Care Home: The Queen Charlotte

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What the care home does well The Home continues to co-operate fully with the Care Quality Commission in an effort to improve the care and facilities for those people living at Montevideo House and have kept us informed of their progress. People told us that staff were kind a considerate in their approach to people living in the home. One person told us "The staff are always very kind and caring to the patients, as well as always helpful and friendly to the relatives." The home is clean and comfortable. People living at the home liked the food provided and enjoyed the choices offered at each meal. Sufficient numbers of staff were on duty throughout the day and night to be able to meet the needs of the residents. What has improved since the last inspection? Staff have had further training opportunities and mandatory training is well underway. The continued programme of refurbishment means that people live in much more comfortable surroundings. The management of the home has improved. People told us; "The home is improving everyday now we have the manager post filled. The staff have more support than ever and the manager also sits with the residents where possible." "Since Althea Healthcare have taken over Montevideo House the service has been vastly improved. The whole atmosphere is calmer, the staff more involved and attentive to residents." "Since the new manager has taken over there has been a vast improvement in the look of the home. The manager and staff are all very approachable, caring and considerate. I hope their positive outlook continues." What the care home could do better: Although care documentation has improved since our last inspection there is still room for further improvement so that the information held is accurate and informs the staff of the needs of each resident. This will help to ensure that people living in the home get the care and support they need. The procedures relating to medication need to be improved so that people living at Montevideo House can be sure that they get the medicines they need in a timely fashion. The home needs to continue to develop a range of activities suited to the varying and specialist needs of people living in the home. Key inspection report Care homes for older people Name: Address: Montevideo House 432 Chickerell Road Chickerell Weymouth Dorset DT3 4DQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Amanda Bell     Date: 2 7 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Montevideo House 432 Chickerell Road Chickerell Weymouth Dorset DT3 4DQ 01305 773128 01305 752570 montevideo.manager@kingsleyhealthcare.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Althea Health Care Properties Ltd Name of registered manager (if applicable) Mr Mark Jon Beech Type of registration: Number of places registered: care home 51 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 51. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Mental disorder (Code MD) Dementia (Code DE) Date of last inspection Brief description of the care home Montevideo House is a mostly purpose built care home with nursing, located on a main road on the western edge of Weymouth. There is a bus stop close to the home, providing a service to and from Weymouth town centre. Montevideo House is registered to provide care with nursing to elderly people with a Care Homes for Older People Page 4 of 27 Over 65 0 0 51 51 2 6 0 7 2 0 0 9 Brief description of the care home mental disorder, including dementia. The home comprises a ground, first and second floor providing accommodation for a maximum of 51 people; all are accommodated in single bedrooms with en-suite hygiene facilities. There are assisted bathrooms and communal rooms on each of the three floors. All registered parts of the home can be accessed without the necessity to negotiate steps or stairs; there are two passenger lifts. In the basement are the laundry, food storage facilities, and the heating establishment; the basement is not accessible to residents and their visitors. Laundering of clothing and household linen is carried out in the home at no additional cost to residents; items requiring dry cleaning are charged extra because it is necessary to send them out of the home for this service. There is a large attractively maintained garden to one side and rear of the Montevideo House building and car parking spaces at the other side. A hairdresser visits the home each week; there is an additional charge for this service. The home is owned by Althea Health Care Properties Ltd and was registered in their name in June 2009. They have managed the service since February 2009 prior to purchasing the service. At the time of inspection there was no registered manager in place. Fees are charged weekly; at present they range between £650 and £900 per person. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality of this service 1*. This means that people experience adequate outcomes. This unannounced inspection took place over two days on the 25th and 27th January 2010 and took approximately nine hours. The purpose of the inspection was to assess all of the key standards and improvements made since the last key inspection in July 2009 and the three random inspections in August and November 2009. The inspection was carried out by two inspectors and the term We is used throughout the report to reflect the findings of the Care Quality Commission (CQC). During our inspection the deputy manager was on hand to aid the inspection process. All staff we spoke with were extremely helpful and courteous and we were made welcome. We gathered information in a variety of ways, which included reports made to CQC by the home; the random inspections; a tour of the premises; observation of care practices and discussion with those people living at, visiting and working in the care home. We also reviewed a number of care records, recruitment and training records and maintenance Care Homes for Older People Page 6 of 27 documentation. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service consults with people before they move into the home and have a clear admission process, but they cannot be assured that their needs will be fully met until all staff have had adequate training in caring for people with dementia. Evidence: The home has not admitted any new residents since the last key inspection in July 2009. The manager had undertaken one assessment of a person wishing to stay at the home for a period of respite care. We reviewed this assessment and saw that sufficient information had been obtained so that the manager could give assurances that this persons needs could be met. Since the last key inspection a programme of training for all staff had been continuing. Most of the mandatory training had been completed. However, at the time of this inspection, some of the staff were just starting training in caring for people with dementia. Until staff have had a chance to complete this and consolidate their learning Care Homes for Older People Page 11 of 27 Evidence: we could not be sure that the staff, as a whole, had the skills to meet all the needs of those people living in Montevideo House. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to provide staff with the information to care for residents. However care documentation needs to continue to improve and be more personcentred to ensure that each individual receives the care they need. Medication management needs to be improved to ensure it does not place people at risk of harm. Evidence: We reviewed the care files for seven people living in the home and found that the standard of record keeping had improved since the last inspection. Each file contained a variety of assessments, information from which was then used to formulate care plans. We saw evidence that residents and their chosen representatives had been consulted in reviews of care. However there were still some shortfalls in recording. The mental capacity assessment forms had been completed incorrectly, therefore it was not clear who had capacity or lacked it; daily care records were still task orientated and did not reflect the mental well or ill being of each resident; care plans were not updated to reflect sudden changes in care, for example, where someone was being treated for a chest infection or urinary tract infection. Care Homes for Older People Page 13 of 27 Evidence: We observed staff undertaking their work during the course of our inspection and found them to be kind and courteous. They were respectful of peoples privacy and there was a calm and friendly atmosphere throughout the home. Since the last key inspection the registered provider had invested in new equipment and each resident had a profiling bed. Where pressure relieving devices were needed they were provided and used correctly. We saw that people living in the home had access to healthcare professionals as necessary and these included GPs, community psychiatric services, chiropodists, dentists and opticians. We reviewed the medication processes in the home. The medication administration records (MARs) showed us that people got the medication they were prescribed. However we saw that there were delays in obtaining prescribed medication in a timely fashion, for example, one person had to wait two days before starting antibiotics for a chest infection; another person had to wait five days before getting their prescribed medication. People praised the staff in the home and said The staff are always very kind and caring to the patients, as well as always helpful and friendly to the relatives. The manager and staff are all very approachable, caring and considerate. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are some opportunities for the residents to engage in recreational and social Activities, however these are limited and as a consequence some people are likely to become bored, apathetic and restless. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. The food provided appears nutritious and appetising. Evidence: The home has a programme of activities in place and designated staff to coordinate them. We observed a small group of people in the lounge to help us understand what day to day life at Montevideo House was like. This took place during the latter half of the morning. We saw that staff engaged positively with residents. The atmosphere in the lounge was calm and cheerful. However there were periods of time when staff were not present or only one staff member was in the lounge and speaking with one resident. There was ample time to go to sleep or appear passive or bored. At one point the television was put on but channels were changed without consultation with the residents who were watching it. Care Homes for Older People Page 15 of 27 Evidence: Visitors told us that they were made welcome. We saw people enjoying their lunchtime meal. Help was given by staff where necessary in a discreet and sympathetic manner. People had a choice of food and were given sufficient time and space to enjoy eating it. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. Protection from abuse is promoted. Evidence: The home has a complaints policy in place. There had been one complaint registered since the last key inspection and it was investigated in accordance with the homes policy. People told us that they knew who to speak with if they had concerns and they felt confident they would be listened to. Staff told us that they had received training in the protection of vulnerable adults and it was evident that they knew what to do in the event that they suspected abuse had taken place. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment at Montevideo House has improved considerably and now the home is maintained and furnished so that people live in a homely, clean, comfortable environment. Evidence: Since our last key inspection in July 2009 we have seen improvements to the environment at Montevideo House at each random inspection. There was a plan of routine maintenance in place. The lounges and dining room on the ground floor had been refurbished and provided a much more comfortable environment than at our last key inspection. We looked at some of the bedrooms and found they were well furnished and personalised with residents own belongings. Equipment was available to assist people and staff in the delivery of personal care, which included assisted baths, profiling beds, accessible showers and moving and handling equipment including hoists. A range of pressure relieving equipment, including specialised air mattresses were available. The home is comfortable and free from any unpleasant odours. Systems were in place to reduce the risk of infection. Disposable gloves, aprons and hand scrub were Care Homes for Older People Page 18 of 27 Evidence: available and were used by staff when handling soiled linen and when supporting people with personal care. We saw that the laundry was well managed. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient care staff are employed to meet the needs of residents. Recruitment procedures have improved to protect residents from the risk of unsuitable staff working at the home. Staff are now receiving the training and support so that they can improve the standard of care for people living at the home. Evidence: At the time of inspection staff rosters demonstrated that there were sufficient staff on duty at that time. During the inspection staff were on hand to meet the needs of the residents. There is an ongoing training programme within the home, which includes NVQ level 2 in care. At the time of inspection less than the recommended ratio of 50 of care staff held this award. We reviewed four staff recruitment files for permanent staff. The files were well ordered and contained most of the information required by law. We found that some employment histories were incomplete and the records for agency staff who had worked at the home did not include information as to the status of their enhanced Criminal Record Bureaux checks. Therefore the home would not be aware of any adverse CRBs. Care Homes for Older People Page 20 of 27 Evidence: Training files demonstrated that staff were receiving induction training and staff we spoke with confirmed that they were encouraged them to take up training opportunities provided. Recent training included the protection of vulnerable adults; moving and handling; infection control and fire safety. The registered provider had experienced some delay in sourcing dementia care training therefore the first day of this training only started on the second day of our inspection. It is hoped that once this has been completed a more person centred approach to care would be adopted. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is now well organised and the daily management and running of the home centres round the care of residents. Improved management practice, systems in place, and records kept, confirm the health and safety of all in the home. Evidence: Since the last key inspection Mark Beech had been appointed manager at Montevideo House. He had submitted an application to the Care Quality Commission to become the Registered Manager of the home. People told us that the management of the home had improved since Mr Beech took up his employment. We saw that good management practices were in place. There was a quality assurance and quality monitoring system in place. The home took steps to review its performance regularly and peoples views were sought and suggestions put forward were acted upon. The home did hold small amounts of personal allowances for residents at their request and accurate records were held of any monetary transactions. Care Homes for Older People Page 22 of 27 Evidence: The deputy manager confirmed that staff supervision had started. Staff spoken with confirmed this. Records showed that staff had received recent training in fire safety and manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Accidents were recorded and appropriate action was taken as necessary. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 4 18 The registered person must 28/10/2009 ensure that the persons employed by them to work at the care home receive training appropriate to the work they are to perform. This must include training in dementia care. This will ensure that those people living at the home who suffer with dementia will receive the appropriate care. 2 12 12 The registered person must consult with service users and make provision for recreational and social opportunities based on their needs and preferences. 28/10/2009 To minimise risks of boredom and associated distress. 3 29 19 The home must make arrangements to safeguard vulnerable peole from the risks associated with potentially unsuitable staff. In advance of any person who is not a private visitor attending the home and likely to have contact with residents, the home must obtain and keep essential information including 26/11/2009 Care Homes for Older People Page 24 of 27 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action references and CRBs to provide evidence of their suitability. To protect the vulnerable people living at the home. Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 The registered person shall 08/03/2010 not employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule 2. This includes ensuring that any agency staff employed have suitable CRBs. To protect the vulnerable people living at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 8 28 29 Mental capacity assessments should be completed accurately and give clear outcomes. 50 of care staff should hold the NVQ level 2 or equivalent in care. Work histories of prospective employees should be fully documented and any gaps explained. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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