Care Home: Montague Street Care Home

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What the care home does well The home ensures that pre- admission assessments are carried out on all new and potential people with only those who needs can be met, being admitted to the home. The home promotes the rights, participation and independence of the people who use the service. Activities and social/community contact are arranged according to individuals choice. Mealtimes are unhurried and provide staff and people who use the service with an opportunity to socialise. All meals are home cooked. The health needs of the people who use the service are well met with evidence of excellent multi disciplinary working taking place. Staff provide personal support to the people accommodated in such a way that promotes and protects their privacy and dignity. The location and layout of the home are suitable for its stated purpose. All areas of the home are accessible to the people who use the service. The home has a welcoming and homely feel and is free from odours. There is an efficient complaints procedure in place and the homes processes and staff training should protect individuals in the event of an allegation of abuse. The home has a staff team that have the necessary skills and experience to the meet the needs of the current people accommodated. Staff training is on going and is appropriate to the level of needs of the people who use the service. The management and administration of the home is good, with evidence of consideration being given to the opinion s of the people who use the service and/or their relatives. What has improved since the last inspection? There were no previous inspection Requirements or Recommendations for good practise made. What the care home could do better: It is recommended good practise that the staff duty rota is updated to include the job designations of staff employed. Daily fridge and freezer temperatures should be recorded on a consistent daily basis and in line with Environmental Health guidance. Key inspection report Care homes for adults (18-65 years) Name: Address: Montague Street Care Home 28-30 Montague Street Mansfield Nottinghamshire NG18 2PN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rebecca Shewan     Date: 1 1 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Montague Street Care Home 28-30 Montague Street Mansfield Nottinghamshire NG18 2PN 01623651368 01623653253 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.mencap.org.uk Royal Mencap Society care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Service Users shall be within categories LD or LD(E) Date of last inspection Brief description of the care home 28/30 Montague Street is a care home providing personal care and accommodation for 12 adults with learning disabilities in two linked houses. The ages of current peole accommodated ranges from 41 to 86 years. The home is located in a residential area, close to shops, pubs, the post office and other amenities. The entrances provide level access. All bedrooms are single and are located on two floors. A stair lift is provided in each house. There is a small patio providing an outdoor seating area, which is accessible by wheelchair users and there is a small car parking area. The people who use the service are known as Tenants. Each Tenant has a Tenancy Agreement with Places for People, the owner of the building. The rent fees for living at the home are needs based and are upwards of £360.80 per week. These fees do not include hairdressing, private transport or chiropody. Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 12 12 Brief description of the care home Potential new people find out about the service via the internet (Mencap website and CQC reports online), via Placing Authorities, Care Managers, Healthcare Professionals and by contacting the home directly. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place during the morning and afternoon of the 11th August 2009. Incident reports, and the homes Annual Quality Assurance Assessment (AQAA), held by the Care Quality Commission, were read before the inspection. The inspection of the home took six and a quarter hours. A tour of the whole home was undertaken and the Registered Manager, Deputy Manager two staff and two service users were spoken with. Records such as support plans, staff files and medication records were also viewed. Ten people were accommodated at the home at the time of the inspection. Responses to CQC staff and service user surveys were positive in all areas of care and provisions provided by the service. Care Homes for Adults (18-65 years) Page 6 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Adults (18-65 years) Page 7 of 25 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides detailed information to prospective new people and their family/representative, allowing them to make an informed choice about their admission to the home. There are appropriate processes in place for assessing potential new people to be accommodated, with services being offered to only those whose needs can be met. Evidence: We observed that the Service User Guide and Statement of Purpose are provided to all new and existing people who use the service and that these documents were found to be comprehensive in detail. From documents viewed and discussions held we observed that the homes Registered Manager and/or Deputy Manager carry out pre- admission assessments. Records viewed provided evidence that the home also obtains a copy of a care management assessment from a placing authority where these exist. We observed that there is a clear Admissions procedure/policy in place. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals support plans are comprehensive in detail and are suitable for meeting the needs of the person who uses the service. Risk assessments are satisfactory and encourage the person who uses the service to maintain their independence. Evidence: We observed a sample of individual support plans and it was noted that these were comprehensive, detailed in content and covered all aspects of the individuals needs and limitations. We observed that support plans allow the assessor to gain a good overview of individuals medical, social and personal care needs. We evidenced that support plans are devised with the involvement of the person using the service and are written in a format that is user friendly. Monthly support plan reviews were also evidenced. Support plans viewed reflected the individuals wishes and detailed how the home Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: assist the individual to make decisions about their lives. We observed that the staff of the home work with the people who use the service, in order to assist them to meet their physical/medical needs, as well as personal aspirations and goals that are within their limitations. The Support plans viewed were seen as an up to date working tool used by the individual and all involved staff. We observed that th support plans can be easily used by people who are not familiar with the individual to deliver a personalised and consistent person centred service. We observed that staff are fully committed in supporting individuals to lead purposeful and fulfilling lives as independently as possible. People using the service make their own informed decisions and have the right to take risks in their daily lives. We looked at the records of all accounts held and found that they were well maintained and we observed that separate lockable tins were utilised for storage of individual accounts. The Deputy Manager reported that the home does not take any responsibility for any of the individuals other finances and that most people have family, friends or representatives who protect their financial affairs. We observed that people who use the service are encouraged to participate in the day to day running of the home. We observed the records of weekly formal house meetings that are held for the people who use the service. We observed that suitable risk assessments were in place. On occasions due to the nature of the individuals limitations, it becomes necessary to restrict/limit choices and decisions. We observed that the need to balance rights against health and safety is kept under constant review by the staff of the home. We observed from records viewed that behavioural charts are also maintained and any limitations that behaviours may have on an individual are recorded and actioned. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals programmes are varied and provide ample opportunities for personal development. The home provides good social, cultural and recreational facilities, including specialist diets to the people who use the service, whilst respecting their choices and wishes. Evidence: We observed that the people who use the service are encouraged to attend college courses and to attend day centres in the local area. We observed that programmes are designed to keep individuals active through the day but there is ample leisure time in the evenings and weekends. The Deputy Manager reported that at the present time there are no individuals in active employment. Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: Records viewed and discussions held confirmed that the people who use the service are able to access the local community. The religious wishes of individuals are observed and arrangements are made to allow people to attend places of worship, records viewed provided clear information about how peoples religious needs were met. We observed that contact with family and friends is positively encouraged with visitors being able to attend the home at any time and in accordance with the wishes of the person accommodated. We observed that the people who use the service have access to all areas of the home to ensure that they have freedom of movement. Records viewed provided evidence that people are called by their preferred choice of address. Individuals, with or without assistance, conduct household chores/tasks, we observed that such tasks are appropriately assessed and agreed in the individuals care plan. We observed the home menus and noted that they are devised on a four weekly basis. The Deputy Manager confirmed that every other fortnight each house group are asked to devise a menu. We observed that medical, therapeutic or religious diets are provided as needed. Mealtimes were observed to be unhurried and a time for social interaction amongst staff and People who use the service. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are offered excellent provisions of health care and personal support by the home. Medication procedures ensure that all necessary precautions are taken to ensure errors do not occur and that medications are stored and administered safely and effectively. Evidence: We observed that personal support that is offered, is given in such a way as to promote and protect the persons privacy and dignity, whilst promoting their independence. We observed that staff respond appropriately and sensitively in all situations involving personal care, ensuring that it is conducted in private and at a time and pace directed by the person receiving the care. Records viewed provided evidence that there is a Key Worker system in place. It was observed that staff had good relationships with the people accommodated and were respectful of their privacy. From the records sampled and from discussions with staff, it was evidenced that the health needs of the people who use the service are well met, with evidence of good Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: multi disciplinary working taking place. We observed the home has established good relationships with Healthcare Providers and Health Advisory Services. We observed that the home has good, clear procedures in place for the monitoring and recording of all drugs administered and those entering and leaving the home. We noted that the home has developed an efficient medication policy, procedure and practice guidance. We observed that staff all have access to this written information and understand their role and responsibilities. Quality assurance systems were observed and we found that they confirm that policy is put into practice. The stores for medication were viewed and these were found to be maintained in a clean and orderly manner. There were no Controlled Drugs being held by the home at the time of the inspection. We observed that the home has stringent checks in place to further ensure that medication errors do not occur. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a robust and efficient complaints procedure, whilst the homes procedures, processes and staff training should protect individuals in the event of an allegation of abuse. Evidence: We observed that the home has a comprehensive complaints procedure in place. Records viewed and the homes AQAA provided evidence that the home has received one complaint in the last twelve months, which was addressed appropriately by the Registered Manager. From staff files viewed we observed that both Criminal record Bureau (CRB) and Protection of Vulnerable Adult (POVA) checks are carried out on all new staff. We observed that staff have attended training in the Safeguarding of Vulnerable adults, this was evident from the staff files that were viewed. We observed that staff have ready access to the Multi Agency Safeguarding vulnerable Adults Procedures. Records viewed and the homes AQAA provided evidence that the home has raised one Safeguarding Adults alerts in the last twelve months, which is currently being investigated under the muliti agency procedures. Care Homes for Adults (18-65 years) Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides accommodation for the people who use the service that is appropriate, well equipped, safe, hygienic and odour free, whilst infection control procedures are adhered to at all times. Evidence: We observed that the location and layout of the home are suitable for their stated purpose. The home has a friendly, relaxed atmosphere and we evidenced that all areas of the house, including the patio area of the garden, are accessible to the people who use the service. Records viewed provided evidence that there is an infection control policy in place and that staff are trained in infection control procedures. Staff were observed adhering to infection control procedures. We evidenced that the house was clean and odour free throughout, that there is a daily cleaning schedule and that appropriate laundry facilities were in place. Fridge and freezer temperature records were viewed and we observed that there were some entries missing for the weekend periods. The Deputy Manager reported that the Environmental Health Officer highlighted this as an area of concern in their report of three months ago. Care Homes for Adults (18-65 years) Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a staff team that have the necessary skills and experience to the meet the needs of the people who use the service. Staff are appropriately trained and supported to conduct their jobs effectively. Evidence: We observed that a competent staff team meets the needs of the people who use the service. We saw that there is a clear staff rota in place, which details staff hours of working. We observed that the duty rota does not include staff job designations. The home has a permanent staff team the Registered Manager, Deputy Manager, fourteen Support Workers and a Cleaner. The Deputy Manager reported that eight Support Workers are trained in National Vocational Qualification (NVQ) level 2 or 3 in care, whilst a further four Support Workers are undertaking NVQ training. This was also confirmed in the homes AQAA and from the staff training records viewed. Staff recruitment files were viewed and it was evidenced that these files contain all items required under the Care Homes Regulations 2001. We observed that the home Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: has an Equal Opportunities policy in place and is an equal opportunities employer. Individual staff training files were viewed and it was evident that staff have received training in Induction, Health & Safety, Food Hygiene, First Aid, Protection of Vulnerable Adults, Infection Control, Fire Safety, Moving and Handling and Medication. The staff induction-training package was viewed and this was found to be comprehensive in content. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is good, with evidence of consideration being given to the choice and opinions of the people who use the service. The health, safety and welfare of individuals accommodated and staff is protected at all times. Evidence: The Registered Manager has many years experience of working with younger adults, has achieved NVQ level 4 in Health and Social Care and the Registered Managers Award. Staff spoken with said that the Manager was always friendly, approachable and pro active. We observed that the home has a Quality Assurance Procedure in place and that effective quality audits have been conducted in the last twelve months. Records viewed confirmed that Regulation 26 visits are carried out by the Registered Providers. Records of staff and House meetings were viewed and there was evidence of actions Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: taken to address any issues raised. From the AQAA provided by the home and from records viewed it was evident that fire drills, fire alarm testing and fire equipment checks, water checks and Portable Appliance Testing (where applicable) had been carried out within the last twelve months. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 30 32 That fridge and freezer temperatures are recorded on a consistent daily basis. That job designations are clearly recorded on the staff duty rota. Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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