is in post, she will make sure that they are reviewed until a new manager is appointed. These plans provide good details for staff about how to care for the people who live in the home. For example, in one person who has visual impairment, it said, ‘‘when entering the room, describe the room layout, the other people in the room and what is The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 11 happening’….‘Tell x if you are leaving and let them know if others are remaining in the room or if x will be alone’. We saw risk assessments for pressure areas, nutrition, continence and falls. There are also details of hospital visits and care provided by other health professionals such as opticians and dentists. A letter showed that the Environmental Services had noted a lack of suitable lifting equipment in the home, but the owner assured us that that she had now sorted this out by purchasing more slings for the hoist. She is also purchasing an additional hoist. The training records show that staff have received training in lifting and handling. There is suitable, secure storage for the medication in the home. Several staff are trained to administer medication and their names are listed in the medication folder. We looked at some old sheets which show the doses which have been given to people and there were some gaps in these. However, the most up to date sheets did not have any gaps. The pharmacist makes regular checks on the home’s medication and the last report did not identify any problems. We saw staff treating the people who live in the home with respect. They knocked on doors before opening them and they knew what each person preferred to be called. The people who we spoke to said that the staff treated them well. One said of the night staff, “I do not sleep well, but they do not disturb me. If am awake they always ask if I want anything or need help with the toilet.” The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Residents have a lifestyle which matches their expectations. They are enabled to maintain contact family and friends and control over their lives. The meals are varied and nutritious and cater for the needs and preferences of each resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We sampled three files and found they contained records of what the residents prefer to do and their interests. We spoke to residents who had recently enjoyed a trip to the Black Country Museum and they showed us photographs of the day. We saw residents sitting in the lounge, the dining room and the garden and some were in their rooms. This showed us that people have a choice of where they spend their time. Residents told us that they like to chat, listen to music or watch the television. Sometimes they like to sing or do exercises. They also enjoy the occasional Sunday church services at the home. Residents told us that there are no restrictions on visiting and that they can entertain visitors where they wish to. One told us, “My family visit me in my room”. There is a small sitting room in the attached bungalow where residents The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 13 may entertain their visitors. There were several visitors in the home on the day of the inspection and they were in different areas. Residents told us that they choose when they get up and go to bed. They are encouraged to handle their own finances for as long as possible. The owner informed us that the home makes information about advocates available to residents and their relatives. The cook told us that she prepares the menus and that the staff keep her informed about the needs and preferences of the residents. She is aware of the needs of people with medical conditions who need specific diets. We saw this information in her folder. The menus show a variety of food and choice at each meal. Residents told us that they enjoy their food and that they may eat where they prefer to. One resident told us that she prefers to eat in her room. Others said that they enjoyed the company in the dining room. If the meals served are different from the menus, this is recorded. A resident told us, “Staff are good at helping residents who need help”. The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. Service users are protected from abuse and they are confident that their complaints will be taken seriously and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure and this is explained in the service user guide. We saw copies of the procedure displayed in residents’ bedrooms. One resident said, “I would speak to (the owner). I use to have a good relationship with the previous manager….but I have no complaints as the staff are very good”. The procedure for referring a complaint outside the home is in the Statement of Purpose and guide but the details need to be amended as the contact details for the Commission for Social Care Inspection have been changed. We spoke with the regional manager who said that she would make sure that this was done. Protection procedures are available within the home including those of Dudley MBC. We saw training records which confirmed that staff attend abuse awareness training. The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 15 The home’s records show that they have not received any recent complaints. An anonymous complaint was made to the Commission for Social Care Inspection. This was concerned with equipment at the home. Another allegation was made regarding medical care and this was referred to Dudley Social services safeguarding. The home cooperated with the investigations which followed. The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The quality in this outcome area is adequate. Service users live in a homely environment, but odour control should be improved. The kitchen is in need of attention and the bathroom needs to be free from clutter. Infection control measures make the environment safer for residents but the necessary equipment needs to be available at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has gardens to the front and rear and off road parking facilities. The front garden looked as if it needed some attention. For example, there were hanging baskets with dead flowers in them. The front door bell did not appear to work. Staff told us that it does not always work and when it does, it can not be heard throughout the home. The interior is homely, with a lounge and separate dining room in addition to a small lounge which is away from the main part of the home and can be used to entertain visitors. Some parts have The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 17 been decorated recently and some of the carpets have been replaced. However, we noticed an odour in the hallway and this needs to be eliminated. We saw that the home looked generally clean. One residents told us, “Staff keep my room lovely and clean. Leave items where I like them”. The laundry is small but located well away from any food preparation area. It has adequate machines for washing and drying. It is provided with two sinks to allow one for staff hand washing purposes as an infection control measure. High-risk areas are provided with liquid soap, paper towels, gloves and hand wash signs. However, we saw staff wrapping a used pad in a disposable apron as the home had run out of bin liners. This could put residents and staff at risk of infection. We saw that the upstairs bathroom was cluttered with chairs, a wheelchair, a laundry basket and clothes hangers, so that it could not be used. Although there are two showers in the home and staff told us that people prefer to use these, the bathroom needs to be cleared so that residents have a full choice of bathing facilities. The kitchen is small and L -shaped. It is difficult for staff to make drinks if the cook is working in there. We saw that the kitchen is in need of deep cleaning, but this is difficult as the floor is lifting by the side of the cooker and the borders on equipment such as the water urn are broken or missing. Cleaning products are stored on a shelf below the sink. The microwave is broken and needs to be repaired or removed. Although this is not a necessary piece of equipment, staff said that they had found it useful for making milk drinks and heating meals for residents who wanted to eat at a different time from the main meal. The records showed that the cooker had been broken for 12 days, but was now in working order. The cooking was done on the hob during this time. The cleaning cloths, mop heads and tea towels all looked worn and these need to be replaced at regular intervals to ensure good infection control. We saw lids missing off coffee pots and teapot lids which did not close properly. The deep fat fryer is used on the hob with a basket. This poses a risk to the user as well as a fire risk and we recommend that this is replaced by a safer version. The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. Service users have their needs met by the staff, who are well trained and competent. Service users are protected by the procedures for staff recruitment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the rota and this showed that there are three members of care staff on duty throughout the day and two at night. There is a housekeeper who works five days a week and a cook prepares the breakfast and midday meals. This means that one member of the care staff is spending time in the afternoons preparing and serving tea. The owner told us that she has advertised for another housekeeper and is planning to employ another cook. There is no manager at present, but the owner spends time at the home undertaking some management tasks. She has made efforts to recruit a suitable manager and continues to do so. We observed the staff during the day and they were busy but remained friendly and attentive to the people in the home. We spoke with several residents and they all praised the staff. Staff told us that they enjoy working at this home. The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 19 This home has a good record for ensuing that all staff have achieved NVQ level 2 or above in care, which means that staff have been assessed as being competent to undertake their work. The training records show that three members of the team have level 3. This is very impressive. We looked at two staff files to assess recruitment processes and found that two written references had been obtained and staff had been checked against the Protection Of Vulnerable Adults list and had a Criminal Records Bureau check carried out. However, on close examination, no reference had been taken up for one member of staff from a previous care employer. This was someone who had been employed several years ago. We brought this to the attention of the regional manager, who said that she was aware of good practice in this area and would ensure that appropriate references are taken up and verified in the future. We looked at the training records and saw that new staff have an induction to the home and do not undertake personal care on their own until this is complete. Staff have been trained in several areas during the past year and further training is planned for 2008, including, manual handling, first aid, health and safety, food hygiene and managing challenging behaviour. This means that residents are looked after by staff who are trained to meet their needs. The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. Processes are in place to ensure that the home is run in the best interests of the residents. Residents’ money is safeguarded by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The previous manager left her post earlier this year. Since then, the owner has been visiting the home regularly and running it with the support of the senior staff. She has made efforts to recruit another one and has recruited a new regional manager for the company, who was present on the day of the inspection and who will oversee the home. The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 21 There is a quality assurance system, which means that there are regular checks on the quality of care provided in the home. This includes details of how the requirements of the CSCI reports have been met. We saw records of regular checks on the environment and different aspects of running the home. There were also questionnaires which had been sent to relatives and other visitors to the home and their comments were positive. The regional manager told us that she plans to improve this system so that it includes more checks in these areas. There are records of visits made under regulation 26, which means that the owner should visit to check that the home is running properly. The regional manager plans to develop these visits further. We saw the records of a meeting held with relatives of residents. This provided them with an opportunity for them to hear about plans and to talk about their feelings about the way the home is run. The home looks after small amounts of money for some of the residents. We checked the amounts held against the records for two residents and found that the records were correct. The money is kept in a safe place and all amounts are receipted and signed for. We saw records of checks on many aspects of the environment such as service records for the hoist, fire equipment tests and lift servicing. All were up to date and this shows that the owners makes sure that the home is safe for residents, their visitors and the staff. We saw risk assessments on residents’ files and records looking at how falls had happened and the action which could be taken to avoid these. Staff training records show that they receive training in first aid. The Mount DS0000025043.V367433.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 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 3 4 5 6 7 Refer to Standard OP1 OP7 OP21 OP26 OP26 OP26 OP19 Good Practice Recommendations The Statement of Purpose and service user guide need to contain up to date information about the home’s staffing and contact details for CSCI. Make suitable arrangements for the care plans to be reviewed and updated on a regular basis in the absence of a registered manager. Make sure that all bathing areas are free from clutter and available to residents. Maintain the kitchen in a state so that it can be cleaned thoroughly. Provide an adequate supply of disposal equipment in order to control infection. Make sure that all kitchen and serving equipment is in a good state of repair and safe to use. Eliminate unpleasant odours so that all areas of the home smell fresh and clean. The Mount DS0000025043.V367433.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 DS0000025043.V367433.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!