Care Home: Mostyn Lodge

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What the care home does well The home provides a small "like a family" home and staff clearly have a real commitment to provide care of a good quality and having an understanding of the individuals health and social care needs. Individuals we spoke with were all very positive about the care they receive and the environment of the home. "The home provides me a safe environment which I am happy in". One individual told us "this is my second home" and another said "the home is very caring and I get all the help and care I need". There is a stable group of staff who have worked in the home for a number of years and this helps in providing continuity of care for individuals who live in the home. What has improved since the last inspection? We made a number of requirements at our last inspection and we looked at these on this inspection to see if the home had addressed the issues we had raised with them. We found that changes had been made with staff receiving the training they need to perform their role and responsibilities and improvement in record keeping.Mostyn LodgeDS0000008156.V377384.R01.S.docVersion 5.2 What the care home could do better: We have made a number of requirements as a result of this inspection of Mostyn Lodge. Firstly the home must make proper provision for the storage of controlled drugs through the use of separate controlled drug cupboard. This is a legal requirement. Where there have changes to individual medication and staff write these changes on the individuals record sheet they must sign so that there is clear evidence of individual who is authorising the changes. We would also suggest as good practice that any changes to medication be recorded in the individuals care plan perhaps using a Medication Care Plan, which also sets out the medication the individual is receiving, the reasons and any possible side effects. Care Planning would also be improved with more information about the individual in terms of routines likes and dislikes, personal history this would make the care plans more person centred and individualised. We have made a requirement about the recruitment practice of the home in that there must be more rigorous selection of prospective employee specifically through the taking up of references from previous employers. It is not sufficient to only have personal references in that they do not have the same legitimacy they must be from employers wherever this is possible. This also acts in helping to protect individuals who live in the home in that through such procedures the employer can make a more informed decision about the suitability of the applicant. We have also made two recommendations firstly there should be a clear choice of main meal available to individuals and secondly where meals are pureed this should be done in the accepted manner with each part of the meal being pureed separately. Key inspection report CARE HOMES FOR OLDER PEOPLE Mostyn Lodge 2 Kelston Road Keynsham Bath & N E Somerset BS31 2JF Lead Inspector John Clarke Key Unannounced Inspection 29th July 2009 09:30 DS0000008156.V377384.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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 older people 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. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 2 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 Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mostyn Lodge Address 2 Kelston Road Keynsham Bath & N E Somerset BS31 2JF 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) 0117 9864297 0117 9869473 Mr Arthur Gent Mrs Jill Clarke Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 16 persons aged 65 years and over requiring personal care only. 19th July 2007 Date of last inspection Brief Description of the Service: Mostyn Lodge has been a registered care home since 1985 providing care and accommodation for up to 16 older people. It is an adapted property over two floors with stair lift to 1st floor. All rooms are for single occupancy and are of a good size some being over the minimum standard of 10 sq metres. None of the rooms offer en-suite facilities however all room are close to bathrooms and toilets. There are two lounge areas one being a quiet lounge overlooking the rear garden and patio area. There is a separate dining area. The home is situated close to the centre of Keysham but not within walking distance. Mostyn Lodge offers a small, homely environment described by one resident as lovely, couldnt find a happier place and another couldnt find a better home. We at Mostyn Lodge wish to enhance our residents quality of life by making sure that they keep their independence. Privacy and dignity are of the uppermost importance. Fee £412 all inclusive other then personal shopping items and chiropody, health treatment where there is not entitlement to NHS treatment. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home as part of our inspection. We received a number of Have Your Say questionnaires from individuals who live in the home (8) and members of staff (7). We also received the homes completed Annual Quality Assurance Assessment. When we visited the home we looked at a number of records and documents relating to the quality of the care provided at Mostyn Lodge. These included care plans, medication administering, staff recruitment and training. We also had an opportunity to talk with individuals who live and work in the home. What the service does well: The home provides a small like a family home and staff clearly have a real commitment to provide care of a good quality and having an understanding of the individuals health and social care needs. Individuals we spoke with were all very positive about the care they receive and the environment of the home. The home provides me a safe environment which I am happy in. One individual told us this is my second home and another said the home is very caring and I get all the help and care I need. There is a stable group of staff who have worked in the home for a number of years and this helps in providing continuity of care for individuals who live in the home. What has improved since the last inspection? We made a number of requirements at our last inspection and we looked at these on this inspection to see if the home had addressed the issues we had raised with them. We found that changes had been made with staff receiving the training they need to perform their role and responsibilities and improvement in record keeping. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 6 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. EVIDENCE: We looked at a number of pre-admission assessments which had been completed by the home. They contained the necessary information about the care needs of individuals. There were also copies of the local authority assessment where this had been completed. If individuals have mental health needs an assessment from the mental health team is obtained by the home. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs of the individual. Individuals are given the opportunity through the admission assessment; preadmission visit and trail period to make an informed decision that the home is suitable and can meet their needs. EVIDENCE: We looked at a number of care plans they provided information about the care needs of the individual. Included were fall risk assessments, nutritional screening and moving and handling assessments. Reviews of care plans had been held on a regular basis. There was little information about the personal routines, likes and dislikes of the individuals. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 10 Individuals who live in the home have full access to community health services such as chiropody, optician and community nurses. Records we looked at confirmed individuals had received these services. Individuals who responded to our Have Your say questionnaire said that they Always 7 and Usually 1 to the question Does the home make sure you get the medical care you needs? We had an opportunity to speak with a community nurse who was visiting the home. They told us the staff were always responsive to assistance and always listened to what was advised and this is done. They found staff approachable and never had any cause for concern about care provided. We looked at the arrangements for the administering and management of medication in the home. Records showed that medication had been given as prescribed the bulk of medication being stored in dossette boxes (this included controlled drug for one individual). There were no gaps in the administering record. There were changes on the administering sheets of individuals and these had not been signed by a member of staff. One individual had controlled drug and this was not being kept in controlled drug cupboard but was supplied in a dossette box. The administering of this drug was recorded on the standard administering record and was not witnessed by a member of staff. We spoke with individuals who live in the home about how they felt they were treated by staff specifically if they felt they were treated with respect. They told us always , I have never had any problem with the staff and how they talk with me, you cant fault the staff all very good. We observed staff through out the time we visited the home and noted that staff were appropriate in their response to individuals. Where they were providing assistance or support this was done in a sensitive and caring and caring manner. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: We spoke with individuals who live in the home about the activities that are available. They told us theres enough for me, something happens most days staff very good having chats with us all. Activities arranged included quizzes, sing-a-long, music for health and occasional outside entertainers. The Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 12 home was due a visit from Fashion For Fun and this was advertised on the homes notice board. Individuals who responded to our questionnaire said there were Always 3 Usually 5 activities that you can take part in? One individual told us how they enjoyed the activities at the home and another I enjoy all the entertainment. We asked individuals about the meals provided in the home and they told us they are very good I enjoy the food here. On the day of our visit the meal was well presented and all of those we spoke with said how much they enjoyed their dinner. It was noted that one individual had their meals pureed and a staff member was assisting the individual. This was done in a sensitive way however the meal was not served in separate portions and all the meal had been pureed as one. However it was noted that individuals were not told what was for dinner and given the option of having something else if they wanted too or didnt like the meal being offered. One individual told us they were not offered a choice. Records we looked at showed a good variety of meals being provided in the home. We asked individuals about their daily routines and particularly if they could chose how they spend their time. One person told us its up to me what I do another who spends a lot of time in their room told us its not a problem do as I want really. We also asked about getting up and going to bed and individuals told us it was their choice and no fixed times. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to staff in this area. EVIDENCE: We spoke with individuals about what they would do if they were unhappy about the quality of the care they were receiving. They told they would either tell one of the staff or talk with Jill (the manager). They also told us they knew they could make a complaint if they wished and all respondents to our questionnaire said they knew how to make a complaint. No complaints had been made since our last inspection of Mostyn Lodge. The home has safeguarding policies and procedures in place and some staff have received training in Safeguarding Adults. It was noted from records we looked at that not all staff have completed this training however training is being arranged for these staff members. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 a safe and hygienic environment for people who live in the home and staff. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. EVIDENCE: In looking around the home it was evident that there is a good standard of maintenance and decoration. However it was noted that some of the furniture in individuals rooms would benefit from being updated and this was also noted in the home AQAA. Individuals we spoke with all said that the home is always very clean its very clean and tidy well kept home. All of the respondents to our questionnaire said that the home is always fresh and clean. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 15 Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. However this must be more robust to make sure that all necessary checks and procedures are followed to protect the interest and welfare of individuals who live in the home. EVIDENCE: Staffing arrangements are such that there is generally two care staff on duty in addition to the manager with waking night staff and the owner who lives on the premises available in an emergency. We looked at recruitment records for two members of staff. For one individual there was not a previous employer reference and for another there were disclosures on the individuals Criminal Record Bureau (CRB) check and no recorded evidence this had been discussed at interview. Full applications had been completed for these staff members and CRBs received. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 17 Training records for five members of staff showed that other then Safeguarding for two staff members individuals had completed the mandatory areas of training: moving and handling, health and safety, fire safety/awareness. Individuals had also completed infection control, first aid, promoting continence, diabetes and medication training. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good opportunities for individuals who live in the home and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff is protected. EVIDENCE: The manager has worked in the home for a period of 25 years and has during that time illustrated a real commitment to the role and responsibilities of manager of the home. Staff and individuals who live in the home spoke warmly of her someone we can talk too shes there for us if we need her will help me whenever I need it. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 19 Health and safety records showed that equipment such as hoists had been serviced regularly. A Health & Safety audit had been carried out in July 2009 which was generally positive about the health and safety aspects of the running of the home. A Food Hygiene inspection of July 2009 was satisfactory and the home was awarded a 4 Star Rating. Weekly fire alarms tests take place and staff have completed fire drills including night staff. Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 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 OP29 Regulation 19 (4) Requirement The registered manager to make sure that they shall not allow a person to work in the care home unless the employer has obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of Schedule 2. (This relates to the need to make sure a reference is obtained from the last employer of the prospective employee.) Ensure all staff undertake mandatory training. (This refers to safeguarding training) The registered manager to make sure there is the required storage of controlled drugs and that recording of medication changes are signed by staff member. This relates to the need to have separate controlled drug storage in the home. Timescale for action 29/07/09 2. OP30 18 (1a,c) 30/01/10 3 OP9 13 (2) 10/10/09 Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 22 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. Refer to Standard OP15 Good Practice Recommendations Where individuals require pureed meals this is done to make the meal as attractive and appealing as possible and each part of the meal is separately pureed enabling the individual to fully enjoy the meal. This is recognised as good practice when serving such meals. Individuals should be offered a daily alternative to the main meal being served so that a choice is available. The daily menu to be displayed in the home so that individuals know what the daily meals are that day. 2 OP15 Mostyn Lodge DS0000008156.V377384.R01.S.doc Version 5.2 Page 23 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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