Care Home: Mountbatten Nursing Home

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What the care home does well The home has an established record of delivering a high standard of nursing and personal care. There is a team of well trained and motivated nurses lead by the registered manager Sarah Collard. The planning and recording of care is of a high standard and reflects current good practise. Nursing staff maintain their clinical skills and are keen to develop new areas of expertise. The home retains care staff and provides them with a range of training and supervision. There are areas of good training practise. Induction for new staff is thorough and enables them to progress directly to National Vocational Qualification assessment at Level 2. The home is well maintained. There is an organised and efficient system of health and safety checks. People enjoy the food in the home. The environment of the home is clean and pleasant. The housekeeper manages the "hotel" aspects of the home efficiently. The owners and registered manager of the home are committed to continually improving standards in the home. What has improved since the last inspection? Policies and procedures have been reviewed. the AQAA stated that all policies and procedures were last reviewed on The application form has been amended as required at the last inspection. Bathrooms and bedrooms have been redecorated and up-graded. The provision of training continues to develop including a thorough training for all staff in infection control. What the care home could do better: Most people spoken to during the inspection said that they were happy to eat their meals and spend their days in their rooms. The home has invested substantially in providing excellent communal dining facilities and a sitting room and conservatory which are currently underused. The service should consider the possible barriers to the use of these rooms and seek the views of people who live in the home. Some people have lived in the home for many years and their lives must be improved by access to some entertainments and social interaction. The quality assurance system within the home should be developed based on the formal seeking and evaluating of peoples opinions and wishes. There is evidence that people are consulted informally however a system that meets the requirements of National Minimum Standard 33 must be implemented. Key inspection report Care homes for older people Name: Address: Mountbatten Nursing Home 82-84 Trull Road Taunton Somerset TA1 4QW     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: Shelagh Laver     Date: 1 9 0 6 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 Older People Page 2 of 24 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. 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 Older People Page 3 of 24 Information about the care home Name of care home: Address: Mountbatten Nursing Home 82-84 Trull Road Taunton Somerset TA1 4QW 01823333019 01823334793 sarahcollard04@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Richard Derek Brice care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 27 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home The Mountbatten Nursing Home was first registered in 1984. The home is registered for 27 persons over the age of 60 needing nursing care. The current provider has been registered since 2000 and has up-dated and invested in the fabric of the home. Mountbatten is an adapted Victorian building providing accommodation on four floors with a large sitting room and conservatory. Doors open onto well tended gardens. There is a call bell system and adequate numbers of assisted bathrooms. Nursing care is provided at all times and the home liaises with other health professionals to ensure service users specialist needs are met. Sarah Collard is the registered manager. She is an experienced nurse who is pro-active in directing the Care Homes for Older People Page 4 of 24 Over 65 27 0 Brief description of the care home nursing care of service users. She is supported by an experienced and stable team of nurses, carers and support staff. The proprietors Mr and Mrs Brice are involved in the management of the home on a daily basis. The current range of fees is from #504.00 to #700.00. Care Homes for Older People Page 5 of 24 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a Key Unannounced inspection that took place over one day. We (CQC) had the opportunity to meet with people who lived in the home. We spoke to some of the staff who worked there as we made a tour of the building. We were able to review care and staff and maintenance records. Before we commenced the visit to the home we requested and received an Annual Quality Assurance Assessment that gave us information about the achievements and plans of the home. It also included factual data and formed the basis of the inspection visit. We reviewed information sent to us on a regular basis from the home and noted that they complied with legal requirements. We sent surveys to people who live in the home. Throughout the inspection we were assisted by the manager Sarah Collard who ensured all information was provided in an organised and accessible form. Care Homes for Older People Page 6 of 24 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 Older People Page 7 of 24 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 sufficient information for people who may be interested in coming to live in the home. The home undertakes a thorough assessment of peoples needs before they come to the home. Evidence: There is a range of information for people who are interested in coming to live at the home. People can read the summary of the last inspection report and information about the home is available in the professionally produced brochurer. There is a web site and people are welcome to visit. Surveys received prior to inspection confirmed that people received enough information before they moved into the home.. Some people come to the home following hospital discharge and may not be well enough to visit in advance. Families may visit and occasionally no one has an opportunity to Care Homes for Older People Page 10 of 24 Evidence: visit. The manager always undertake an assessment and this involve a visit to see the person in hospital or at home. We saw examples of assessments and documentation from health and social care professionals that are used in making a decision about whether staff are able to meet peoples needs at the home. There were assessments by social workers and information provided on discharge from hospital. The nursing home provides care for people with a wide range of needs. Some people come into the home needing lots of care but recover sufficiently to move to residential care or to go home. Some people have lived at the home for several years. Others are very unwell on admission and required skilled care at the end of their lives. the end of their lives. Care Homes for Older People Page 11 of 24 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 receive an excellent standard of health and social care which meets their needs. Care plans aclearly record the personal and healthcare needs of people. There is a skilled, trained and knowledgeable team of nursing staff who lead the delivery of health and personal care. People are treated with respect and kindness in the home. There is a system of medication storage and administration that is safe and accurate. Evidence: There is evidence that people in the home receive excellent health and personal care. THe home has an established record of delivering a high standard of nursing care. Sarah Collard and her nursing team continue to develop clinical practise in the home.There is evidence that peoples health improves in the home and that people who come into the home with pressure damage have their wounds healed. Three care plans were reviewed. They recorded personal and healthcare needs and detailed how they could be delivered. Plans are reviewed and up-dated regularly. One file demonstrated that attention was given to the robust and effective pain Care Homes for Older People Page 12 of 24 Evidence: control. Attention had been made to asssessing peoples nutritional status and action taken in order to maintain peoplesweights. There was evidence of prompt responses to indications of infections and appropriate requests for medical support when needed. Additional information regarding one persons illness had been included in the folder. There was evidence that people receive regular support from a team of health care professionals. General Practitioners visit regularly and there were records of visits from chiropodists, opticians and nurse specialists. Care needs are reviewed both in house and by health and social care professionals. The medications in the home are audited internally and by the supplying pharmacy. The most recent pharmacy report indicated that the home was performing safely and meeting clinical guide-lines. We spoke with thirteen people during the inspection. They said that staff were always kind and respectful. Throughout the day staff were heard to talk to people in a respectful and kind manner. We overheard one member of staff offering choices in aspects of personal care and encouraging the person to make choices. There are plenty of aids and equipment in the home and the home invests in the latest pressure relieving equipment. We asked four care about the care provided to people we were case tracking. One member of staff gave a particularly good account of the care provied to one person and the ways in which his needs are met. Staff receive regular training on health topics and are encouraged to learn more. Care Homes for Older People Page 13 of 24 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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 enjoy a choice of appetising and nutritious meals in the home. People make choices about how they spend their time in the home. There are a range of social activities offered to people however the home should investigate why so few people chose to leave their rooms. Evidence: People are encouraged to make choices about how they spend their day. People said that they enjoyed their meals in the home and benefit from having a good cook in the home. One person said that the food was excellent. Another said It is hard not to gain weight here. We spoke to most people who lived in the home. They made many positive comments. I am perfectly happy and I enjoy my quiet room. It was a concern however that so many people chose to stay in their rooms for most of the day. The home has invested in a very attractive sitting room and dining extention which seem to be little used. One person said that they did occasionally go to the sitting room but preferred to do crossword puzzles. Other people had televisions and books in the room. Most people prefer to eat their meals in the rooms. Social care records showed that some people did arts and crafts, had communion and visits from families. People are free to make choices but much can be added to peoples lives by contact Care Homes for Older People Page 14 of 24 Evidence: with others and by social events that provide stimulation. The home should undertake research to discover why people do not want to leave their rooms. The journey to the lounge or dining room in a small lift may seem daunting or the events offered may not be of interest. New admissions to the home may feel initially shy about going out of their rooms. Care Homes for Older People Page 15 of 24 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. There are policies and procedures in place to keep people safe. Staff are kept up to date in the legislation and procedures needed to keep people safe. People who live in the home felt happy to raise concern and make complaints if they need to. Evidence: There was evidence that staff in the home have received training and up-dates in safeguarding adults using a DVD. The manager has ensured copies of the Safeguarding Adults in Somerset policies and procedures are available. Recruitment procedures were seen to be robust and designed to protect people. One file demonstrated the manager understanding and action taken in a safeguarding situation. There was an assessment of a persons ability to make decisions and actions to be taken to promote her wellbeing. People who returned surveys said that there was someone that they could speak to informally if they were not happy and knew how to make a formal complaint. People spoken to during the inspection all said that they would speak to the registered manager and knew her name. The manager said that they are Usually able to deal with issues before they exacerbate and they tend to be quite minor problems. There is an open door policy and everyone knows who they can come to. The home has digital safes in all bedrooms. Care Homes for Older People Page 16 of 24 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, 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. 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 live in a comfortable and well maintained environment. There are policies and procedures in place to control the spread of infection. Evidence: On the day of the inspection the home was clean, cared for and free from all odours. The home is tidy and well maintained with a system of planned maintenance in place appropriate to an older building. The housekeeper manages the cleaning of the home professionally ensuring that rooms are deep cleaned on a regular basis. There has been considerable investment in the home over the past years. Following the major extentions providing additional communal space there are attractive and spacious facilities on the lower ground floor. The home is arranged over four floors and there is access throughout by means of a lift. Bathrooms have been up-graded and the home continues to have rooms redecorated and furnishings replaced. There are plenty of adjustable beds and chairs. There were staff hand wash facilities and waste disposal arrangements that encouraged good practise in infection control. There has been extensive staff training in the prevention of infection. Care Homes for Older People Page 17 of 24 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. 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. The service has a highly developed recruitment procedure that aims to ensures a high calibre of carers. Management prioritise training and facilitate staff to access a wide range of training. People in the home benefit from the care given by well trained and supervised staff. They know the staff well and speak positively about them. There are regular staff meetings that promote good practice. Evidence: There is a skilled core team of nurses and carers. Good continuity is maintained through staff retention and no use of agency. A review of the off duty indicated that there is a good ratio of staff on duty including at least one trained nurse. We spoke to a new member of staff. She confirmed that before being employed at the home she had had an interview and that references had been taken up and a Protection of Vulnerable Adults check had been made. The recruitment file was checked and found to be complete and well organised. There are several aspects of excellent training practice in the home. There is a very effective system of training for National Vocational Training in the home. A very thorough induction is used as evidence towards the NVQ. The home has two in-house manual handling trainers who undertake staff annual updates according to Health and Safety guidance and provide theory and practice instruction during staff inductions. Care Homes for Older People Page 18 of 24 Evidence: A care supervisor takes the lead in infecton control training and has delivered training to all staff based on current guidance and good practice. Three staff files reviewed showing that staff receive regular training. Manual handling and protection from abuse had been updated since the last inspection. The home has a selection of training material that can be used in house and staff can also access external training events. A nurse had undertaken up-dates in wound care and the Mental Capacity Act. Not all training attended is recorded in staff files and the home should devise a system by which the information can be easily accessed and up-dated. The home is currently developing the skills and knowledge of staff with regard to Palliative and End of Life care. People who live in the home knew the staff well and made positive comments about them throughout the inspection. One surveys received at the home said The friendly and competent staff always have time for patients and help to make life as pleasant as possible. One relative wrote The home manages to keep its staff which means Mum is not continually seeing new faces. Care Homes for Older People Page 19 of 24 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 in the home benefit from a professional and committed manager and management team. The manager has a clear vision of the high standards of care that she expects to be delivered in the home. There are systems in place to ensure the heath and safety of people in the home. The quality assurance systems in the home should be further developed based on the seeking and evaluation of peoples views. Evidence: The manager is a qualified nurse with wide experience of managing care homes. She continues to actively develop both her clinical and management skills. Most recently she has been undertaking training to lead the home into the Gold Standard Framework for palliative care. She has a clear vision of the standards of care that are required in the home. The management team is composed of Mr and Mrs Bryce who are closely involved in Care Homes for Older People Page 20 of 24 Evidence: the home, the manager/matron and her deputy and the housekeeper. It is a strength of the home that each person is effective and committed to the standards within the home. There was evidence that the home receives positive feedback from residents, relatives, visiting professionals and get lots of letters of thanks and appreciation for the quality of care given. The home has social service contracts which involve regular individual and contract reviews. The home has both the Quality Rating and Investors in People awards. There are audits which monitor aspects of performance of the home such as medication and care planning. The quality assurance and monitoring system system should be further developed and formalised to include regular seeking of peoples views in line with National Minimum Standard 33. There are effective systems in place to safeguard peoples personal finances and there are administration systems that ensure record keeping is of a high standard. Finances are professionally audited and further investment in the home is planned. There are systems in the home to maintain the health and safety of people who live there and staff. The management and maintenance staff are aware of the need to have rigorous systems for servicng equipment and making checks on fire and water systems. A review of maintenance records indicated fire risk assessments that included an emergency plan for day and night. There were records of weekly fire alarm testing and staff fire drills and training. Safe manual handling is given a high priority with in -house trainers and well maintained eqiuipment. The maintenance of the home is undertaken in a planned and monitored way. Care Homes for Older People Page 21 of 24 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 Older People Page 22 of 24 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 1 33 24 The home must implement 01/12/2009 an effective assurance and quality monitoring system that is based on seeking the views of people in the home. The results of questionnaires should be used as part of the annual development plan for the home and reflect the aims and outcomes of people. 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 12 The service should review the opportunities offered to people who live in the home for social interaction and activities. The home should undertake an audit to establish peoples preferences for eating lunch. There should be consideration of ways in which the dining room could be used more effectively. 2 15 Care Homes for Older People Page 23 of 24 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). 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