Care Home: Mundy House Care Centre

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What the care home does well The manager ensures that an assessment of each person`s individual needs is undertaken and that the person is included in this as much as possible. This ensures the manager can confirm to the person that their needs can be met at Mundy House before they decide to live there. Some aspects of care plans, such as for sleep and rest, were well detailed, and showed that the person`s preferences had been listened to and respected. Staff were able to demonstrate that they had a good understanding of the needs of the residents they were caring for. Staff spent time interacting with the residents and provided support in a dignified and respectful way. Residents told us that staff at Mundy House are and friendly and helpful. Residents had recently attended a meeting where they could share their views and ideas about the home and we saw evidence that some of these had been implemented. Residents we spoke to said they find the new managers approachable and that they feel listened to now. Visitors told us that they always feel welcome at the home. Residents told us they are happy with the meals at Mundy House and have choices about what to eat and when. What has improved since the last inspection? Since the last key inspection Southern Cross have provided additional support to Mundy House, they have shown us that they have monitored the service and told us of their plans to improve it. The quality rating for this service has improved from zero stars at the last inspection to one star at this inspection. The recent appointment of an experienced permanent manager is expected to give stability in leadership to staff and support the implementation of planned improvements in outcomes for residents. Staff spoken with told us that this has improved staff morale and that they are feeling listened to and want the manager to stay. Residents spoken with also told us that changes for the better are now happening at Mundy House. Staff have had training on writing care plans and risk assessments. The care management documents that we looked at last time and had concerns about showed improvements at this site visit. This will provide staff with up-to-date information on people`s care needs so they can meet them effectively. Work has taken place on the garden so that it is an accessible and pleasant place for residents to spend some time. Some new furniture has arrived and remedial and decorating work has taken place on some resident bedrooms which residents told us they were happy with. The sluice room has been tiled and is easier to keep clean so promoting effective management of infection.Residents have had opportunity for input to the planned menu and menu cards with pictures and larger print are ready to be printed. Following a residents` meeting, the timing of the evening meal has changed to suit residents better. There has been successful staff recruitment. This means there are more permanent staff available to residents and less use of agency staff, providing more consistency and continuity of care for residents. Training for staff has improved. Training and development of staff supports them in meeting the needs of residents more effectively. Complaints are properly recorded along with the information about their investigation so that we can see that people are listened to and their concerns are actioned appropriately. The manager and staff were aware of policies and procedures on adult abuse and whistleblowing to safeguard residents. A Dignity Champion has been appointed and trained to support good practice in people`s right to make choices and be treated with dignity and respect at Mundy House. What the care home could do better: The additional support and management at Mundy House needs to be sustained and become established so that the improvements planned, and those noted at this site visit, continue and develop. The care plans continue to need development to show that the manager and staff know all of people`s individual care needs and that they have clear actions identified to meet these in a way the person prefers and is safe. The manager and staff also need to show that where they make plans to promote people`s health and wellbeing, they follow these through to ensure people living at the home receive good quality care outcomes. Aspects of recording, storage and administration of medication need to improve to ensure safe management, infection control and residents` wellbeing. Residents will benefit from the planned refurbishment and additional investment in the home to provide them with a pleasant living environment that meets their needs. Key inspection report Care homes for older people Name: Address: Mundy House Care Centre Church Road Basildon Essex SS14 2EY     The quality rating for this care home is:   one star adequate 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: Bernadette Little     Date: 1 0 0 6 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 37 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Mundy House Care Centre Church Road Basildon Essex SS14 2EY 01268520607 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): mundy.house@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 65 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Personal care can be provided for up to a maximum of three service users with dementia. Personal care to be provided for older people aged over 65 years. The total number of service users for whom personal care can be provided shall not exceed 65. Date of last inspection Brief description of the care home Mundy House Care Centre is a large home that was purpose built in 1965. Care and accommodation is offered for up to sixty-five older people, including up to a maximum of three service users who have a diagnosis of dementia. It is close to local shops and is on a bus route with services to Basildon and Wickford. The majority of bedrooms are Care Homes for Older People Page 4 of 37 Over 65 0 65 3 0 0 4 0 3 2 0 1 0 Brief description of the care home situated on both floors of the main building. An additional eight bedrooms are sited in the Lodge annexe, which can be reached through an internal walkway on the first floor. Single and double bedrooms are available and the majority offer ensuite facilities. Access to all rooms is available via passenger lift. The home has a number of communal lounge/dining areas. There is a courtyard and garden area accessible to service users. The area manager advised at this key inspection site visit that the current contracted fee is £453.11 per week. Premier rate rooms will be available at £650 per week. Care Homes for Older People Page 5 of 37 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: one star adequate 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 of Mundy House was undertaken on 4 March 2010. At that key inspection, continued breaches of regulation relating to care planning and risk assessing were identified. As a result of this, documents were taken as part of Code B of The Police and Criminal Evidence Act 1984 and Statutory Requirement Notices were issued on 4th and 5th May 2010, with a date of 2nd June 2010 for compliance to be achieved. This key inspection site visit was undertaken by two inspectors over a nine hour period on one day. Care plans and risk assessment documentation were reviewed at this site visit and sufficient improvement noted to consider that compliance had been achieved. Time was spent with residents, visitors and staff and information gathered from these conversations as well as from observations of daily life and practices at the home have been taken into account in the writing of this report. Care Homes for Older People Page 6 of 37 As a result of of some people with dementia and/or poor cognitive ability not always being able to tell us their experiences and what it is like to live at Mundy House, we observed a number of residents in a small lounge for a period of time. We looked at peoples wellbeing, how they interacted with care staff and others and what they did during this time. A tour of the premises was undertaken and records, policies and procedures were sampled. The manager was present during the site visit and assisted with the inspection process. The outcomes of the site visit were fed back and discussed with the managers and area manager and opportunity given for clarification where necessary. The assistance provided by all those involved in this inspection process is appreciated. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? Since the last key inspection Southern Cross have provided additional support to Mundy House, they have shown us that they have monitored the service and told us of their plans to improve it. The quality rating for this service has improved from zero stars at the last inspection to one star at this inspection. The recent appointment of an experienced permanent manager is expected to give stability in leadership to staff and support the implementation of planned improvements in outcomes for residents. Staff spoken with told us that this has improved staff morale and that they are feeling listened to and want the manager to stay. Residents spoken with also told us that changes for the better are now happening at Mundy House. Staff have had training on writing care plans and risk assessments. The care management documents that we looked at last time and had concerns about showed improvements at this site visit. This will provide staff with up-to-date information on peoples care needs so they can meet them effectively. Work has taken place on the garden so that it is an accessible and pleasant place for residents to spend some time. Some new furniture has arrived and remedial and decorating work has taken place on some resident bedrooms which residents told us they were happy with. The sluice room has been tiled and is easier to keep clean so promoting effective management of infection. Care Homes for Older People Page 8 of 37 Residents have had opportunity for input to the planned menu and menu cards with pictures and larger print are ready to be printed. Following a residents meeting, the timing of the evening meal has changed to suit residents better. There has been successful staff recruitment. This means there are more permanent staff available to residents and less use of agency staff, providing more consistency and continuity of care for residents. Training for staff has improved. Training and development of staff supports them in meeting the needs of residents more effectively. Complaints are properly recorded along with the information about their investigation so that we can see that people are listened to and their concerns are actioned appropriately. The manager and staff were aware of policies and procedures on adult abuse and whistleblowing to safeguard residents. A Dignity Champion has been appointed and trained to support good practice in peoples right to make choices and be treated with dignity and respect at Mundy House. 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. Care Homes for Older People Page 9 of 37 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 37 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 who use the service are assessed and assured that their needs can be met. Evidence: The Statement of Purpose and Service User Guide had been updated since the last inspection to reflect the recent changes to the management team. These documents give information to people about the service to help inform their decision about living at Mundy House. It was also noted positively that the documents were dated. This ensures that people have the most up to date information available to them. There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Admissions are not made to the home until a full needs assessment has been undertaken. In addition where appropriate, supplementary information is provided by the persons Placing Authority or Primary Care Trust. Information recorded within these documents is used to inform and provide the basis for the individual persons Care Homes for Older People Page 11 of 37 Evidence: plan of care. Records also showed that formal assessments are also completed in relation to dependency, moving and handling, pressure area care, nutrition and continence. We looked at the care files for two people newly admitted to Mundy House since the key inspection of 4th March 2010. Records showed that a pre admission assessment had been completed for each person by the Care Manager and prior to their admission to the home. There was evidence to show that the information recorded was informative and detailed. There was clear evidence to demonstrate that the prospective person had been actively involved in the admission process and that their views had been incorporated where possible. The pre admission assessment for one person recorded that during the assessment process a friend was present. We spoke with both people and they confirmed that although they had not visited Mundy House prior to admission, a family member had looked around the home and made the decision on their behalf that Mundy House was suitable. The manager confirmed that usual practice is for the prospective person and/or their representative to be given the opportunity to visit Mundy House prior to admission so as to look around the premises, to have a meal, to meet people who already live in the home and to meet staff. Both people confirmed during discussion that the admission process to the home had been smooth and they had been made to feel welcome by staff. Records showed for one person that a formal review had taken place five weeks after their admission to Mundy House and comments recorded included I am very happy here, the staff are very lovely and the service user and family are very content with the care provided. Care Homes for Older People Page 12 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in management of care planning, documentation and medication could adversely affect care outcomes for people using the service. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. In addition to the care plan, formal assessments are completed in relation to manual handling, nutrition, pressure area care, falls, continence and dependency levels. Of those people case tracked, each person was observed to have a plan of care and these were devised from information undertaken as part of the pre admission assessment and as stated previously, from other associated information provided by external stakeholders. As part of the inspection process we looked at eight peoples care files (two in full, four in relation to the Statutory Requirement Notices served to the registered provider on the 4th and 5th May 2010 and two in relation to specific healthcare needs). Care Homes for Older People Page 13 of 37 Evidence: At the key inspection of 4th March 2010 and as a result of concerns relating to inadequate care planning and risk assessing processes, copies of documents were taken under Code B of the Police and Criminal Evidence Act 1984 and subsequent Statutory Requirement Notices served on the 4th and 5th May 2010. A prompt response was received from the registered provider detailing the actions taken to address the concerns raised. In addition we were advised that the actions taken would be included within the homes improvement plan and monitored as part of the organisations on-going internal inspection process by one of their Service Quality Advisors. Actions taken were to include all care files to be reviewed and updated, all staff to receive training pertaining to completion of care planning documentation, all areas of risk to be identified and to include the steps to be taken to reduce the risk and monthly audits to be conducted. Since the last key inspection to the service on 4th March 2010, improvements have been made to the care planning system so as to ensure they now clearly depict the individual persons care needs, provide appropriate guidance to care staff as to how the persons care needs are to be met, ensure that identified risks to the individual person are recorded and proactively managed and there is a clear audit trail of care and interventions provided by care staff and other healthcare professionals and agencies as required. The care file for one person who was diagnosed with an infectious disease was inspected. The care plan clearly recorded preventative infection control measures in place and the treatment to be provided by care staff and other healthcare professionals. When discussed with care staff it was evident that all were aware of the persons specific care need and the precautions to be taken so as to ensure the spread of infection was minimised. Records also showed that efforts have been made by staff to make the care records more person centred and to include peoples wishes and personal preferences. This was particularly noticeable within their personal hygiene and sleep and rest elements of their care plan documentation. For example care plans examined (sleep and rest) included the persons specific wishes e.g. window to be left open or closed, the time they retire to bed and preferred time they rise in the morning, whether or not they like a drink before going to bed, whether or not they like a side light to be left on and the wish of some people to have a nap during the afternoon. We looked at the care files for those people detailed as part of the Statutory Requirement Notices served. Records showed significant improvements and there was evidence to show that each of the care files had been reviewed and rewritten with previous gaps of information in most cases now replaced. Where gaps pertaining to Care Homes for Older People Page 14 of 37 Evidence: information remained outstanding, we discussed this with the senior management team and examples where further improvement are required were highlighted. For example the care file for one person in March 2010 made reference to them having a diagnosis of epilepsy however at the time of the key inspection no care plan was completed. A care plan for epilepsy is now in place but it was unclear as to why this was only devised at the end of May 2010, 3 months after initially being highlighted and approximately 5 weeks after they had experienced two seizures. As a result of our findings and taking a proportionate view we consider both Statutory Requirement Notices to be complied with by the due date. Where further improvements to care planning are required, specific examples were discussed with members of the management team. From discussions with staff we looked at the care files for 2 people who are known to exhibit challenging behaviour towards others. Both care plans were seen to be basic providing limited information as to the specific nature of their challenging behaviour, known triggers and inadequate guidance for staff as to how to proactively manage their inappropriate behaviours so as to ensure theirs and others health and wellbeing. Neither person had a risk assessment in place detailing the steps to be taken to minimise the risk. Daily care records showed that information recorded was ambiguous and confusing with little descriptive information recorded in relation to the challenging behaviour exhibited and a lack of information detailing staffs interventions. In addition one care plan made reference to a referral being made to a healthcare specialist for advice and support however there was no evidence to support this having been followed up and/or addressed. We looked at one persons care file in relation to pressure area care. Records showed there was no care plan in place detailing the treatment being provided or the type of pressure sore sustained. Records showed the person was assessed as being at high risk of developing pressure sores and was being seen regularly by a healthcare professional. A body map was evident to show the location of the pressure sore however this was not up to date therefore providing an inaccurate audit trail. When discussed with the management team it was of concern that the manager appeared unaware that a care plan should be devised. Of those people case tracked, records showed that three people were at risk of losing weight. Each person was observed to have a plan of care relating to nutrition and this included a risk assessment detailing the steps to be taken to minimise the risk to the persons health and welfare. Instructions for staff included monitoring the persons weight each week and where there was a weight loss of 2KG or more, a healthcare professional to be contacted for advice and appropriate intervention. Records showed Care Homes for Older People Page 15 of 37 Evidence: in each case that their weight was not monitored and recorded each week as per instructions and where there had been a loss of 2KG or more there was no evidence to show that a healthcare professional had been contacted. At feedback this was discussed with the management team of the home and we were made aware of an additional weight monitoring record having been newly implemented and in place. We were advised that the rationale for this was to record the weights for those people red flagged as being at risk of poor nutrition. On inspection of this folder it was of concern that none of the people case tracked were highlighted as at risk yet their nutritional risk assessment recorded them within the range of cause for concern, high risk and very high risk. Records showed that people living at Mundy have access to a range of healthcare professionals and services as and when required, both at the care home and within the local community. These include District Nurse Services, GP, attendance at hospital appointments, Optician, Chiropody, Phelebotomist, Community Psychiatric Nurse etc. As stated previously care should be taken to ensure there is a clear audit trail detailing care staffs interventions and any follow up actions. Staff spoken with were able to demonstrate a good understanding and awareness of individual peoples care needs and throughout the day of the inspection, there were positive interactions between care staff and people who live at the home. Where support and assistance was provided by staff in relation to individuals personal care, this was conducted with respect and sensitivity. Staff confirmed there are daily handovers and communication is good. Practices and procedures for the safe storage, handling and recording of medication were examined as part of this inspection on both the ground and first floors. A medication identification record for each person was in place providing a photograph of the individual, their name, date of birth, date of admission, name of GP, room number, known allergies, information as to whether or not they are able to self medicate and details of each prescribed medication. During the morning and at lunchtime the medication round was observed within the main dining room. The senior administering medication was observed to interact well with people who live at the home when giving them their medication and this was observed to be undertaken in a respectful manner. However we observed one resident to drop their medication on the floor and for the senior member of staff to pick this up with their fingers and to give it back to the resident to take. This is not good practice as it does not maintain safe infection control measures. We also observed the medication trolley being left open and the keys left in the lock on several occasions Care Homes for Older People Page 16 of 37 Evidence: while the senior member of staff administered medication to people in the dining room. This meant that medication was left unattended and easily accessible to people who live at the home and others who may be visiting. The temperature of the medication storage areas are monitored and recorded each day. Records showed that the temperature where medication is stored was within recommended guidelines however on the first floor this was seen to be at its maximum (25 degrees centigrade). In addition the temperature of the dedicated fridge used to store medication that requires cold storage was also recorded each day and this too was within recommended guidelines. We looked at the Medication Administration Records (MAR) for a random sample of 13 people. These showed that records were generally of a good standard with few unexplained gaps or omissions. For two people the MAR record for one of their medications showed a discrepancy between the number of tablets received and administered and the number of signatures recorded. For example 21 antibiotic tablets were received for one person yet there were 22 signatures recorded on the MAR sheet. When discussed with the Care Manager they were unable to provide a rationale for this. The MAR record for one person recorded G (see overleaf) and on the reverse of the MAR record this detailed waiting new delivery and waiting for prescription for their pain relief medication. We discussed with the management team of the home the importance of ensuring that there is a good supply of medication available for peoples healthcare needs. We looked at the last medication audit which was conducted on the 2nd May 2010 by the Care Manager. The audit did not meet the required standard as medication stock balances were incorrect and there were inaccurracies on some of the MAR records. Residents spoken with told us that staff do resect their privacy and dignity, for example by knocking on doors before entering rooms or during personal care. Some residents have a key and so can lock their private space when leaving their bedroom. A male resident told us that they have a male care manager who they find very friendly and professional, they would also like to have more male care staff supporting them with their care. Staff were heard to speak residents with respect and residents told us that staff are friendly. The activities co-ordinator told us that since the last inspection their have undertaken training and are now the homes Dignity Champion and that an additional four staff have recently been identified/trained for this role. Care Homes for Older People Page 17 of 37 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. Overall residents can expect to have their social care needs met and be offered a nutritious diet. Evidence: An activities co-ordinator is employed at Mundy House for 35 hours per week Monday to Friday however these hours are flexible to cover weekends, evenings and special events. The home is registered with NAPA (National Association for Providers of Activities for Older People) and the activities co-ordinator regularly meets up with other activity co-ordinators from within Southern Cross Healthcare to share ideas. A copy of the activity programme was observed to be displayed in each of the lounge areas and a copy provided to each person who lives at the home. Following the last key inspection to the service in March 2010 the activity programme is now provided in larger print so as to enable people who have a sensory impairment to make an informed choice. We looked at 4 weeks activity programme and these showed that people who live at the home have the opportunity to participate in a varied schedule which includes both in house and community based activities. Activities provided included music, films, reminiscence, bingo, gentle exercises, shopping, games, quizzes, visits by an ice cream van, religious observance, external entertainers and Care Homes for Older People Page 18 of 37 Evidence: the opportunity for people to pursue individual hobbies and personal interests. The home has access to a mini bus on several occasions throughout a four week period. We looked at two peoples care plans in full and both were observed to have their social care needs recorded. The activities co-ordinator wherever possible meets with the resident and their representative and from this an All About Me form and life history is completed. This provides useful information about the individual persons past interests, hobbies and personal preferences. Several people spoken with confirmed they were happy with the level of activities provided and comments included the activities girl is lovely and always something to do. While we accept there are lots of positives for people who have good communication skills and good cognitive ability, more needs to be provided for those people who have poor cognitive ability and/or poor communication. During the morning we spent a total of 2.5 hours in a small lounge on the ground floor observing staff interactions and activities provided for a group of 8 people. While in general terms verbal interactions were positive, apart from one person reading a newspaper and then watching television until lunchtime, no activities or stimulating occupations were provided and several people were observed to spend the majority of this time asleep. There remains an open visiting policy at the home where visitors can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at the home are actively encouraged and supported to maintain friendships and relationships. Relatives spoken with confirmed they are made to feel welcome by staff when they visit and can visit the home when they choose. The dining experience for people in the both the small lounge and the dining room on the ground floor was observed overall to be positive. People in the upstairs Lodge unit told us that they enjoy the meals and all spoken with were aware of the menu for that day. The meals provided were seen to be plentiful and in sufficient quantity. Where possible people are given the opportunity to eat independently and where assistance was provided by care staff, this was undertaken in a respectful and dignified manner. The relief manager was noted to intervene and respond confidently to a resident wanting to leave the meal table and arrange for them to have something different from the offered meals and to successfully encouarge the person to eat. This was a positive outcome for this person who needs support with their nutrition. Residents in the main dining room were asked which meal of two meals they would like and some, under the direction of the manager, were offered a choice from two plated meals. This is good practice that needs to include desserts and drinks. Improvements need to be made to ensure that people are given choices of drinks Care Homes for Older People Page 19 of 37 Evidence: throughout the day as we observed at both breakfast time and mid morning that people were only given tea or one choice of cold drink. This was particularly disappointing as it was an action point for improvement following a recent meeting with residents that was to have been implemented as part of everyday practice at Mundy House. Ideas regarding food and mealtimes were shared with the chef who attended the most recent residents meeting. New menus are being produced with photographs and large print to support people to make active choices. In response to resident views, the tea time has been moved from 4pm to 5 pm. Peoples comments about meals provided were positive and included oh the food is good, theres plenty of choice, sometimes too much food you dont want it all and I have no complaints. Care Homes for Older People Page 20 of 37 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. People can expect their concerns to be listened to and acted upon and to be safeguarded by the knowledge of staff and supporting systems. Evidence: The complaints procedure had been updated as confirmed at the last inspection and was displayed in the home. Information on the complaints procedure was contained in both the service user guide and the statement of purpose. The last inspection report contained a requirement that Southern Cross send the Commission evidence that complaints they had received in the last year had been properly recorded, investigated and responded to. This information has now been received. The relief manager told us that one complaint has been received since the last key inspection. This related to poor communication where staff could have made better efforts to inform the relatives of issues related to the residents health on two occasions even though updated contact details had been provided. The complaint was logged and recorded, the family had been offered a meeting with the relief manager, a letter was in place advising them that an investigation was taking place and that they will receive a reply within 28 days. In line with Southern Cross procedures the managers monthly audit tasks will include reviewing complaints. This should ensure that complaints are monitored and actioned in a timely way. Residents and relatives spoken with confirmed that they would feel able to raise any Care Homes for Older People Page 21 of 37 Evidence: concerns, said that the staff and the new manager were approachable and that they would know how to make a complaint. One resident and their relative told us there have been too many changes of manager and this did not help in addressing issues previously. They stated that it has been difficult to get things done/changed in the past but that things are really moving now and things are getting done. The manager and the support manager confirmed that there have been no safeguarding events referred or investigated since the last key inspection. The manager confirmed that they have undertaken training on safeguarding in the past and will ensure evidence of their training will be available at the home in future. The manager also told us that they will undertake safeguarding training again as part of their induction at Mundy House. The manager advised they have experience of safeguarding and referring and gave clear examples of appropriate actions. The manager also had readily available a copy of the Southend, Essex and Thurrock guidance and protocols and a copy of the alert form to demonstrate awareness of local procedures. Southern Cross have their own and procedures in relation to abuse, protection and whistleblowing. The management team told us that there has been updated training for staff in relation to safeguarding and that 98 of staff now have current training. Staff files sampled demonstrated evidence of training including for new staff during their induction period. We spoke to three staff to review their knowledge on safeguarding. All three staff, who had different responsibilities within the service, were aware of different types of abuse, how it can occur in care settings, confirmed that they had had training, were aware of the whistleblowing procedure and were able to demonstrate appropriate actions in reporting any concerns. Two of the staff also clearly linked their understanding of safeguarding to respecting peoples dignity and right to make everyday choices. Care Homes for Older People Page 22 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe and clean environment and will benefit from the planned improvements. Evidence: Following the last inspection Southern Cross provided the Commission with an action plan that confirms that improvements will occur to the environment for people living at the home. The responsible individual for the service was on site at the time of this inspection to view the necessary improvements to be able to ratify the expenditure and move things on. We have subsequently received a detailed action plan for works to improve the premises, all of which are due to be completed by the end of September 2010. This includes work both externally and internally including decorating of some resident bedrooms. This has been an outstanding requirements for some time and will remain as part of this report. We will monitor it at future reviews of the service to ensure that a pleasant and well maintained environment is now provided for residents in a timely way. Some improvements were already noted to different areas. Two of the upstairs toilet were in the process of being decorated. New furniture was seen to be available in some resident bedrooms. A resident told us that more new furniture is to come and this was confirmed by the manager. In the Lodge a resident told us that they had been able to move to a different room and while there were still issues with the Care Homes for Older People Page 23 of 37 Evidence: premises and decoration both they and another resident told us they can open their windows now and have heating that works. Residents in this unit also told us that they can make tea and coffee as they choose as they have their own small kitchen. One person advised that there are a limited number of electrical sockets in their bedroom and this was fed back to the manager to follow up. The delay identified by a resident in getting small repairs undertaken was discussed with the area manager who confirmed that they are reviewing the skills and competencies of maintenance staff in the locality and that this will be better used to ensure a more timely and effective service. Another positive development since the last inspection has been in the garden. This was well maintained, the patio had been cleaned, new patio furniture was available and flowers planted. A resident spoken with confirmed that they were very pleased with this and really enjoyed using the garden. They would like a better quality of lawn so that activities could safely take place there. New furniture had arrived for the dining room and was being used for the first time on the day of the site visit. The additional furniture clearly caused some difficulty in accessing parts of the room with wheelchairs. The relief manager observed the lunchtime period to see how this worked and changes were made by the teatime meal to improve this. A limited number of residents who previously had their meal in Daisy lounge and always waited a long time for their meal, now ate in the main lounge. The manager told us that this was implemented very shortly after it was picked up at the last inspection as there was no reason for these residents not to be able to join others in the dining room. As this site visit, the premises was noted to be clean and odour free. The sluice room has been retiled so that the wall surfaces can be kept clean. Staff were clearly aware of procedures to manage cross infection and shared that information promptly. Appropriate protective clothing was seen to be used. People we spoke to overall told us that they are satisfied with the level of cleanliness at Mundy House. Care Homes for Older People Page 24 of 37 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 by adequate numbers of competent staff. They would be better safeguarded by more robust recruitment procedures. Evidence: There were 49 people advised as living at Mundy House at the time of the site visit. The support manager advised that staffing levels are currently eight care staff and two senior care staff on shift all day and three care staff and one senior care staff on duty at night. Evidence of this was seen in the rotas sampled. The area manager advised that they are not staffing according to the dependency levels of residents but are maintaining higher staffing levels for example to enable staff to attend training, including in relation to care planning. Residents spoken with told us that staff are generally available when they need them and that staff speak to them appropriately and are friendly. It was disappointing that the rota was not accurate to the staff on duty as this was a requirement in the last inspection report and needs more effective management. However, it was noted positively at this occasion, that while the actual record may not have been updated, action had been taken to cover the shift where staff had reported in sick and there were the full complement of staff on duty, a noted improvement from the last inspection. The support manager confirmed that an accurate record of the hours worked by staff would be maintained so as to inform payroll. It was also Care Homes for Older People Page 25 of 37 Evidence: disappointing to note that not all staff were recorded on the rota, and issue also identified at the last inspection. This includes the manager and the activities coordinator. The AQAA provided prior to the last key inspection demonstrated that at least 50 of the care staff had achieved NVQ level II or above in health and/or social care. The support manager confirmed on this occasion that an additional six care staff had been identified and were to be registered to commence NVQ training in the near future. A recent action plan from the area manager stated that eight staff had been recruited since the last key inspection. Files of two of these staff were reviewed to assess if appropriate references and checks had been undertaken to ensure that the prospective staff are suitable people to work with residents. Neither of the files contained a photograph of the person as required to confirm identity. Both of the files contained all other appropriate references and checks, however a gap in employment history on one of the files was not recorded as identified and discussed with the person during their interview. While both staff were employed in caring roles, only one application related to a caring role, the first-day induction records of both were recorded for those of ancillary staff and only one had a job description and contract of employment. This clearly indicates an area for improvement and more effective management of the recruitment process to safeguard residents. The manager and support manager advised that the staff had been employed before they came to work at Mundy House. They state they have reviewed all the staff files and determined that there is insufficient evidence of completeness in relation to induction records. They plan that all staff will undergo a full Skills for Care induction process to ensure basic competency, with assessments being undertaken by the manager and deputy manager. They confirm that they have not yet had time to audit all the staff recruitment files, which will occur, and that the issues raised will be addressed. There was evidence that both staff have completed mandatory training for example in relation to moving and handling, fire and safeguarding as part of their induction training. Induction training helps staff to know the care needs of the people they are to support and be able to meet them. An action plan received from the area manager following the last key inspection advised that training statistics have improved in all subjects with mandatory training being above 85 . The training statistics on the day of the site visit show current moving and handling training at 95 , control of substances hazardous to health (COSHH) 90 , food hygiene 89 , health and safety 87 , abuse/pova 98 , infection-control 89 , nutrition 81 , safer use of bedrails 94 , dementia awareness Care Homes for Older People Page 26 of 37 Evidence: 97 , pressure care 79 , safe handling of medication 189 , and medication update 100 . This is a noted improvement from the last inspection. The training records of two staff reviewed had evidence to support this and staff spoken with told us that there has been a lot of training since the last inspection. Care Homes for Older People Page 27 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management team stability would support more consistent and effective outcomes for residents. Evidence: There is a history of unsettled and inconsistent management at Mundy House that has been shown to have had an impact on the quality of the outcomes for residents. Southern Cross have responded on each occasion providing additional support to the service but improvements have not been sustained. At the last key inspection in March 2010 the home was judged as having poor quality care outcomes for residents. The Commission subsequently issued Statutory Requirement Notices in relation to care planning and risk assessment. As noted earlier, these were reviewed at this site visit and, while additional work is agreed as needed, sufficient improvement was noted to consider that compliance has been achieved. The Commission will monitor Mundy House to ensure that action plans are implemented in a timely way and that improvements continue and are sustained. Therefore the requirement in relation to competent management of the service will be repeated in this inspection report. Care Homes for Older People Page 28 of 37 Evidence: The manager in post at the key inspection of March 2010 has since resigned and two relief managers have managed the home in the interim. A new permanent manager has been appointed and has now been in post for approximately two weeks. The manager told us that they have relevant experience as a registered manager of a care home for older people, having worked their way up from care assistant over time and that they also have an appropriate qualification, NVQ4 in Care and Management. Evidence of the managers qualifications and training was not available as these are held centrally by Southern Cross. The area manager told us that this will be maintained at the home in future. The manager will have an induction of up to three months supported by the current relief manager, who is an experienced manager in care homes for older people for Southern Cross and has been based at Mundy House for the past three weeks. The manager told us they are waiting for their Criminal Records Bureau check to be returned after which they will be making prompt application to be registered with the Commission. Residents, relatives and staff spoken with told us that they find the new manager approachable and available to them. A staff member told us that the new manager listens, get things done or tells them if it is not possible to achieve what they want. Staff also told us that this is having a positive effect on staff morale as there seems to be clearer leadership and support. There is noted improvement relating to the organisations quality assurance management of the service. Following a requirement in the last inspection report, Southern Cross have sent the report of their monthly visit of Mundy House as required by regulation to the Commission to evidence that they are regularly monitoring the quality of the service provided there. Additionally, Southern Cross have continued the external quality audits and inspections of the service commenced just prior to the last key inspection, produced action plans to address the outstanding issues and kept the Commission up-to-date with these. The new manager showed us their own planned monthly monitoring tools which they advise will have an overview of relevant systems including medication, care planning, accident and complaint monitoring as well as any concerns for residents in relation to falls and weight loss. It was disappointing to note that while a record was available to demonstrate a higher alert for some residents in relation to their weight/nutrition, none of the residents that we identified as having a weight concern from their care documentation were included in the managers records. It is acknowledged that the manager has been in post for a limited period of time and that additional improvements to the service are required to demonstrate that it is effectively Care Homes for Older People Page 29 of 37 Evidence: managed. Issues identified in this report that require more effective management include care management documentation, medication and more robust recruitment procedures. The positive actions taken both by Southern Cross and the managers in place since the last inspection are also acknowledged. The responses to the Southern Cross surveys being received at the time of the last key inspection had been collated by a previous support manager and indicated a range of views in relation to the care provided, the quality of the environment etc. At the time of this site visit, a letter was being prepared to be sent to all relatives to invite them to a meeting with the new manager and enclosing a questionnaire to obtain their views, particularly if they were unable to attend the meeting. Minutes of a recent residents meeting indicate, but do not record, that a number of residents attended. A number of issues were discussed with the main focus being in relation to food/drinks and the chef attended the meeting. A number of suggestions were made and an action plan implemented. This includes changing the time of the teatime meal from 4pm to 5pm, improving the new picture menus to have bigger print and for residents to be regularly offered a choice of coffee as well as tea. We observed during the day that some residents were offered a choice of tea and coffee on some occasions but that this was not consistent in practice. A computerised system is in place for recording the management of personal allowance money for residents who require this service. Residents money is maintained in a non-interest-bearing bank account with a limited float being available so that residents can have access to cash when they need it. The system allows records to be monitored by head office to ensure accuracy and safeguard residents. The homes administrator demonstrated that records are maintained of money received and withdrawn, monthly audit and reconciliation is undertaken, and receipts were available. The records randomly sampled were found to be well maintained. The improvement to the security and safety of records storage noted at the last inspection has been maintained. Improvement was noted at this inspection to the quality and availability of the accident records which were readily to hand, were well organised and sequential and demonstrated monthly audit in line with Southern Cross policy and procedure. The area manager also confirmed that the managers at Mundy House had entered the details on to the organisations computerised system which allows them to be monitored for trends. As noted previously better management of the quality and content of, for example, care management documentation, rotas, recruitment files and induction records is an area for development. Care Homes for Older People Page 30 of 37 Evidence: Aspects of health and safety were reviewed and found to be satisfactory. Separate checks were recorded in relation to fire safety including fire alarm and fire equipment. Current safety inspection certificates were available in relation to the passenger lists, gas, fire equipment and emergency lighting. The manager informed us that a new fire risk assessment has just been undertaken on the premises by the Southern Crosss facilities manager although a copy was not yet available on site. A current certificate of liability insurance was displayed. Care Homes for Older People Page 31 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15(1) Care planning at the home 01/05/2009 must identify, and be effective in meeting all residents assessed needs and give staff clear instructions on how to apply these in daily practice to ensure that residents get the care they need and in the way they prefer. Previous timescale of 01/08/08 not met. This is an outstanding requirement. 2 8 17(2) Where a person is at risk of 01/05/2009 losing weight maintain records of nutrition that include weight gain and loss and demonstrate appropriate action is taken. Risk assessments must be 01/05/2009 devised for all areas of assessed risk so that risks to residents can be minimised. Previous timescale of 01/08/08 not met. This is an outstanding requirement. 3 8 13(4) 4 19 23(2) To respect residents right to 01/06/2009 live in a pleasant and wellmaintained environment, the premises must be Page 32 of 37 Care Homes for Older People 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 refurbished and redecorated in a timely manner and a detailed programme with clear timescales to be sent to the Commission. Previous timescale of 01/10/08. This is an outstanding requirement. 5 31 10(1) The registered person must ensure that the home is managed with sufficient skill and competence so as to ensure the smooth running of the home and that residents needs are met. 01/06/2009 Care Homes for Older People Page 33 of 37 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 8 17 Ensure where someone has a pressure sore the treatment provided and equipment in situ is recorded within their plan of care. So as to ensure peoples health and welfare. 30/06/2010 2 9 13 People must be protected from harm by having their medication administered safely and in accordance with the prescribers instructions. So as to ensure peoples safety and wellbeing. 30/06/2010 3 9 13 If medication is dropped on the floor this must be destroyed. So as to ensure safe infection control measures are adopted at all times. 30/06/2010 Care Homes for Older People Page 34 of 37 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 4 9 13 Ensure that medication is not left unattended and easily accessible to people who live at the care home. So as to ensure their safety and wellbeing. 30/06/2010 5 9 13 Ensure that the number of signatures on the MAR record tallies with the amount of medication prescribed. To demonstrate that people are given medication prescribed for them. 30/06/2010 6 37 17 An accurate duty roster must be maintained of all staff working at the home. To demonstrate the staff working at the home and to safeguard residents. 26/06/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 12 29 29 37 Provide social stimulation for people who have poor cognitive ability and/or poor communications skills. A current photograph of all staff working in the home to be available. Gaps in employment history to be explored and outcomes recorded. Keep a record on file to show that staff have completed full induction training at Mundy House. Page 35 of 37 Care Homes for Older 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 Care Homes for Older People Page 36 of 37 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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