Inspection on 07/06/05 for The Mount

This inspection was carried out on 7th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Mount 09/08/07

The Mount 07/08/06

The Mount 09/01/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Mount Main Road Whiteshill Stroud Glos GL6 6JS Lead Inspector Richard Leech Unannounced Tuesday 7 June 2005 14:30 th 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 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 Stationary 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 D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Mount Address Main Road Whiteshill Stroud Glos GL6 6JS 01453 757291 01453 757291 Telephone number Fax number Email 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 Cindy Woodwards, Grapevine Care Ltd Mrs Paula Henderson-Dean Care Home - Personal Care 6 Category(ies) of Learning Disability (6) registration, with number of places The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25/11/04 Brief Description of the Service: The Mount is a care home for adults with learning disabilities who may also present with mild challenging behaviour. It first opened in August 2003. At the time it was registered for up to four people, but a variation has since been successfully applied for increasing the registered numbers to six.The home is a large Georgian property on the outskirts of Whiteshill, near Stroud. It has been renovated to a high standard. There are two bedrooms on the second floor, three bedrooms on the first floor and one bedroom on the ground floor. There are two lounges and a separate kitchen/dining area. Bathroom facilities are either exclusive or shared between two people. The home is set in large, attractive grounds and has views over the surrounding countryside. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began in the middle of a Tuesday afternoon and lasted until about 6pm. The manager was present for the inspection. All of the service users were spoken with during the visit, along with some members of staff. Some records were checked, and most of the building was inspected. The inspector would like to thank the service users, the manager and the staff for their time and help. What the service does well: Service users who may be moving to the home have the chance to visit as many times as they need to. Their needs are assessed thoroughly to help make sure that it would be the right move. Service users living in the home feel in control of their lives and that they are offered choices. They are involved in the day-to-day running of the home and help to make decisions such as about where to go on holiday. The team provide a varied programme of activities in the home and community which are individual and meet each person’s need and interests. The food served in the home is varied and balanced. Comments from service users included that it was ‘nice’ and ‘delicious’. Medication is well handled in the home and staff are competent in this area. Service users feel that they are able to speak openly with staff and the manager, and that they can voice concerns and complaints if they wish to. They are confident that they will be listened to and taken seriously. The Mount is attractively decorated, spacious and well furnished. Service users like their rooms. One person described the Mount as ‘homely’. Service users were very positive about the staff team. Some people described the staff as ‘nice’ and ‘friendly’. One person talked about how well the staff understood them. The home is a safe place to live and work. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 6 What has improved since the last inspection? 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 Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 There is a thorough admission process which helps to ensure that the placement will be appropriate and that the home can meet the person’s needs. EVIDENCE: Since the last inspection one service user has moved into the home. Their file included detailed background information form a variety of sources. A thorough assessment had been conducted by the manager in conjunction with the service user and their family (though this did not appear to be signed and dated). Although the person had moved in relatively recently their file already included detailed information, care plans and protocols (completed in conjunction with the family members and external professionals). The manager said that staff had read the care plans and been given information about a medical condition experienced by the person. A staff member confirmed this. The manager said that the person had visited the home over the course of six months before moving in. The service user confirmed that this was the case. They also said that they had been aware of terms and conditions of living in the home including that the building is non smoking. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 10 Staff support service users to consider options and to make decisions, resulting in them feeling empowered and in control of their lives. Good arrangements are in place for service users to be consulted about life in the home, and service users also participate in the daily running of the Mount. Some shortfalls in the storage of personal information could jeopardise service users’ confidentiality. EVIDENCE: The manager said that she is currently reviewing care plans and condensing them into smaller, working files. Some service users were asked about how they were offered choices, and confirmed that they felt in control of their lives and supported to make decisions for themselves. They described having choices in their daily lives over what they ate and when they went to bed, as well as over issues such as activity programmes. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 10 Staff look after one person’s cigarettes and lighter. There was a risk assessment on file and documentary evidence of the person’s consent to this arrangement. The manager said that service users now each have their own bank accounts and that their benefits go directly into these. They are invoiced for their contributions towards care, and are accompanied to the bank to make withdrawals and other transactions. Some minutes from a recent residents’ meeting provided evidence of wideranging discussion about areas such as holidays, the menu and activities. A survey of people’s views had been conducted. This resulted in very positive feedback about the home. Activity schedules provided evidence of service users’ involvement in the daily running of the home. Service users confirmed that they were happy with their participation in day-to-day tasks such as cleaning and testing the fire alarms. Whilst much of the more personal and sensitive information is held securely in the office, some had been left out in the kitchen in care planning files. The manager said that there are locked away at certain times. However, it was agreed that they need to be locked away securely when not in use in order to protect service users’ confidentiality. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13, 15, 16 & 17 The service users lead active lives through programmes adapted to individual needs and interests. They are supported to access resources in the local community and to get to know the area. Staff support service users to maintain family relationships and friendships. Service users are aware of their rights and their responsibilities, and staff support them to exercise these. The food served in the home is varied and balanced and individual preferences and tastes are accommodated. EVIDENCE: Service users’ activity programmes are presented in a symbol or text format according to each person’s needs. There is an activity board in the kitchen and each person has a personal copy in their room. Activities offered are varied, including pottery, horse riding, sports, art & craft, bowling, computing, music, basic skills and horticulture. Some are in-house whilst many are in different venues in the community. Service users confirmed that they enjoyed their The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 12 activity programmes and felt that they had plenty to do. Some commented that they also had enough time to relax at home. Use is made of facilities and services in the local community. Some people choose to go to church. As noted, service users are supported to go the bank where they oversee their own financial transactions. One person was going clothes shopping on the afternoon of the inspection. Service users confirmed that they are supported to maintain contact with family and friends. One person described how they took the cordless phone to their room for privacy sometimes, and also talked about plans for visiting a friend in the near future. Some people have their own mobile phones. Service users described their involvement in the daily running of the home and also talked about cleaning their rooms and doing their laundry with support. Discussion with service users provided evidence that their rights are respected. For example, they can choose whether to spend time alone in their rooms or to join in activities/socialising downstairs. Some people talked about being able to have a lie-in if they wished to (depending on commitments). Service users indicated that they liked the food served in the home and that their favourite dishes were provided. They also confirmed that alternatives were available if there was something on the menu that they did not like. The menus for three weeks were checked and appeared to offer variety and balance. Special dietary needs are catered for. Fresh fruit and vegetables are available/used. Minutes from a recent residents’ meeting documented positive feedback about the food. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 Systems for handling medication in the home are safe and robust. EVIDENCE: The manager described the close links the home had with the Community Learning Disability Team, particularly in respect of one person’s care needs. Medication administration records appeared to be in order. A monitored dosage system is used and staff have received training from the pharmacy. Since the last inspection the medication cabinet has been moved away from a radiator, although the team still monitor the temperature. Creams and other items are labelled with the date of opening. Service users’ consent to staff administering medication has been obtained and is on file. The manager has checked with the GP whether there is any leeway over the administration of morning medication and obtained agreement for some of them to be administered slightly later to avoid waking the person up unnecessarily (for example, at weekends). The manager has tried to get a copy of the latest BNF but found that they are not readily available. The manager agreed to consider the scope for people to control and administer their own medication within an individual risk assessment framework where appropriate, though it was also agreed that service users should not feel pressurised into doing this and that they may prefer current arrangements to continue. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Service users feel able to voice concerns and complaints, and are confident that they will be listened to if they do so. EVIDENCE: Service users confirmed that they would feel able to raise any issues and concerns with staff and the manager. The home has a complaints procedure which includes reference to CSCI and describes the different stages of a complaint. Symbols and photographs are used. The home has obtained a safe for secure storage of money. A copy of the PoVA guidance issued by the Department of Health has been obtained since the last inspection. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 28 & 30. The Mount provides a high quality environment which is comfortable, clean and homely. Bedrooms are attractive and personalised. Service users benefit from pleasant and spacious communal areas and grounds. EVIDENCE: The home is set in large grounds. Service users described using the garden and outside seating. It has been renovated to a high standard and is homely and comfortable throughout, with good quality fixtures and fittings. Service users expressed satisfaction with their rooms, which are spacious, bright and personalised. A requirement from the last report to address the overuse of multi-socket devices in one bedroom has been met. The manager said that some people have lockable storage space in their rooms, and that other service users have been consulted about whether they would like this facility. The home offers a main lounge and a second lounge/computer room. Communal areas are bright, homely and attractively decorated. There is a kitchen-dining area. Since the last inspection a new fridge-freezer has been purchased. Temperatures are recorded and were satisfactory. The home appeared to be clean and hygienic throughout. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 & 35 Shortfalls in recruitment procedures could put service users at risk through unsuitable carers being employed. Service users in the home benefit from a well-trained staff team. EVIDENCE: In the last report some shortfalls were identified around recruitment. One person had started in October 2004 and used a CRB check dating from April 2004. This was found still to be the case during this inspection. An up to date CRB check must be completed. A further requirement had been made that staff must not start work prior to their CRB being back unless they have a POVAfirst check and two written references and are required urgently (and then only subject to a risk assessment). In two cases during this inspection staff were found to have started work in the home with neither a PoVA-First or a CRB check in place. One person’s employment history was incomplete. They also had only one written reference (the second being verbal), although there had been attempts to chase this up with the referee. It was agreed that a front sheet/checklist for each person’s staffing file would be helpful in order to ensure that nothing is missed. Schedules 2 and 4 could be used a guide for this. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 17 Records provided evidence that staff were generally up to date with core training, and that this had been booked for newer staff. The manager said that they are considering changing their provider for some mandatory courses since they had been unreliable. She also plans to transfer booked and completed training to a large calendar in order that it is easier to keep track of. The manager described plans for staff to undertake NVQs in care to level two or three. Staffing files included evidence of an in-house structured induction. The manager and staff could consider whether there are any additional training needs identified, either individual or as a team, related to conditions experienced by service users. This might for example include input on autistic spectrum conditions and on mental health issues. Some minutes from a recent residents’ meeting reflected positive feedback about the staff. Comments included that ‘ the staff are nice to us’ and ‘absolutely brilliant’. There was also feedback about how people felt that they could talk openly to the staff. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Health and safety is well managed in the home, making the Mount a safe place to live and work. EVIDENCE: The fire log provided evidence that alarms and emergency lighting are being tested at suitable intervals. A fire drill took place on May 6th 2005. Assessments of the risk posed by unguarded radiators have been carried out. Covers are to be fitted in some rooms as a result. The manager said that this should happen during Summer 2005. Records showed that routine checks are made on window restrictors to ensure that they are working. A new table has been purchased for the hall to ensure that a telephone cable is no longer a trip hazard. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 3 3 x 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 4 x 4 x 4 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 1 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Mount Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Version 1.30 Page 20 YES 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. 2. Standard 10 34 Regulation 12 (4) a. 17 (1) b 19. Sch. 2 Requirement Timescale for action 31/07/05 Ensure that all confidential information is securely stored. Conduct a new CRB check for the 30/06/05 person who started in October 2004 and used a CRB check dating from April 2004. Staff must not start work prior to satisfactory CRB clearance unless they have a POVA-first check and two written references, and are required urgently. Undertake a risk assessment and liaise with CSCI in such cases. Ensure that applicants supply a full employment history. Staff must have two satisfactory written references in place before starting work. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. The Mount D51_D03_S62415_TheMount_V231711_070605_Stage4.doc Refer to Good Practice Recommendations Version 1.30 Page 21 1. 2. 3. 4. Standard 2 20 34 35 Ensure that assessments are signed and dated. Consider the scope for service users to control and administer more of their own medication (within a risk assessment and care planning framework). Devise a front sheet/checklist for each person’s staffing file using Schedules 2 and 4 as a guide. The manager and staff could consider whether there are any additional training needs identified, either individual or as a team, related to conditions experienced by service users. This might for example include input on autistic spectrum conditions and on mental health issues. 5. 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