CARE HOMES FOR OLDER PEOPLE
The Mount Elderly Persons Home 136 Tennyson Road Luton Bedfordshire LU1 3RP Lead Inspector
Andrea James Unannounced Inspection 31st January 2006 10:00 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 Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 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 Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service The Mount Elderly Persons Home Address 136 Tennyson Road Luton Bedfordshire LU1 3RP 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) 01582 723944 Luton Borough Council Mrs Susan Stevens Care Home 40 Category(ies) of Dementia - over 65 years of age (40), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (40) The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. No of residents: 40 Gender: Male and female Age: 65 upwards Category: Older people with Dementia and Service Users who are over 65 years of age (OP and DE(E)). Date of last inspection Brief Description of the Service: The home is situated on the outskirts of Luton, but still not too far from the city centre. Public transport did not stop close by and the home had to rely on other forms of transport. The size of the home affected the provisions positively as it was relatively easy to bring in additional services such as a GP, dentist, chiropodist, hairdressers, physiotherapist, district nurses etc. The home was in a building on three floors and the first two floors were used for residential purposes. The third floor was used for teaching computer courses and was not a resource used by the home. The building also housed a day centre that some service users attended along with service users from the wider community. The day centre was designed to accommodate 12 service users providing various activities. The manager also over sees the project but employed two staff to run the centre on a day-to-day basis. The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place over a 4-hour period. A partial tour of the home took place and staff, service users and visitors were spoken to. The focus of the inspections undertaken by the Commission for Social Care Inspection (CSCI) is based upon outcomes for service users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that needs further development. The main method used in the inspection was “case tracking” which involved selecting a sample of service users and tracking the care they receive through there view of their records, discussion with them, the care staff, relatives and the observation of care practices. This inspection report additionally addresses specific areas where requirements and or/ recommendations were identified at the previous inspection in August 2005. It is important to note that because this was the second inspection of the inspection year, some standards were not assessed because they were assessed and met at the last inspection. What the service does well: What has improved since the last inspection?
The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 6 Since the last inspection better security systems have been installed to ensure care staff were aware of who they were allowing to enter the service users home. The home had recruited an activities co-ordinator who appeared dedicated to improving stimulation and motivation offered to the service users. The manager had removed some service users carpets and replaced them with more suitable flooring in order to eradicate offensive odours in the home. On the day of the inspection no offensive odours were identified. The manager said this was also due to the dedication of the 3 domestic staff employed in the home. The home had 5 vacancies and as a result the level of staffing was sufficient to meet the needs of the service users. Staff spoken to said they felt the current staffing levels was sufficient to meet the needs of the present service users. The home had 6 care staff on shift and the manager had recently recruited an additional 5 care staff. The average number of agency had been reduced since the last inspection. Three service users within the home with high needs had been reassessed, and were due to leave the home in the forthcoming weeks, to another establishment who could better meet their needs. Improvements have been made to the reviewing of service users care plans. Several bedrooms and bathrooms had been redecorated and improved to ensure the comfort and safety of the service users. The front door was replaced to enable better access for disabled service users. The home had also received new net curtains throughout. What they could do better:
The manager had made significant efforts in improving the standards of décor within the home but further development was needed to be made to several areas of the home namely in the communal areas. Some carpets were also identified as needing replacing. Arrangements should be made to ensure that meals to be transferred to service users are done so as to maintain the temperature of the meal until it is given to the service users. The home needed to make improvements to their monitoring system to ensure regular monitoring of service delivery is carried out and improvements made where identified. Their was a need to replace or make good the dining tables used by the service users as the current ones used were worn and the protective varnish removed,
The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 7 which could cause a build up of bacteria to remain on the tables used for servicing service users at meal times. The Commission would like to thank the service users, care staff, relatives and manager for their co-operation in the inspection process. 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 Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 8 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 Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4. Service users and their representatives were provided with sufficient information that enabled them to know that the home would be able to meet their needs, as a result service users needs were adequately met and service users were happy in the home. EVIDENCE: A new admission to the home said she felt the home was able to meet her needs. Relatives spoken to said they were very impressed with the homes’ ability to meet the needs of the service users. The home had satisfactory assessment procedures in place and the manager was able to assess the needs of the service users prior to admission. Some service users were receiving reassessments to identify if the home could still meet their needs. The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11. The service users needs were set out in an individual plan and the personal, social and health care needs were generally well met. The medication at the home was satisfactorily maintained and the service users privacy and dignity was upheld, as a result good care practices were in place for service users. The system for ensuring service users wishes regarding their wishes concerning terminal care and arrangements after death was not robust. EVIDENCE: The assessment tools and care plans were specific in terms of the relationship between assessment and care planning with clear instructions for care staff to follow. The care plans and evaluations seen showed that health care needs were being met. The files seen also had various risk assessments for service users. These also ensured that service users privacy and dignity was maintained. Service users spoken to said they were treated with respect as to activities, the time they went to bed and the meals they chose to have. The home did not have a record service users last wishes. The information needed to be incorporated into the assessment documentation and kept with the plan of care.
The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 11 The medication policies and procedures were satisfactorily maintained within the home. The manager had identified that in order to maintain satisfactory stock control of medication a better system of storage of medication was needed, as a result the home was due to have a bigger medication storage system in place. The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 and 15. Improvements were noticed for service users wishing to participate in social activities, they were encouraged to exercise some choice and the meals offered were wholesome and provided a balanced nutrition enabling the service users to have live a fulfilled lifestyle. The presentation of meals to some service users could be improved to maintain appetite and nutrition. EVIDENCE: The home had recently recruited an activities coordinator who appeared dedicated to meeting the social needs of the service users. Service users were observed drawing and painting and when asked they said they enjoyed the activities. The home manager had also identified a room on the ground floor where service users could use solely for the purpose of activities and which she hoped would encourage those service users on the ground floor to participate. There were several service users who still needed to be motivated but the home was aware of these needs and had plans to address them. The home encouraged service users to engage in religious activities of their choice and were able to participate in Holy Communion if required. The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 13 The service users spoken to said they were able to have regular visits from their relatives and several relatives visited the home during the inspection. The home provided satisfactory balanced and nutritious meals that offered choice, using a 4-week menu plan. The meals were served in various forms to enable digestion to service users. It was disappointing to see that some service users received their meals at a cooler temperature because it was taken and left on unheated trolleys before the service users were seated or the tables were prepared. It took an average of 25 minutes before the meals were served to the service users. The staff member explained that the meal could be reheated but the contents of the meal once reheated would be unpalatable. The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were assessed and met at the last inspection. EVIDENCE: The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,23,25 and 26. The environmental standards in the home had improved which resulted in service users receiving better standards of living conditions both communally and in their individual bedrooms. The home was clean and free from offensive odours. EVIDENCE: The manager explained that several bedrooms had received redecorations and only two remained to be completed. The bedrooms seen appeared to have been of a high standard. On the day of the inspection one bathroom on the ground floor was also redecorated to include better showering facilities for service users. The manager explained that the programme in place was also to redecorate communal areas. The home also had a new front door and various net curtains and flooring were replaced. There were still further decorations to be carried out but the home should be commended on the efforts made to modernise the environment to benefit the service users. The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 16 The home had employed an extra ancillary staff and was dedicated to ensuring good hygiene standards, on the day of the inspection no offensive odours were identified. The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 and 30. The home had a good core of staff that remained dedicated to meeting the needs of the service users in ensuring their safety. They were also trained in meeting the changing needs of the service users. EVIDENCE: In the last inspection the staffing levels were strained in meeting the needs of the service users of which several had high needs. The home had 6 vacancies and another 3 service users were being reassessed to be re-homed which would result in more proportionate working levels of staff to service users. The home was also using less agency staff to cover their shifts but was still reliant on agency cover for sickness and annual leave. The home ensured service users were in safe hands by ensuring their safety and security at all times. The home continued to train the staff in various aspects to ensure they are equipped in meeting the needs of the service users. The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36 and 38. The service users lived in a home that was effectively managed and satisfactory health and safety procedures were implemented, there was however some concerns about future developments that would infringe on the manager’s time. The quality assurance systems also needed further development. EVIDENCE: The manager continued to provide good leadership and vision for the team. The staff and relatives spoke positively about her attributes. They felt she was supportive and offered good care to the service users. The organisation is due to expand the day care centre and it was of concern that the manager could be asked to manage this facility which would impact on the time she spent managing the home.
The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 19 The staff continues to receive support from the management team through regular supervision and appraisal systems. Health and safety procedures were satisfactorily maintained in the home. The home needed to improve their quality assurance systems in accordance with the regulations of the standard. The manager said they had sent out questionnaires to GPs, relatives and staff but the information was not yet collated. There were no annual development plans available and as a result the home was not able to demonstrate how they monitored the service delivery to the service users. The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 20 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 x x x 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x 2 x x x 3 x 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x x 3 x 3 The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? No 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 OP11 Regulation 12 (1) (a) Requirement Arrangements must be made to ensure the wishes of all service users are recorded to include terminal illnesses and their wishes in the event of death. All main meals served to the service users must be of a certain temperature that will enable service users to receive good eating pleasure and maintain nutritional balance. Arrangements must be made to replace or make good the existing dining tables used by the service users for meals. Effective quality monitoring systems must be implemented in the home to ensure satisfactory service delivery is maintained. Timescale for action 30/03/06 2. OP15 16 (2) (i) 30/03/06 3. OP19 23 (2) (b) 30/04/06 4. OP33 24 (1) (a) (b) 30/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations
DS0000032878.V281587.R01.S.doc Version 5.1 Page 22 The Mount Elderly Persons Home 1. 2 Standard OP19 OP31 The redecorating of the home should include communal areas and the replacement of worn carpets. Arrangements should be made to ensure the manager is given sufficient time to manage the home. The Mount Elderly Persons Home DS0000032878.V281587.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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