Care Home: Mountdale Nursing Home

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What the care home does well The environment within the home was warm, relaxed and friendly. The home provided care for some residents with high dependency care levels and the delivery of care was noted to be unhurried and calm. Staff were pleasant, attentive and knowledgeable about residents` needs. The manager demonstrated good management skills. This was evident within the recording systems, delivery of care and the management of staff. The environment itself was pleasant and clean. There was a strong emphasis on infection control. We received positive feedback from staff, residents and relatives. Those we spoke with were open and happy to discuss their experience of the home. What has improved since the last inspection? All policies, procedures and guidance information had been reviewed and updated. This means that staff are able to provide care based on sound practice. Care practices especially with the administration of medicines had been reviewed and updated. All care plans, risk assessments and other aspects of the recording system had been reviewed and updated. The manager now has a presence in the home on a daily basis and works routinely from 10am - 6pm weekdays. There were monitoring tools in place to ensure that records were kept up to date. The roles and responsibilities of key members of staff had been reviewed and senior staff now have specific responsibilities based on skill and experience. There was an improved sense of leadership and direction within the home. The storage facilities for refuse, wheelchairs and lifting apparatus had improved. Further improvement are to be made in the future. The quality assurance process within the home had been strengthened and there was evidence of how some things had changed as a result of listening to residents. Examples are within the report. What the care home could do better: Aspects such as the staff supervision system and some management monitoring tools were relatively new and and in time should become robust and embedded on a daily basis. We noted some hazards in the home and requested that a full environmental audit take place to ensure that all risks to residents are minimised. Reference has been made to this within the report. Key inspection report Care homes for older people Name: Address: Mountdale Nursing Home 59 Mountdale Gardens Leigh On Sea Essex SS9 4AP     The quality rating for this care home is:   two star good 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: Ann Davey     Date: 0 6 0 1 2 0 1 0 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 26 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 26 Information about the care home Name of care home: Address: Mountdale Nursing Home 59 Mountdale Gardens Leigh On Sea Essex SS9 4AP 01702421019 01702511777 mountdalenursing@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Davinder Thakar,Mr Nathaniel Dogar care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category terminally ill Additional conditions: Number of service users to whom nursing and personal care is to be provided must not exceed 22. (Total number not to exceed twenty two). Terminal Illness to include persons aged 55 years and over, to be provided up to and including 4 residents. (Total number not to exceed four). To provide personal and nursing care to 6 service users over the age of 65 years with a diagnosis of Dementia. Date of last inspection Brief description of the care home Mountdale Nursing Home is a purpose built establishment, situated in a predominately residential area of Leigh on Sea. A local bus route provides access to Southend on Sea town centre. The home provides accommodation with nursing to twenty-two older people including the provision of care for people who have dementia. The residents Care Homes for Older People Page 4 of 26 Over 65 6 22 0 0 0 4 0 6 0 1 2 0 0 9 Brief description of the care home accommodation is situated over three floors. There is a passenger lift to all floors within the home. There is a Statement of Purpose, a Service Users Guide, a copy of the current inspection report and a coloured brochure available. The weekly charges range from £555.00 to £650.00. The exact fee depends on the source of funding (public or private) and the assessed nursing care needs. There are additional charges for items of a personal nature. Care Homes for Older People Page 5 of 26 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: two star good 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: The last key inspection took place on 6th January 2009. This inspection took place over approximately 6.30 hours. The visit started around 8.30am and finished approximately 3pm. The registered provider is also the registered manager. For ease of reference we have referred to them as the manager for the purposes of this report. The homes Annual Quality Assurance Assessment (AQAA) which is required by law had been completed. It was dated 10th December 2009. The document provided the home with the opportunity of recording what it does well, what it could do better, what had improved in the previous twelve moths and its plans for the future. We sent questionnaires to the home asking that they be distributed to stakeholders and returned to us so that we could have an undertaking of how residents, staff and Care Homes for Older People Page 6 of 26 health/social care felt about the care provision. We received seven completed questionnaires from staff and seven from residents. Some had been completed on their behalf by a relative. We have made reference to some of the comments received within the report. During the day we spoke with the manager, residents, staff and relatives. We looked around the home, viewed aspects of various records and observed care practices. We discussed all our findings with the manager. We asked that they took notes so that immediate development work could be started where necessary. We appreciated the co-operation and assistance given to us by the residents, staff, relatives and management throughout the day. Care Homes for Older People Page 7 of 26 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 8 of 26 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 9 of 26 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 10 of 26 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. People using the service can expect to have their needs assessed or identified to ensure that their admission would be appropriate. Evidence: The previous inspection report was available and the homes current Statement of Purpose and Service Users Guide was displayed in the entrance hallway. There was a good selection of useful current publications, pamphlets and items of information and interest on display in this area. The majority of admissions to the home are made from the local hospital. This is reflected within the homes category of registration. We looked at the pre-admission and admission records of two residents who had been recently admitted to the home. The manager had undertaken both the assessments within the local hospital. There was evidence that both residents and their respective families had taken part in the assessment process. Care Homes for Older People Page 11 of 26 Evidence: The assessment records we saw were detailed and comprehensive. The manager told us that over recent months the information and assistance given to the home by the hospital as part of the pre-admission process had improved significantly. The outcome was that the manager had been in a much better position to carry out a detailed assessment to ensure that any admission would be appropriate. We took the opportunity to speak with a relative who had recently been involved in the pre-admission and admission process to the home. They told us that they had been provided with all the information they had needed, the home had been very friendly and inviting, and they had found the experience positive. Care Homes for Older People Page 12 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to receive the level of care required to meet their known assessed needs. Evidence: We looked at six care plans and associated documentation such as risk assessments and daily records. We sampled various aspects and elements of these records.Care plans and risk assessments were current and we could see that they had been reviewed on a regular basis. The information within the documentation provided a fair overview and outline of current care needs and requirements. We noted that residents (and relatives)views, wishes and preferences had been recorded. We also noted that the residents preferred name had been recorded clearly. We particularly looked at how the home manages end of life issues as this was pertinent to the category of registration. All care plans had reference to this aspect of care and staff had received training. We observed various aspects of care practice during the day. Care was provided in a sensitive supportive manner and undertaken in a dignified way. We noted that staff engaged with residents in a friendly and natural way whilst undertaking tasks. Care Homes for Older People Page 13 of 26 Evidence: We noted that the home maintained a daily record of each resident. Each record had a day and night entry which was informative and provided an overview of the care provided within any twelve hour time frame. We sampled two entries within the accident book and noted that the information had been appropriately transferred to the respective residents daily care notes. The manager told us that the home had a good working relationship with all health and social care professionals. We saw clear records in residents files providing detail of where and when a resident had received community health care support or provision. All medicines are managed and administrated by the qualified nurse in charge of the shift. One of the nurses on duty showed us the homes medicines storage facilities, the administration records and explained how the system worked. We saw where the medicines were securely stored and sampled some of the entries within the administration records. We noted that the polices, procedures and guidance about all aspects of managing medicines with the home were available to the nurses and were current. The medicines storage facilities were orderly and tidy. The medicine administration records were in good order with no obvious poor recording anomalies noted. We spoke with some residents about the care they had received and they told us we never have to worry here...they look after us so well...yes, we choose things...they always ask us what we want...I love it here, so friendly...so kind...they look after me ok. We also spoke with three staff about care practices. We were told I have access to care plans all the time...the information I have is good...we have to keep it up to date...yes the information helps me know what to do. Care Homes for Older People Page 14 of 26 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. Residents benefit from a varied balanced diet and are able to participate in a developing activity programme. Evidence: The menu for the days lunch was displayed in the dining room late morning. Earlier in the morning, we noted that the chef was going around to individual residents giving them a choice for lunch. There was liver and bacon, sausage and onion or a cheese omelette on offer. For dessert there was cherry sponge and custard or fresh fruit. The chef showed us previous records which provided information about what each resident had eaten and in what quantity. We also noted that some residents had fluid intake charts in their bedrooms. We sampled two of the records and noted that they were current. We noted that the tables at lunchtime had clean linen tablecloths and napkins. There was a flower arrangement on each table and residents were provided with a drink in wine style glasses. The lunch looked and smelt very appetising. Residents were very positive about the provision of food. We spoke with one resident who was being cared for in bed. They confirmed that they had regular drinks and nutrition. One visitor told us that they had sampled the food and thought it had been very tasty. Care Homes for Older People Page 15 of 26 Evidence: The manager told us that the vast majority of residents have family or friends who visit and play a significant part in the social and recreational life of the home. The home had an activities programme in place which was not very imaginative. There were organised activities for an hour most afternoons and included quizzes, singing, hangman games, watching old films and light exercise. A member of staff had a designated hour for these activities. The manager told us that they pan to appoint a designated activities co-ordinator in the near future and will develop the activities programme a lot further. We spoke to residents about this who agreed that they would like to do more. We spoke with two residents who were being cared for in bed. They confirmed that staff regularly come to see them. These residents also confirmed that staff ask if they would prefer the television, radio or music CD to be left on for them. All said that their choices had been met. We noted that all the residents being cared for in their bedrooms had access to a call bell. We spoke with the member of staff who had responsibility for the activities programme. They confirmed that the programme needed to be developed to ensure that the needs of all individual residents are met. Care Homes for Older People Page 16 of 26 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. Residents can be confident that their concerns will be managed appropriately and their care provided in a safe way. Evidence: The homes complaint procedure was clearly displayed in the entrance hallway. The manager told us that there had been no complaints since the last inspection. The home had a complaint record log book should it be required. We asked residents what they would do if they were not happy about something within the home. They said that they would either speak to a relative or the manager direct. We asked if they would feel uncomfortable about raising an issue with a member or staff or the manager. The response we got were oh my goodness no, I say what I think...theyre fine...I know they would listen to me...no, Im not frightened as they are so nice and would help me. We spoke to five staff about their understanding of safeguarding vulnerable adults from harm procedures and what they would do if they suspected poor practice. All those spoken with had a good understanding of the matter and confirmed that they had received training. Care Homes for Older People Page 17 of 26 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. Residents can expect to live in an environment that is clean and comfortable. Evidence: The home was clean and comfortable. There had been some refurbishment and decoration work carried out in the past year with more planned. Bedrooms were personalised and the communal rooms were comfortable. The bathrooms were functional and clean. The manager confirmed that storage space was at a premium which meant that some items such as hoists and domestic cleaning equipment was stored in a variety of places. We would acknowledged that the situation had improved since the last inspection. At the time of the inspection the home was in the process of improving the automatic door closures system should the fire alarm system be activated. We noted that the door to the sluice on the ground floor could not be shut because of the work being carried out. We asked the manager to prepare a risk assessment for this as should a resident go in there they would be at some risk because of the machinery and chemical cleaning substances. We also noted that the carpet in the entrance to the passenger lift was frayed and loosened from the floor. There was a risk that a resident or member of staff could trip on this or a wheelchair or walking fame be caught up. Risk assessments were put in place for both these matters before the end of the inspection. The secure rear garden was particularly attractive. There was also a secure Care Homes for Older People Page 18 of 26 Evidence: smaller garden area to the front of the home. The manager told us about their plans to extend the rear of the home to create and provide additional communal areas and two more bedrooms. They will make an application to increase the registration numbers in due course. Care Homes for Older People Page 19 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be cared for and have their needs met by a team of trained and supervised staff. Evidence: The staff rota was on display and the information and detail on it was clear. The manager confirmed that the staff levels were the same throughout the week including weekends. The manager confirmed that on day shifts, there is one nurse and four carers at all times. In addition, there are kitchen and housekeeping staff on duty. A nurse and a carer are rotared to be on awake duty at night. The manager is rotared to work 10am -6pm weekdays and comes in to the home at other times. This was confirmed by staff. The home had one full time care vacancy. The home does not use agency staff and had their own bank of staff to call upon to cover holidays and sickness. A bank nurse was on duty at the time of the inspection. Their knowledge and understanding of their role and responsibility was good. The home is registered to provide care for 22 residents. At the time of the inspection 19 residents were accommodated with one resident in hospital. Staff told us that there were sufficient staff on duty to meet the care needs of residents. Residents made no reference to any shortages of staff or having to wait for attention. During the day we Care Homes for Older People Page 20 of 26 Evidence: made several trips to the 1st and 2nd floors of the home where some residents were being cared for in bed. We noted that there was a member of staff around in these areas attending to residents. Residents in these rooms told us that staff were always around and I have a call bell to get somebody. We looked at the records of two staff who had recently been recruited. These records were well indexed and orderly. The elements we looked at were compliant with regulatory requirements. We noted that the home had a detailed induction programme in place. We saw a programme of forthcoming staff training sessions. Staff training records were in individual staff members files. We noted that there were records of staff supervision sessions. Staff meetings take place on a regular basis and there were records to support this. Care Homes for Older People Page 21 of 26 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. Residents can expect to live in a home where their care is managed effectively Evidence: Following the last inspection the manager had reviewed and updated all the homes policies, procedures and guidance documentation. This meant that staff had current information about work practices. In addition the manager had reviewed all documentation recording systems. This meant that resident and staff records were well indexed, orderly and current. The roles and responsibilities of individual senior and nursing staff had been reviewed and were now linked to identified strengths and skills. The manager had taken a more hands on approach to the day to day management of the home and this was evident. There was a clear line of leadership within the home. The manager had developed management tools to monitor and ensure that records are kept up to date and various tasks are undertaken. For example, reviewing of care plans and staff supervision sessions. We saw records to support that regular residents and relative meetings take place. Care Homes for Older People Page 22 of 26 Evidence: We noted how the suggestions raised by residents at these meetings had been implemented. For example mealtimes and the layout of the dining area. The manager caries out surveys with stakeholders twice a year about the provision of care. The results of the May 2009 were available and the December 2009 surveys were beginning to come in. We saw the current Quality Assurance and Annual Development Plan. This was detailed and incorporated the survey results together with how matters had been developed or improved to meet residents expectations. We selected and sampled some health and safety records such as fire drills, health and safety policies, the fire risk assessment and noted they were current. We selected and sampled some maintenance and service certificates such as lift apparatus and passenger lift service certificate and noted they were current. We noted that Essex County Fire and Rescue and Southend Borough Council (Food and Hygiene) had undertaken routine visits during the past year. Within their surveys staff reported we give quality service to users in areas of need, adequate time and relevant support and service...the management of our handover sessions between shifts is excellent...good relationship between staff and management...good communication between management and staff...we all get along so well. Relatives within their surveys were positive about the management of the home. Care Homes for Older People Page 23 of 26 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 24 of 26 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 12 The activities, recreational and occupational programme should be developed so that the needs of all residents are fully met. This will be reviewed at the next inspection. A full premises audit should be undertaken to ensure that all environmental risks are noted and addressed or minimised. 2 26 Care Homes for Older People Page 25 of 26 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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