Care Home: The Mount

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well The staff work hard to ensure that residents` needs are appropriately assessed and that their care is planned to ensure that these needs are met, whilst encouraging and enabling residents to maintain their independence where possible. Residents spoken with expressed their satisfaction with their quality of life at the home. Comments received from residents included: `They are very kind and help me in anyway they can` and `Nothing is too much trouble.` Comments received from relatives included `They provide a family environment. The staff are very friendly. Interesting and varied menu. Good activity programme.` and `the home always feel clean and welcoming. The staff always make you feel welcome.` All interactions observed between the management, staff and residents evidenced that the home has a close and caring staff team. One member of staff commented that `they give everyone the opportunity to get relevant training and the room to discuss any issues to improve on the service.` What has improved since the last inspection? The ongoing maintenance, redecoration and refurbishment programme provides residents with a comfortable and homely environment in which to live. All requirements and recommendations made at the last inspection have been met. The bathrooms identified at the last inspection have all been redecorated, repairs have been made to the laundry building and a raised flowerbed has been built outside of the main lounge. There are plans to build more raised flowerbeds later this year. Safeguarding adults training has been provided to all staff and is now included in the induction training of all new staff. Quality assurance surveys are carried out 3 monthly and the results are published in the home`s quarterly newsletter. What the care home could do better: Requirements have been made regarding the provision of staff training relating to the specific needs of individual residents and the need for all staff to understand the definitions of abuse and the action they need to take in line with the local protection of vulnerable adults procedures. Recommendations have been made that staff relate their daily notes more directly to the care plans and that residents or their representatives sign the care plans to show their involvement with and agreement to the plan of care.Recommendations have also been made that the manager further explore the opinions of the residents, their relatives and the staff relating to staff availability at the home. CARE HOMES FOR OLDER PEOPLE The Mount School Hill Wargrave Berkshire RG10 8DY Lead Inspector Denise Debieux Unannounced Inspection 6th February 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Mount Address School Hill Wargrave Berkshire RG10 8DY Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0118 9402046 0118 9404909 Majestic Number One Limited Mrs Sarah Ntshudu Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Of the 37 beds up to 29 may also receive nursing care. Persons under the age of 60 will not be received except for respite care for periods not exceeding 3 weeks. 29th June 2006 Date of last inspection Brief Description of the Service: The Mount is a converted and extended Victorian house located on the northern bank of the river in the picturesque village of Wargrave. The Mount accommodates up to 29 people needing nursing care and people needing residential care up to a total of 37 residents. The home is run by Majestic Number One ltd. Residents rooms vary in size, though many have en-suite facilities. The communal areas include two dining areas, a large lounge, a conservatory and a large garden with additional seating areas provided in the warmer months. Specialised equipment has been obtained for the comfort and safety of the residents. Parking areas are provided to the front and side of the building. Residents are encouraged to bring in personal possessions and occasional furnishings to feel even more at home. Each room has a nurse call system and most have a TV. Fees range from £565 - £875 per week. This fee does not include toiletries, hairdressing, chiropody or opticians. This information was provided on 6th February 2008. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This unannounced visit formed part of a ‘key’ inspection and was carried out by Denise Débieux, Regulation Inspector. The Registered Manager was present as the representative for the establishment. It was a thorough look at how well the service is doing. It took into account detailed information provided by the manager and any information that CSCI has received about the service since the last inspection. Service users at this home prefer to be referred to as ‘residents’ so this term is used throughout this report. A tour of the premises took place. On the day of this visit the inspector spoke with nine of the twenty-six residents and six on-duty staff. Prior to the inspection, survey forms were sent to residents, their relatives and/or advocates and to staff employed at the home. Survey forms were returned by fourteen residents, twelve members of staff and twelve relatives/advocates. These comment cards were correlated and the results were shared with the manager during the inspection. Comments made on the survey forms, both positive and negative, were included in the correlation and shared with the manager. Care was taken to exclude any comments that could identify the writer. The manager demonstrated a very pro-active attitude to the results of our survey and plans to explore any concerns raised further as part of the home’s quality assurance process. Some of the comments made to the inspector and made on the survey forms are quoted in this report. The home had completed an annual quality assurance assessment (AQAA) and residents’ care plans, staff recruitment and training records, menus, health and safety check lists, activity records, policies, procedures, medication records and storage were all sampled on the day of this visit. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. The inspector would like to thank the residents and staff for their time, assistance and hospitality during this visit and the residents, relatives and staff who participated in the surveys. What the service does well: The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 6 The staff work hard to ensure that residents’ needs are appropriately assessed and that their care is planned to ensure that these needs are met, whilst encouraging and enabling residents to maintain their independence where possible. Residents spoken with expressed their satisfaction with their quality of life at the home. Comments received from residents included: ‘They are very kind and help me in anyway they can’ and ‘Nothing is too much trouble.’ Comments received from relatives included ‘They provide a family environment. The staff are very friendly. Interesting and varied menu. Good activity programme.’ and ‘the home always feel clean and welcoming. The staff always make you feel welcome.’ All interactions observed between the management, staff and residents evidenced that the home has a close and caring staff team. One member of staff commented that ‘they give everyone the opportunity to get relevant training and the room to discuss any issues to improve on the service.’ What has improved since the last inspection? What they could do better: Requirements have been made regarding the provision of staff training relating to the specific needs of individual residents and the need for all staff to understand the definitions of abuse and the action they need to take in line with the local protection of vulnerable adults procedures. Recommendations have been made that staff relate their daily notes more directly to the care plans and that residents or their representatives sign the care plans to show their involvement with and agreement to the plan of care. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 7 Recommendations have also been made that the manager further explore the opinions of the residents, their relatives and the staff relating to staff availability at the home. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident is only admitted to the home following a comprehensive needs assessment to ensure that the home can meet the resident’s identified needs. This home does not offer intermediate care. EVIDENCE: Three care plans were sampled during this visit, including those for the two residents who had most recently moved into the home. In each case comprehensive pre-admission assessments had been carried out to ensure that the home could meet the residents’ identified needs. In the AQAA, to demonstrate what the home does well, the manager stated that ‘needs assessments are carried out promptly and comprehensively ensuring that the home can meet needs assessed. All equipment as found to be required is sourced and in place before admission takes place.’ The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 10 Data provided in the home’s AQAA does not identify any residents with specific religious, racial or cultural needs at this time. However, from the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Staff surveyed stated that they felt the home provided training that helped them to understand and meet the individual needs of the residents. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care and healthcare support and assistance is planned and was seen to be provided, where needed, in a respectful and sensitive manner. Policies, procedures and practices are in place to ensure the safe administration of medication. EVIDENCE: The staff at the home demonstrate an in depth knowledge of each individual residents’ needs, abilities and preferences in how they wish their care to be delivered. Of the fourteen residents surveyed, five said they always receive the care and support they need and nine answered ‘usually’. The care plans sampled during this visit were all based on pre-admission assessments and had been drawn up shortly after each resident’s admission to the home. These care plans clearly set out the actions which need to be taken by care staff to meet the health, personal and social care needs of the residents and to reduce any identified risks to their well-being. Care plans are reviewed on a monthly basis, and are amended promptly when changes occur. The home also carry out a three monthly review and audit of the care plans. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 12 Risk assessments are thorough and include falls, nutrition and risk of skin breakdown. The organisation have just introduced a very detailed risk assessment for the use of bedrails, in response to the recent medical device alert published by the Medical and Healthcare products Regulation Agency. Staff record the care given in daily notes, these notes demonstrated that any changes or new concerns are promptly acted upon. However, at times the daily notes made are very general (e.g ‘all care given’) and a recommendation has been made that the staff relate their daily notes more directly to the actions set out in the care plans in order to evidence that the resident’s needs are being met and that their care is being carried out in the way they prefer. The care plans sampled were not signed by the residents or their representative and a recommendation has been made that the home obtain the signature of the residents to signify their involvement with and agreement to their care plan. At present the home are working with the Royal National Institute for the Deaf to identify, if possible, an appropriate loop system to be installed in the home. The difficulty at present is the amount of different systems available and the numerous different hearing aids that the residents have. The home are trying to find a system that will be effective for everyone with hearing difficulties. The inspector was shown one quote that the home have recently obtained but this is still a difficult work in progress which may not have an easy or practical solution. Of the twelve relatives surveyed, eleven said they were always kept up to date with important issues affecting their relative and one answered ‘usually’. One relative comment that ‘The Mount is very good in this regard, I am always informed.’ The lunchtime medication round was observed and the medication administration records, medication storage, controlled drug storage and register, policies and procedures were all sampled and found to be in order. In the AQAA, to demonstrate how the home has improved in the last 12 months, the manager stated that ‘Care plan training done; 3 monthly care plan reviews improved a lot; training on risk of falls done; nutritional screening, much improvement observed; staff members are now aware of policies; advocate services are displayed in the reception area.’ During the tour of the home staff were observed to always knock before entering the residents’ bedrooms and all interactions observed between staff and residents were seen to be caring and respectful. Residents spoken with confirmed that they felt their privacy was always respected. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activities provided by the home are individualised to each resident and include contact with the local community both within and outside the home. Contacts with family and friends are encouraged. Meals are well-balanced and varied with individual choices and preferences catered for. EVIDENCE: The routines of daily living are arranged to suit individual resident’s preferences and choices. This was confirmed by residents spoken with. The home have a full-time activity co-ordinator who works five days a week. The activity programme for February was seen at this visit. Planned activities included: an exercise group; a church service; baking; crafts; bingo and bus trips. The hairdresser also visits on a weekly basis. All residents had an individualised care plan for social activities. Three of the fourteen residents surveyed stated that there were always activities they could participate in, with nine answering ‘usually’ and two answering ‘sometimes’. One resident commented that they enjoyed all the The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 14 activities. Another resident remarked that they felt there were not enough activities for people that may be ‘confined to their room’. Comments received from relatives included: ‘the needs of the residents are always taken care of and there is plenty of entertainment and celebrations.’ ‘The Mount are very good at trying to keep up the spirits of the residents, there is a good programme of games and parties.’ ‘Activities provided are wide-ranging and well thought out.’ One relative commented that ‘it is possible that some residents would like to be more active but there may not be enough staff to assist the residents with walking on a one-to-one basis.’ Another added that they felt there could be more activities at the weekend when the activity co-ordinator does not work. Residents are able to choose which activities they attend or participate in and their individual rooms were all seen to contain many personal possessions which were arranged to suit their individual wishes. There are no restrictions to visiting times and staff support and encourage residents to maintain family links and friendships inside and outside the home. Menus sampled showed that the home offers a varied and well-balanced menu, with residents able to choose alternatives if they do not want the dish that is on the menu on the day. The lunchtime meal was taking place during this visit, the food was well presented, the atmosphere in the dining room was pleasant and relaxed and there were ample staff available to offer help and assistance as needed. Of the fourteen residents surveyed, two said that they always liked the meals at the home, eight answered ‘usually’ and three answered ‘sometimes’. One resident commented that the food is sometimes cold and a relative felt that the food and drinks could be served hotter. One relative suggested that photographs of the different foods could help residents make their menu choices. The manager felt that was a very good idea and plans to put that suggestion into practise. Residents spoken with during lunch all said they were enjoying their meal with one resident saying how much she enjoyed the variety of puddings every day. In the AQAA, to demonstrate what the home does well, the manager stated: ‘A very active relatives committee. Events and activities are well planned and all users aware of forthcoming events. Goals set for residents are met on a regular basis and are achievable. Interdenominational visits are well established with residents able to observe personal preferences. Autonomy and choice encouraged well and rooms are personalised. Residents exercise autonomy in respect of managing their personal finances and they are enabled to maintain this. Meals are presented well and are suitable for the residents needs.’ The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a simple, clear and accessible complaints procedure which includes timescales for the process. Policies and procedures are in place to protect residents from potential harm or abuse. EVIDENCE: The home has a complaint’s procedure in place that is available to all residents and their relatives and is also included in the residents’ guide. No complainant has contacted the Commission with information regarding a complaint or allegation made to the service since the last inspection. Five residents surveyed said that they always knew who to talk to if they were not happy, four answered ‘usually’ and three answered ‘sometimes’. All relatives surveyed were aware of the home’s complaints procedure with seven feeling the home always responded appropriately if concerns were raised and four answering ‘usually’. One relative commented that they had not been made aware of the outcome of their concern and another commented that ‘if I raise a concern it is dealt with promptly and efficiently.’ There is a whistle blowing policy in place and the home have a copy of the latest Berkshire Multi-agency Procedure for the Protection of Vulnerable Adults. Training in safeguarding adults is included in the home’s staff induction and all staff have now received training in the protection of vulnerable adults following the requirement made at the previous inspection. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 16 In the AQAA, to demonstrate what the home does well, the manager stated: ‘Managing complaints and staff awareness of the procedure to follow. Current residents have been directed to advocacy services and they are enabled to exercise their rights in this area. Staff awareness of protection issues is good and they demonstrate a good understanding of ensuring that residents are protected from all forms of abuse, which is evidenced by the outcomes for residents and the training records in this area. Confidentiality is well respected.’ Actions taken, following a recent concern raised with the home, indicate that staff need a review of their training and understanding of the officially recognised definitions of abuse and of the Berkshire Multi-agency Procedures. Following the concern being raised, staff had followed the organisation’s policy, which was not in line with the local Berkshire procedure at that time. The organisation had already recognised the need to review their own policy and the inspector was advised that the organisation is introducing their new policy this week and have amended their procedure to mirror the Berkshire one. This is addressed further in the ‘Staffing’ section of this report. Additional and immediate steps were taken by the manager on the day of this inspection to bring their actions into line with the Berkshire procedure and the home’s new policy. All residents spoken with said that they felt safe at the home with one resident adding ‘very’. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The location and layout of the home and gardens are suitable for their stated purpose. An ongoing maintenance and redecoration programme provides the residents with clean, pleasant and homely surroundings in which to live. EVIDENCE: The Mount is a converted and extended Victorian house located on the northern bank of the river in the picturesque village of Wargrave. Residents rooms vary in size, though many have en-suite facilities. The communal areas include two dining areas, a large lounge, a conservatory and a large garden with additional seating areas provided in the warmer months. Specialised equipment has been obtained for the comfort and safety of the residents. Residents spoken with expressed their satisfaction with the accommodation provided at the home. Ten of the residents surveyed said that the home was always fresh and clean and three answered ‘usually’, (one survey form was left blank.) The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 18 Some relatives commented that ‘A coat of paint would improve some areas’, ‘it could do with a facelift’, and that the home could ‘brighten and freshen up the dining room décor’. Many positive comments were also received from relatives regarding the standards of cleanliness at the home, these comments included: ‘the home is very clean’; ‘the home always feels clean and welcoming’; ‘the home is clean, warm and comfortable’; ‘furnishings and surroundings very good, I especially like the facility to use the garden.’ The home was toured during this visit. Communal areas were bright and warm and presented a homely feel. Personal bedrooms were all seen to be personalised to the individual resident’s wishes. The maintenance and redecoration programme for the home was seen to be ongoing. Since the last inspection there have been a number of improvements to the communal and individual areas of the home. The bathrooms identified at the last inspection have all been redecorated, repairs have been made to the laundry building and a raised flowerbed has been built outside of the main lounge. There are plans to build more raised flowerbeds later this year. Laundry facilities are sited in a separate building in the grounds, with washing machines suitable for the needs of the residents at the home. In the AQAA, to demonstrate what the home does well, the manager stated that ‘Maintenance and environment audits and records demonstrate excellent management and all areas present well . The environment is welcoming, clean and fresh and refurbishment is ongoing in areas identified as in need of improvement from the audit process.’ Areas that the home have identified for improvement include: ‘We have started a programme to buy profile beds for our nursing residents. Improved communication system for hard of hearing.’ Previous plans to develop a unit for people with dementia are currently on hold. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of the staff enables them to meet the needs of the residents most of the time but the home needs to assess staffing arrangements at times of peak activity and at weekends to ensure that there are sufficient staff to meet the personal, health and social care needs of the residents at all times. The home has a staff recruitment and training programme which incorporates all areas needed to ensure, as far as reasonably possible, that residents are in safe hands at all times. However, the staff training programme needs to be developed further to include training specific to the individual needs of the residents currently living at the home. EVIDENCE: The staff rota evidenced that staff are provided in sufficient numbers to meet the needs of the residents at the home for most of the time. The morning (8am – 2pm) shift is covered by one registered nurse plus five care workers, one registered nurse plus four care workers cover the afternoon/evening shift (2pm – 8pm) and the night staff consists of one registered nurse and two care workers. Of the fourteen residents surveyed, two stated that staff are always available when needed, eight answered ‘usually’, three answered ‘sometimes’ and one answered ‘never’. One resident commented that: ‘sometimes there is a delay in being taken to the toilet’ and another felt that there were enough staff most The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 20 of the time but that at some times they felt they were being rushed by the staff. Of the twelve staff members surveyed, four felt that there were always enough staff to meet the individual needs of all the residents, four answered ‘usually’ and four answered ‘sometimes’. Comments received from relatives in this respect included: ‘sometimes there is a delay when my relative needs the toilet’ and another felt that an increase in the ratio of staff to residents would allow the staff to spend more time with each resident. These results and comments are similar to the findings at the last inspection when a requirement was made. Following that inspection the home had reviewed their staffing levels and deployment, as required. However, the above results of the surveys and comments received prior to this inspection would indicate that staff availability at different times of the day and night, and staff availability to meet the social care needs of the residents who do not or are not able to participate in group activities, is still something that concerns some residents, relatives and staff. A recommendation has been made that these areas are explored in more detail by the management of the home in order to ensure that the needs of all residents are being met at all times. During this visit the files of four recently recruited members of staff were sampled. The files sampled evidenced that the home have robust recruitment procedures and carry out all pre-employment checks in line with the regulations. Staff induction is in line with the new, mandatory Skills for Care common induction standards and the inspector was advised that staff are supervised until they have completed their induction. The staff training log evidenced that staff have received all mandatory safe working practice training and a spread sheet has been implemented so that the manager is easily able to identify and schedule regular updates as required. Of the twenty care workers, thirteen now hold a National Vocational Qualification (NVQ) level 2 or higher in care, with a further four currently undertaking the training. The manager has already identified that the home need to source and provide additional training to the staff that relates to the specific needs of individual residents, e.g. training related to the needs of people with Parkinson’s disease; care of people with confusion; care of people who have had a stroke; care of people with sensory impairment; care of people who have dementia etc.. It is important that the home now take action to meet this identified need for additional staff training and a requirement has been made. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 21 A requirement has also been made in relation to the incident mentioned earlier in this report that identified that staff need a review of their training and understanding of the officially recognised definitions of abuse and of the Berkshire Multi-agency Procedures for the Protection of Vulnerable Adults. In the AQAA, to demonstrate what the home does well, the manager stated that ‘Continuity for residents is well maintained. Staff training is being continued. Improvements in the last 12 months: We have continued to train staff on NVQ2 and NVQ3, 1 staff member is doing an assessors course, created a person specification for all job roles and created a training and development plan for each staff member.’ Of the fourteen residents surveyed, eleven said that the staff always listened and acted on what they said and two answered ‘usually’. All care staff said that they had received training which is relevant to their role; training to help them understand and meet the individual needs of the residents and training that keeps them up to date with new ways of working. Staff were complimentary regarding the training provided by the home. When asked what they thought the home does well a number of staff members cited the provision and availability of staff training. Many positive comments were made by relatives about the staff at the home. These comments included: ‘the staff are courteous and patient with all residents’; ‘kind and supportive care’ and ‘the staff always make you feel welcome.’ The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the clear management approach at the home providing an open, positive and inclusive atmosphere. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the residents. Policies and procedures are in place to protect residents’ financial interests. All policies, procedures and practices are in place to ensure, so far as is reasonably practicable, the health, safety and welfare of residents and staff. EVIDENCE: The manager is a registered nurse and also holds a Registered Manager’s Award (RMA). Her management style is inclusive and the residents benefit from the ethos, leadership and clear management approach of the home. The deputy manager of the home is also a registered nurse and holds an RMA. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 23 A total of eleven care staff survey forms were received prior to the inspection. From observations made on the day and from comments made on the staff questionnaire it is clear that the home have a close and happy staff team. Staff feel well supported by their manager with all staff saying they meet with their manager on a regular basis for support and discussion on how they are working. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the residents and their relatives. The inspector was advised that the home carry out quarterly resident surveys, correlate the responses and then formulate an action plan to address any issues that are raised. Outcomes of surveys are published in the home’s monthly newsletter. Policies and procedures are in place to protect residents’ financial interests. The home have a clear accounting and safe storage system for residents’ money and these records are checked on a monthly basis by the area operations manager during monthly statutory visits. Health and safety monitoring check sheets were sampled and found to be wellmaintained and up to date. The day before this inspection all hoisting equipment had had it’s six monthly service and safety checks, certificates were seen by the inspector. All staff have received required safe working practice training and updates. Staff were observed to be following appropriate health and safety practices as they went about their work. The home keeps records of any notifications made to CSCI as required by regulations and the manager ensures that these are generally sent without delay. However, notification of a recent incident was not made. It is noted that this was during the manager’s annual leave and a recommendation has been made that the home download the most recent ‘notifications guidance’ (24/01/08) from the CSCI website and ensure that any staff left in charge of the home are made aware of and follow the guidance. In the AQAA, to demonstrate what the home does well, the manager stated that ‘The aims and objectives of the company and of the home are made known to staff in a variety of ways. Knowledge of the standards and the regulations is good throughout the staff team and all areas are monitored in line with company procedures. Records are well maintained and safety issues well managed.’ All interactions observed between the staff and residents were inclusive, caring and respectful. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP30 Regulation 18(1)(c) Requirement Timescale for action 06/05/08 2 OP30 13(6) In order to ensure that the individual needs of all residents living at the home are met, the registered person must develop and implement a programme of additional training that covers areas specific to the residents’ individual needs. E.g. . training related to the needs of people with Parkinson’s disease; care of people with confusion; care of people who have had a stroke; care of people with sensory impairment; care of people who have dementia etc.. The registered person must 06/04/08 ensure that all staff have a full understanding of the officially recognised definitions of abuse and of the Berkshire Multiagency Procedures for the Protection of Vulnerable Adults in order to ensure that prompt and appropriate action is taken to protect the residents at the time of any report of possible abuse. The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that staff relate their daily notes more directly to the actions set out in the resident’s care plans in order to evidence that the resident’s needs are being met and that their care is being carried out in the way they prefer. It is recommended that residents or their representatives be asked to sign and date the care plans to signify their involvement with and agreement to their care plans. It is recommended that the results and comments made on the CSCI pre-inspection surveys relating to staff availability at different times of the day and night, as well as staff availability to meet the residents’ individual social care needs, are explored in more detail by the management of the home in order to ensure that the needs of all residents are being met at all times. It is recommended that the home download the most recent ‘notifications guidance’ (24/01/08) from the CSCI website and ensure that any staff left in charge of the home are made aware of, and follow, the guidance in relation to statutory Regulation 37 notifications. 2 3 OP7 OP27 4 OP38 The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Mount DS0000011007.V357896.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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