Inspection on 09/08/07 for The Mount

This inspection was carried out on 9th August 2007.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Mount 07/08/06

The Mount 09/01/06

The Mount 07/06/05

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 Gloucestershire GL6 6JS Lead Inspector Mr Tim Cotterell Unannounced Inspection 9 and10th August 2007 09:30 th The Mount DS0000062415.V339035.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 DS0000062415.V339035.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 DS0000062415.V339035.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Mount Address Main Road Whiteshill Stroud Gloucestershire GL6 6JS 01453 757291 01453 757291 grapevinecareadmin@gmail.com 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) Grapevine Care Ltd Mrs Sonia Marie Rimmer Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That 1 service user with learning difficulties and an underlying mental health need is accommodated until such time as this is no longer required. 7th August 2006 Date of last inspection Brief Description of the Service: The Mount is a care home for adults with learning disabilities who may also present with mild challenging behaviour. The home opened in August 2003. At the time it was registered for up to four people, but a variation was successfully applied for, increasing the registered numbers to six. The home is a large, renovated Georgian property on the outskirts of Whiteshill, near Stroud. There are two bedrooms on the second floor, three on the first floor and one bedroom on the ground floor. There are two lounges and a separate kitchen/dining area. The home is set in large, attractive grounds and has views over the surrounding countryside. Prospective service users and others involved in their care are provided with information about the home including a copy of the Statement of Purpose and Service Users Guide. The manager reported that the fees averaged just under £1000 per week. Further information about what is covered by fees is in the Service Users Guide and terms & conditions document. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This was an unannounced inspection undertaken over two visits. During the visits the Registered Manager was present and all staff who were on duty were seen individually. Staff were seen as competent and caring and having a good understanding of the needs of the residents. All of the accommodation was seen and found to be in good decorative order and appropriately furnished. The resident survey which was returned to the Commission said that they enjoyed the activities in the home and the ability to have time with one member of staff. What the service does well: All of the residents were seen and spoken to and it was clear that they were happy in the home and had an excellent relationship with staff. Their comments included- “I enjoy living here staff are very nice” and “ we are able to talk to staff at any time and they always listen”. The record keeping was good and the proposed introduction of a new planning format will provide more information and a greater opportunity for residents to comment on the planning of care. The home provides a home where needs and wishes are met for each individual and residents are able to develop lifestyles that are planned and appropriate for them. The residents see the home as “their home” and the Inspector felt that this has been achieved through the support and guidance of staff who have allowed residents to take responsibilities for some aspects of their day-to-day lives, e.g. what they eat and how they spend their day. During the visits residents were engaged in a number of activities in the local community, e.g. visits to the local leisure facilities and it was evident that they enjoyed them and the company of the staff who provided the support. Staff were seen to provide a flexible service which helped them to respond to individual needs. Residents enjoyed deciding how they should spend their time in a home which respected their privacy and dignity. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 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 summary of this inspection report can be made available in other formats on request. The Mount DS0000062415.V339035.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 DS0000062415.V339035.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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The procedures for the pre-admission assessment ensure that individual needs and wishes are identified EVIDENCE: There had not been any admissions since the last inspection. The inspector discussed the admission procedure with the registered manager and looked at the format used by the home. It was clear that considerable time and effort was given to ensuring there is a comprehensive assessment before any admission, and that prospective residents are able to see and experience the home before any final decisions about admissions are made. The question of mental health needs was raised and the registered manager will now review the matter to determine how they are assessed ,before an admission, and if the present assessment form is appropriate. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 9 It is essential that all new residents have a formal assessment; this includes admissions from other homes in the Company which runs The Mount. It may be appropriate for the registered manager to receive formal training in the “assessment of need”. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 10 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): s.7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is introducing a more comprehensive care-planning format that will provide a better picture of the needs and plans of the residents. Responsible risk taking is encouraged and residents are involved in the day-today decisions, which affect their lives. EVIDENCE: The home has a plan of care for all residents and this refers to physical needs and the management of certain behaviours. There are also risk assessments and there was evidence of review in the examples seen. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 11 The registered manager advised the inspector that all residents will soon have new plans of care and that they will be based on a wider view of the needs and plans of the resident. The new format for care planning is based on the model “Personal Planning” and will enable residents to formally comment on matters which affect them, and influence how the home will meet specific needs. It will also allow other parties e.g. parents and health professionals to be included in the plan. The home also completes an annual review of the plan of care, which is usually managed by the sponsoring authority. The registered manager had recently contacted the local advocacy scheme as there was an issue with a resident where conflicting views about what should happen had complicated the matter. To ensure the views and needs of the resident were presented by someone who was seen as “independent”, an advocate was appointed. The home is to be commended on taking this action as it will improve the independence of the view and ensure the decision is based on what the resident would have wanted. Two of the existing care plans were seen and there was evidence of a monthly review, which is completed by the manager. The staff in the home encourage responsible risk taking and the written risk assessments were seen. One member of the care staff is looking at the opportunities for “sheltered employment”, and the safeguards of an adequate risk assessment will ensure that any associated risks are minimised. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 12 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): 12.13.15.16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Flexible routines in the home enable residents to enjoy an active life style with support to maintain links with families and the community. The residents enjoy a varied and flexible menu which responds to individual tastes. EVIDENCE: One member of staff has particular responsibility for activities and this includes any form of employment. The residents are continually assessed to determine if they can be employed and the home is at present pursuing one avenue, which is managed by an agency of Gloucestershire County Council (Gloucestershire Industrial Services). It was evident , after talking to the The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 13 member of staff, that a comprehensive assessment will be undertaken to ensure the proposed placement is appropriate. The local college and various activity centres are used and where support was appropriate this was readily available by the staff. The residents were seen as having a busy and varied programme and the weekly activity sheet indicated the individual activities for each resident. All of the residents were seen and spoken to and it was clear they enjoyed the various activities and that everything was being done in an attempt to meet their individual needs. Staff were seen to discussing proposed trips with the residents and the inspector saw them as attentive listeners, providing ample time and oppoportunity to ensure residents views are known. People’s rights are respected, helping to contribute to a culture where they are valued and treated as individuals. A varied, balanced diet is offered which includes individual preferences, contributing to people’s health and wellbeing. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 14 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): 18.19.20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The healthcare needs of the residents are met by supportive and competent staff, ensuring their well being. EVIDENCE: The home manages all medication and there was a record of the receipt, administration and disposal of any unwanted medicines. All staff are being trained through an accredited scheme for the administration of medicines, and there was evidence that the medication is reviewed by the doctor or consultant annually. The training for emergency procedures in the event of a seizure is ongoing, and if the home does not have a suitably competent person on duty to administer the emergency medicines they are instructed to contact the NHS emergency services. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 15 The personal support provided by the staff was seen as sensitive and flexible to meet individual needs. All staff who were on duty during the two days of the inspection were seen individually responding to the needs of the residents, and the inspector was impressed by the care, patience and flexibility provided by the staff. The records indicated that getting up and going to bed times were determined by residents and that the day provided flexibility and support to ensure the service was based on the needs of the residents, as opposed to the organisational needs. It is recommended that staff receive “infection control” training. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 16 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): 22. 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a caring and friendly environment where concerns are received in a sympathetic manner and dealt with informally and without delay. Staff were clear about identifying the many forms of abuse which contributes to ensuring a safe environment for residents. EVIDENCE: The home has a written complaints procedure and this is in a written and pictorial format. The atmosphere in the home was relaxed and pleasant and the inspectors view was that vulnerable residents live in an environment where they are listened to and if they had concerns they would be able to raise them in an informal manner. The residents who were able to talk to the inspector confirmed that they felt safe and that they could easily raise issues if they felt they needed to. They saw staff as supportive and caring and would not be afraid to comment on matters, which affected them. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 17 Staff have now attended training in the identification of abuse which was provided by Gloucestershire County Council and it is anticipated that further training will be available to all staff. The home had not had any formal complaints since the last inspection. The inspector felt that the residents lived in a safe and caring environment where all forms of abuse were recognised by staff. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 18 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): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has been maintained to a good standard and provides an appropriate and comfortable physical environment EVIDENCE: All of the accommodation was seen by the Inspector. The accommodation has been maintained to a good standard and provides an appropriate and comfortable physical environment. There are however, two areas which requires attention. They are – The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 19 1) the bathroom floor on the first floor. If this cannot be cleaned it should be replaced. and 2) the entrance to a bedroom (D) needs repairing and repainting. The outside areas have been well maintained and provide a pleasant alternative for the residents. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 20 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): 32.34.35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff in the home were seen as caring and competent with the skill of being able to offer time to listen to the residents. They had a good understanding of the disabilities and were providing a stimulating environment. EVIDENCE: All of the staff who were on duty during the two visits were seen individually. The care staff seen were either undertaking, or had completed NVQ studies at levels 2/3 and had a good understanding of the needs of the individual residents. They were seen to listen attentively to the residents and were very patient and understanding when working with demanding and vulnerable residents. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 21 In view of the “disabilities” of the residents it is recommended that further training in “autism” be provided for the care staff. The staff had an excellent relationship with residents and it was evident that staff saw their needs as paramount. The registered manager meets with staff on a monthly basis and there is a record held. Details of the last recruitment were seen and they included an application form, references and a health check. The registered manager was aware of the requirements when appointing staff. The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 22 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): 37.39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was seen as well run, with supportive Providers and a competent and caring Registered Manager. The proposed quality assurance system will further increase the ability for residents and relatives/health care professionals to comment on the type of service they need. . EVIDENCE: The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 23 The Registered Manager has recently completed the Registered Managers Award and will now undertake NVQ 4 studies in Care. She was appointed in 2006 and continues to make improvements in the service. The first priority has been to review the policies and procedures and this is progressing well. There is a clear management line between the Registered Manager and the providers and there is good communication and support provided. The home is to introduce a quality assurance tool through a questionnaire which will be sent to relatives and health care professionals and the home will consult with everyone before its introduction. The Regulation 26 visits are being completed and the person who is undertaking these was seen and spoken to during the inspection. The health, safety and welfare of the residents is seen as paramount and a risk assessment has been completed on the building. The night fire procedure was discussed and it was recommended that the procedure is tested to ensure it is effective. The fire equipment and call points are tested and recorded by a competent person and the Registered Manager will confirm that the emergency lighting is also being inspected. It it recommended that the Registered Manager receives some formal training in respect of risk assessment The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 24 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 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 3 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x The Mount DS0000062415.V339035.R01.S.doc Version 5.2 Page 25 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 YA24 Regulation 23 Requirement Address the issues about the environment noted in the text i.e repairs to bathroom floor and entrance to identified bedroom on the first floor. Timescale for action 30/10/08 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 YA19 YA42 Good Practice Recommendations The home should ensure staff are trained in “infection control”. The home should ensure the night evacuation procedure is effective. 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