Care Home: The Mount Eventide Home

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What the care home does well The Mount Eventide provides a safe community life for its residents. Their environment is calm and they enjoy regular Christian services, prayer meetings, and singing of religious songs. Residents are treated with respect, and their dignity is preserved. The relative of a person who had come for a second respite stay said they `were very pleased with the service, and had no complaints.` Plenty of time is allowed for decision making while people are moving in, with full information provided, and choice of rooms according to availability. People who live here accept that the home has a no smoking and no alcohol policy.The staff worked in an unhurried way, with time to talk with the residents, and to take them out individually on occasion. In surveys, ten out of thirteen residents said that staff are `always` available when they need them, the other three said `usually`. This elegant house is well maintained, well decorated and provides a homely, comfortable and well-furnished home for the residents. The home has a volunteer group of friends, who raise money for social activities and organise coffee mornings, an annual garden party and outings for residents as well as the Church services. What has improved since the last inspection? The home`s registration has changed, to mark the fact that the service is not designed for people with dementia. Older people who become mentally frail after admission may be accommodated as long as the service can suitably meet their needs. Staff levels had remained the same, but there were fewer residents who were highly dependent, so staff found they had time for their duties, except when they were short of a kitchen assistant and had to spend time preparing trays at breakfast time. Staff training had been provided during the past year. In particular, all care staff had attended training on the Protection of Vulnerable Adults, as well as an introductory course on care of people with dementia, and fire safety. Those for whom it was appropriate had attended training on administration of medication. All Senior staff attended a First Aid course for appointed persons. A number of care staff completed National Vocational Qualification (NVQ) training in care, level 2, and two Seniors started NVQ level 3. Catering staff had training in kitchen management. The dining room had been redecorated, and new flooring laid, to make it attractive and hygienic. What the care home could do better: Staff knew the residents well, but the recording of the care they have given was unreliable. Some Care plans included some but not all of the resident`s healthcare needs. Each plan should be considered carefully, and in consultation with the resident or their representative, to make it a useful document. Many of the current residents are independent, and when residents are capable of monitoring their own health needs and bodily functions, this should be recorded in their care plan and no records need to be kept. However, the home needs to make its practice sufficiently reliable and consistent to assure good care of its residents when they become frail and ill. When it is judged that a person needs records kept of their fluid intake, nutrition, or elimination, the team must keep these records accurately, so thatthey are useful. They must include when care has been offered but declined, with the reason, so that staff can account for what they have done. When residents wish to keep their own medication, their ability to do this safely should be recorded, with any risk factors, and should be reviewed at suitable intervals. The main medication system was carefully administered, which includes all the medication regularly prescribed for residents. Non-prescribed drugs (such as pain-killers) needed to be accounted for just as well, so that the Manager may know who has been given this medication, and how much should still remain in the cupboard for which she is responsible. The recruitment procedure was followed carefully, to ensure that suitable people were appointed to care for residents, except the Manager needed to use the system for checking applicants against the POVA list (Protection of Vulnerable Adults) to make sure they have not been involved in abuse of any sort. It is recommended that the Manager should keep a chart showing staff`s training achievements, as this will also show when up-dates are needed. We found that Moving and Handling training needed to be up-dated, to ensure the safety of both staff and residents. Handrails are needed by the front door to the home, to help residents come and go in safety. The Manager told us that Planning Permission had been obtained. CARE HOMES FOR OLDER PEOPLE The Mount Eventide Home 7 Lipson Terrace Lipson Plymouth Devon PL4 7PR Lead Inspector Stella Lindsay Key Inspection (unannounced) 18th March 2009 10:30 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 Eventide Home DS0000003497.V374749.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 Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Mount Eventide Home Address 7 Lipson Terrace Lipson Plymouth Devon PL4 7PR 01752 665222 01752 672777 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) www.keychange.org.uk Keychange Charity Mrs Margaret Barrett Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2006 Brief Description of the Service: The Mount Eventide is a care home providing accommodation and personal care for 28 people aged over 60. It is owned by a voluntary organisation, and is part of the Key Change Christian based charity, which is a national organisation providing residential and nursing homes following Christian principles. The home is situated in the residential area of Lipson and is close to Plymouth city centre. The home has been a care home since 1948 and was first registered in 1985. It is comprised of a three-storey end of terrace house. Bedrooms are on all three floors and are single rooms with en suite facilities. The 1st and 2nd floors are accessed by a shaft lift and stair lifts, as well as stairs. On the ground floor there is a large lounge, with doors opening onto the garden, a smaller lounge situated on the ground floor of the Kate Ford Wing and a dining room. There is a call bell system throughout the home. There is a large back garden, that has been attractively landscaped with a patio, lawn and flowerbeds, and all areas are accessible to the residents. Current fees range from £408 - £445, depending on size and location of room. Where a person’s care needs have increased, the fees have been increased by the amount of their Attendance Allowance. Information about the home, including the previous Inspection report, is available in the home’s office. The Mount Eventide Home DS0000003497.V374749.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. This inspection was unannounced and took place on two days, ending on 23rd March 2009. It was carried out by one inspector, but the report is written using ‘we’ as it was carried out on behalf of the Commission for Social Care Inspection. Prior to the unannounced inspection we sent questionnaires to people who live at the home, and to people who work there. Thirteen residents and five staff completed and returned these. During our visit we spoke to seven people who use the service and two regular visitors, the registered manager, and six other staff members. The Service Provider sent us their annual quality assurance assessment (AQAA) when we asked for it. It was clear and gave us all the information we asked for. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We met with them, spoke to staff about their care, and looked at records that related to them. We looked at staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. All this information helps us to develop a picture of what it is like to live at The Mount Eventide. What the service does well: The Mount Eventide provides a safe community life for its residents. Their environment is calm and they enjoy regular Christian services, prayer meetings, and singing of religious songs. Residents are treated with respect, and their dignity is preserved. The relative of a person who had come for a second respite stay said they ‘were very pleased with the service, and had no complaints.’ Plenty of time is allowed for decision making while people are moving in, with full information provided, and choice of rooms according to availability. People who live here accept that the home has a no smoking and no alcohol policy. The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 6 The staff worked in an unhurried way, with time to talk with the residents, and to take them out individually on occasion. In surveys, ten out of thirteen residents said that staff are ‘always’ available when they need them, the other three said ‘usually’. This elegant house is well maintained, well decorated and provides a homely, comfortable and well-furnished home for the residents. The home has a volunteer group of friends, who raise money for social activities and organise coffee mornings, an annual garden party and outings for residents as well as the Church services. What has improved since the last inspection? What they could do better: Staff knew the residents well, but the recording of the care they have given was unreliable. Some Care plans included some but not all of the resident’s healthcare needs. Each plan should be considered carefully, and in consultation with the resident or their representative, to make it a useful document. Many of the current residents are independent, and when residents are capable of monitoring their own health needs and bodily functions, this should be recorded in their care plan and no records need to be kept. However, the home needs to make its practice sufficiently reliable and consistent to assure good care of its residents when they become frail and ill. When it is judged that a person needs records kept of their fluid intake, nutrition, or elimination, the team must keep these records accurately, so that The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 7 they are useful. They must include when care has been offered but declined, with the reason, so that staff can account for what they have done. When residents wish to keep their own medication, their ability to do this safely should be recorded, with any risk factors, and should be reviewed at suitable intervals. The main medication system was carefully administered, which includes all the medication regularly prescribed for residents. Non-prescribed drugs (such as pain-killers) needed to be accounted for just as well, so that the Manager may know who has been given this medication, and how much should still remain in the cupboard for which she is responsible. The recruitment procedure was followed carefully, to ensure that suitable people were appointed to care for residents, except the Manager needed to use the system for checking applicants against the POVA list (Protection of Vulnerable Adults) to make sure they have not been involved in abuse of any sort. It is recommended that the Manager should keep a chart showing staff’s training achievements, as this will also show when up-dates are needed. We found that Moving and Handling training needed to be up-dated, to ensure the safety of both staff and residents. Handrails are needed by the front door to the home, to help residents come and go in safety. The Manager told us that Planning Permission had been obtained. 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 Eventide Home DS0000003497.V374749.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 Eventide Home DS0000003497.V374749.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): 1 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information is available for prospective residents. Full assessment is carried out before accommodation is offered, and new residents are helped to settle in. EVIDENCE: The Mount Eventide offers a Statement of Purpose which includes its mission statement, as it is a Christian home, open to all faiths. Details of staff and their qualifications is included, and kept up to date. Care is offered to older people who may be mentally or physically frail, but do not have advanced dementia, nursing care needs, or major mobility problems. All facilities are described, and the home’s complaints procedure and fire procedure are available. The home has a no smoking and a no alcohol policy. Twelve of the 13 respondents to our survey said they had enough information about the home before moving in. The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 10 The Manager visits people at home or in hospital or another care home, to assess their needs before offering them accommodation. We saw that she uses an assessment form to make sure she covers all necessary aspects of their care needs. We saw care plans provided by social workers and discharge notes from other care homes. Emergency admissions are not normally accepted. People are invited to visit the home for a short period or to stay a few days. We met one resident who was in the process of moving in. They had come for a short stay, and decided to move in. They were given a choice of rooms, and were able to spend an afternoon reading their book in the two rooms, eventually choosing the quieter room. We met their social worker, who said they were impressed with the way the staff had helped their client to settle in. Another resident in a survey said they had initially ‘arrived on a respite break via the RITA team, then decided to stay.’ (The RITA team is a 7 day a week Occupational Therapy service which assesses hospital patients following an injury, and makes arrangements for their safe recovery.) The Mount Eventide does not provide Intermediate Care. The Mount Eventide Home DS0000003497.V374749.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. The staff know and understand the residents’ care needs, although the care records do not fully support this. Residents’ privacy and dignity are respected. Medication is safely administered. EVIDENCE: Many of the current residents at The Mount Eventide are independent and able to look after themselves. At the time of this visit eight (of 25) were in need of help with personal care, and all were able to weight-bear. We looked at the care of people who had become ill or frail, and needed support. We looked in detail at three care plans. Some good information was included, and some had been updated, but there were gaps. We saw that the initial assessment was completed by answering the questions posed by the standex forms, rather than considering the overall needs of the resident. The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 12 Staff were able to tell us in detail how they provided care for the more frail residents. This daily routine was not written, to inform new staff who might need to cover for absence, and provide consistency. We saw a bowel chart, which had so few entries that action would have been necessary, but staff told us that the person would ask for a laxative when they needed it. We saw bathing records which suggested that a resident had only two showers in three months, and only an occasional body wash. The team must consider in each case whether a chart is necessary, and if it is, then it must be complete in order to show the care that has been given. In those cases staff should record when care is offered but declined, in order that they may account for what they have or have not done. A social worker was pleased to tell us that one resident had, prior to moving in, suffered severe self-neglect, but after a few weeks at The Mount Eventide they were eating well and taking showers. A visiting District Nurse said they were pleased with improvement in their patient’s pressure areas. There is a keyworker system in place, with a small number of residents allocated to each Carer. Staff told us that they make a record about anything that happens that is out of the ordinary, and ensure the resident has toiletries they need. We found that some care plans included information regarding the person’s family, Church, hobbies and skills, but not all. One person had been living in the home for three months, with no information on file to inform staff about their social history, their skills and interests, and no evidence of consultation. However, this person said they like this home ‘better than others I have been to…I get more company’. We did not see evidence of risk assessment or consultation with regard to bed guards (cot-sides) that were in use. However, the occupant of that room said they were happy with these and did not consider themselves to be restricted. We saw that District Nurses made regular visits to certain residents, and that staff were taking notice of their advice and keeping records of their visits. The home has a policy and procedure with respect to the safe administration of medication. We saw that the medication was being administered safely. A monitored dosage system was in use for the safe administration of medication. The records were full and accurate so that we could see that medication had been given accurately. Non-prescribed painkillers were kept for residents, which should also be recorded in a way that shows how many tablets have been given, and how many should still be in the container. Residents may self medicate where this is assessed as safe. This decision was part of the pre-admission assessment, and two residents were currently doing this. One had no record on their file, though we were told that a Senior Carer The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 13 had made this assessment. The other had a note on their file from over a decade ago, saying their medication was to be kept securely in their room. There should be a clear assessment of their capability, updated at suitable intervals. There was good advice for staff on what to do if a resident declines to take their medicine. No-one was currently prescribed Controlled Drugs, but there was a suitable system in place for when this should occur. The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 14 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 lifestyle in this home reflects the Christian principles observed by most of the residents who positively choose this home for this reason. Food is of a good quality and a balanced diet is offered with a varied selection of meals available that meets residents’ tastes and choices. EVIDENCE: Staff told us that residents could choose whether to have breakfast in their room or come down to the dining room. Most come down for lunch, but may stay in their room if they prefer. Christian services are held twice a month on a Tuesday afternoon. A Communion service is also held once a month, on a Tuesday afternoon. Residents do not feel they have to attend, and some choose to stay in their rooms. Grace is said before meals. Monthly activities were arranged. A notice was on display in the hallway. ‘Favourite Hymns’ was held during this visit, in the large lounge through the afternoon. We saw there was a good attendance. Forthcoming events included The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 15 a ‘Day of Fellowship’ at a local church, an outing, venue to be arranged, and a visit from Hand bell ringers. Staff said they sometimes put the television on in the evenings for residents. Two go to the lounge sometimes, and one often goes to the ‘Green Room’ in the evenings. The Manager told us in that family and friends are encouraged to take residents out, if appropriate, and are welcome to stay for a meal, and attend any social activity that is taking place. The cook told us residents have free choice at breakfast, with various fruit juices on offer, ten different cereals as well as porridge, and toast done to peoples’ own taste. The main meal is served at lunchtime. Residents told us that staff ask them during the evenings what they would like for lunch the following day. During this visit, there was a choice of roast lamb or sweet and sour chicken. A resident told us they could change their mind and it would not be a problem. Pudding was any combination of junket, peach flan, custard or cream. We saw that residents who came to the dining room enjoyed their meal. In our surveys, 7 residents said they always enjoy their meals, 5 said usually, and one said they sometimes enjoy them. One said they would like more variety in salad and pasta dishes, and another said that supper could be more interesting, but most said they thought the food was good. The cook told us she is not restricted in the food-stuffs she can buy. We saw that staff gave residents help in a sensitive way when this was necessary. A Carer told us she asks residents if they would like classical music while they eat. The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 16 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 clear complaints procedure and residents feel able to discuss issues with the Manager. Residents are protected from abuse by an open culture and good communication between staff, who are aware of abuse issues through training. EVIDENCE: All thirteen residents who completed surveys said that they knew how to make a complaint. One added that they ‘have residents’ meetings, where opinions can be voiced’. The Manager told us she had not received an official complaint. Residents often come to discuss issues with her that may or may not come under her power to improve. We advised that a record is kept of minor concerns, in order that she can show what has been done in response, and to see if any problems occur frequently. The home has a suitable policy for recognising and dealing with abuse, including the local Alerters’ Guidance. The Manager undertook to add the local contact number for the safeguarding Team, in case an alert should be made in her absence. On 11th January 2008, the Manager had contacted us to let us know there had been a safeguarding alert. The investigation found no wilful abuse, but poor practice with respect to the care of a resident who was frail and ill. We carried The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 17 out a Random Inspection in response to that situation, and made requirements with respect to staff levels and training. During this visit, we found staff levels to be good, and all staff had received training with respect to the Protection of vulnerable adults from abuse during June 2008. We still found that care planning and recording for residents who were frail and ill was insufficient. However, the home had changed its registration to show that it admits people over the age of 60, but not those with dementia or challenging behaviour. The home had a good track record of obtaining Criminal Record Bureau checks on staff before allowing them to start work. POVA First checks, to ensure that applicants had not been referred to the list of people who are considered unfit to hold any position in care, had not been carried out. The Manager said she had not been aware of the need to do this, and would look into it. The Manager had attended a training session on the Deprivation of Liberty Safeguards (DoLS) in respect to the Mental Capacity Act 2005. No residents are currently subject to these procedures. One resident often wishes to go out, and is not considered safe to go alone. However, staff often accompany them, and they are satisfied to walk safely in the garden if staff are not available. Staff told us that they had not seen any aggression to a resident by anyone including a fellow resident. One resident gets frustrated sometimes due to their condition. Staff were alert to this and guided them to their room when necessary, in order to protect other residents. The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 18 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, 23 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment inside and outside of the home is very good, providing the residents with an attractive, clean and comfortable place in which to live. EVIDENCE: Over the years extensions have been added to the original older house in a sympathetic manner. On the day of the inspection the whole house was found to be well maintained and in a good state of decoration. The home was very clean and free from any offensive odours. We met the handy man, who said he can get any resources necessary through the Manager. On the day of this visit, he was cleaning the garden paths and benches in readiness for the warmer weather. Several residents told us they had already been out in the garden enjoying the spring flowers. The garden is enclosed, and easily accessible from the house. There are steps from the The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 19 pavement to the front door. One resident said in a survey, ‘It is essential that hand-rails are provided at the front door, otherwise some of us will become house bound, or have accidents’. Within the house, accessibility is good with a shaft lift giving level access to 20 of the 28 rooms. The others are accessed via various stair-lifts. All rooms had en suite facilities. Some showers were big and easily accessible. For residents who were unable to use their showers, a communal bathroom had an Arjo bath. Sit-on scales had been obtained. We saw a variety of bedrooms, with different amounts of space, accessibility, facilities, and views. We did not see lockable storage space, but were informed that people needing secure storage eg for medication, did have ‘a cash box in a lockable wardrobe’. We found the house to be warm and comfortable. One resident had an electric heater. The Manager said that the windows in this person’s room were drafty, and were due to be replaced soon. This person was considered competent to deal safely with a free-standing heater. We did not see a record of this risk assessment in the person’s care plan. There is an amenity room’ on the ground floor, where the chiropodist treats residents, and there is a suitable sink and hairdryer for the use of visiting hairdressers. The laundry system is very up to date, with disinfection, washing and sanitising programmes built in to highly technical washing machines. This system affords protection against cross infections. We met the dedicated Laundry Assistant, who maintained the laundry system well, and returned clothes promptly to residents. The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. The staff team are caring and committed, and provide a good level of care to residents. The procedure for recruitment is followed carefully and staff training is provided, to ensure that suitable people are available to provide care. EVIDENCE: We were given a copy of the staff rota, which showed that the Assistant Manager or one of the Senior Carers are on duty every day, with three or four other carers in the mornings and three in the afternoons. This was found to be sufficient during this inspection. Twelve residents’ surveys said that they ‘always’ get the attention they need, with the thirteenth saying they ‘usually’ do. Ten said the staff are ‘always’ available when they need them, three said ‘usually’. The cook and kitchen assistant were additional. Staff agreed that morning routines were rushed and unsatisfactory if the dining room assistant is not in and care staff have to do the trays. Two residents said, ‘the staff here are wonderful’, and others said, ‘I have never heard them raise their voice’, and ‘they are very helpful’. The eight care staff have achieved National Vocational Qualification (NVQ) level 2 in care, and the Assistant Manager and Senior Carers all have NVQ 3. The The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 21 Manager told us that there are eight Night care staff - four Seniors with NVQ3, and four Night Care staff with NVQ2. We looked at the personnel files of three recently appointed staff. All had two written references, and CRB checks had been received before the person was allowed to start work. The need to apply for POVA 1st checks has already been recorded (Complaints and Protection). There had been considerable provision of training in the previous year. All new staff had records in their files that stated that they had undertaken an induction period, and staff confirmed that this was the case. All staff had attended training on the Protection of Vulnerable Adults during June 2008. The Assistant Manager had arranged a list of dates to ensure that all night staff could attend. We saw evidence of training in continence/catheter care, health and safety, and administration of medication. Most staff had attended a training session that had been held at the home by a professional trainer as an introduction to Dementia care, giving insight into residents’ conditions. Staff told us they were keen to have more training in the best ways of dealing with distressed residents and disturbed behaviour. Staff had shown particular interests, which promoted good practice in the home. The Assistant Manager had attended a forum on ‘Dignity in Care’ in February 2009. One Senior had attended training on osteoparosis, and following this had made an assessment of all residents and referred people who were found to be at high risk to their GP for calcium supplements. Another Senior attended training on ‘Common eye problems’. The Manager told us that a member of the local Sensory Team visits annually to check residents’ hearing aids, and to give a talk to staff about how they can help people with hearing loss. One carer told us they had found a training session on Parkinsons disease, which had been partly presented by a sufferer, had been of great interest and help in understanding the needs of one of the residents. We suggested that the Manager keeps a chart showing what training staff have attended, as it was not easy to tell from peoples’ files when up-dates were necessary, or who had missed out. The Mount Eventide Home DS0000003497.V374749.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, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Mount Eventide is run by a well-qualified and experienced Manager who is supported by a committed staff team who carry out their duties in the spirit and ethos of a Christian community. EVIDENCE: Mrs Margaret Barrett is the Registered Manager. She is a qualified nurse, and has also achieved the NVQ 4 in care and the Registered Managers’ Award. Mr David Shafik is the Responsible Individual for Keychange Charity, which is an evangelical organisation that offers care in an active Christian community. A representative for Keychange visits monthly. We were given reports from their visit from 2008, but reports from recent months were not available. The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 23 Residents told us that they can put their views across at the regular Residents’ meetings. Records showed that food and outings are amongst the topics covered. Cash was kept safely in the office for six residents, by their wish. Records were clearly kept, with two signatures, and receipts kept. Most transactions were for the hairdresser and chiropodist. The Manager said that families mostly bring toiletries, for residents who are unable to shop for themselves. Two residents have recently chosen to buy themselves a television, though the home does provide these in private rooms. The home’s administrator checks these accounts, countersigns, and deals with fees and petty cash. We saw that the Manager had held supervision with some of the care staff, to give feedback on their performance, and discuss any issues or training needs. However, she is not able to provide individual sessions for all care staff frequently as is considered good practice. She should set up a system of delegation to make sure all staff get the support and guidance they need. Fire safety had been attended to with care and diligence. Professional training had been provided on 16/02/09, with 20 staff in attendance, covering means of escape and alarm procedures. There had been a training session on 15/08/09 with 11 staff in attendance, covering hands-on experience with fire extinguishers and fire blanket. The fire alarm system had been checked twice a year, the last time being on 19/12/08. Extinguishers had been professionally tested on 02/03/09. A room by room fire risk assessment had been written professionally, dated 20/04/09. It was not recorded whether staff had read this, or when it would be reviewed. Staff told us that they had been trained in safe moving and handling, either at this home or previous places of employment. Records showed that some staff needed updates in this training, to ensure their safety and that of the residents for whom they care. The Mount Eventide Home DS0000003497.V374749.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 The Mount Eventide Home DS0000003497.V374749.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 OP7 Regulation 15 Requirement Timescale for action 31/05/09 2. OP18 13.6 3. OP19 23(2)a Care plans must be complete, and reviewed in consultation with the resident (or their representative), in order that staff know the best way of providing their care. Care records must be complete in order that staff can account for the care they have given. ‘Reg 15 The registered person shall, after consultation with the service user, or a representative, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met.’ The Registered Manager must 31/05/09 arrange for applicants to be checked against the POVA list before they may work in the care home. ‘The registered person shall make suitable arrangements …to prevent service users…being placed at risk of harm or abuse.’ Hand-rails must be provided at 30/06/09 the front door to the home, to help residents come and go in safety. ‘The registered person shall DS0000003497.V374749.R01.S.doc Version 5.2 The Mount Eventide Home Page 26 4. OP38 13.5 having regard to the… needs of the service users ensure that the physical design... of the premises… meets the needs of the service users.’ All care staff must be up to date with Moving and Handling training, to ensure the safety of any resident they need to help with mobility, as well as their own safety. ‘The registered person shall make arrangements to provide a safe system for moving and handling service users’. 31/07/09 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 Care plans should include information about the person’s life history, personal interests, skills and aspirations, as well as their faith and Church, to help staff gain a fuller understanding of them. There should be evidence of professional consultation with respect to any restraint used in the home, such as bed guards. Risk assessment for this equipment should be recorded, with advice to staff on how to avoid problems. Risk assessments should also be recorded to any other possible risk factor such as the use of free standing heaters. The Manager should produce a format for recording the assessment of a resident’s competence to look after their own medication, and this should be reviewed at appropriate intervals, to ensure that residents are still safe to do this. 2. OP7 3. OP9 The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 27 4. OP9 The use of non-prescribed medication should be recorded in such a way to make audit possible, so that the home can account for all tablets given. The Manager should keep a chart showing staff training attendance, with dates, so that she can easily see when up-dates are needed. The Manager should make arrangements for all care staff to have supervision sessions on a regular basis with one of her management team, to provide support and guidance to ensure they fulfil their job roles. 5. OP30 6. OP36 The Mount Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Region PO Box 1251 Newcastle upon Tyne NE99 5AN 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 Eventide Home DS0000003497.V374749.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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