24 February 2015
During a routine inspection
The inspection visit was carried out on 24 February 2015 and was unannounced.
The previous inspection was in November 2013. In June 2013 we identified a breach in the regulations in regards to the safety and suitability of the premises. Concerns were referred to the Kent Fire and Rescue Service Fire Safety Officer for their consideration.
Mont Calm Sandgate Road provides accommodation and support for up to 20 older people, including people who are living with dementia and have other complex needs.
The service provider (Mr Stephen Castellani) has been in administration since 23 January 2014. Moorfields Corporate Recovery are the receivers, and they have employed Goldcare Future Management Ltd. to oversee the running of the services. We have referred to these as the ‘administrators’ in the body of the report.
The premises are a large detached older building, and provide communal rooms and three bedrooms on the ground floor, and bedrooms on the first and second floors. There is a passenger lift to all floors. Some of the bedrooms on the second floor were out of use as a visit from the Kent Fire and Rescue Service Fire Safety Officer had confirmed that the external fire escape was unsafe. Action was being taken to remedy this situation. This meant that the home could currently accommodate 15 people, even though the home’s registration was for 20. There were 15 people in residence on the day of our inspection.
The external presentation of the building was spoilt by moss covered steps, and cracked and peeling paintwork. Internal décor was satisfactory, but we agreed with a relative who said, “It is a beautiful building, but the paintwork and décor looks very tired”. We observed that there were lots of scuffed areas of paintwork. Maintenance records showed that there were many items of repair work to be carried out, and this work was being gradually completed. Health and safety risk assessments had been completed, and had been updated every three months.
The service is run by a registered manager, who was present on the day of the inspection visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.
The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and DoLS. The registered manager had been in contact with the DoLS office, and was in the process of applying for DoLS authorisations for all of the people living in the service, as none had been assessed as safe to leave the building unaccompanied. Urgent applications had already been made.
The service had suitable processes in place to protect people from different types of abuse. All of the staff had been trained in safeguarding people and in the service’s whistleblowing policy. (Whistleblowing enables staff to raise matters of concern about other staff in an unbiased way, and without fear of discrimination). Staff were confident that they could raise any matters of concern with the registered manager or with the local authority safeguarding team.
The registered manager had systems in place to record accidents and incidents, and to monitor these to see if there were any patterns of occurrence, such as the same time of day, or the same staff on duty. The registered manager analysed these to assess if any action could be taken to avoid further accidents, and any identified action was taken in response.
Medicines management was overseen by the registered manager, who carried out arrangements for repeat prescriptions and receipt of medicines into the home. Care staff were not permitted to administer medicines until they had completed medicines training and had been assessed for their competency. The medicines storage did not meet regulatory requirements. Controlled drugs (CDs) were stored in a locked cupboard which met requirements, but the cupboard was not fixed with the required ‘rag’ bolts to a solid wall.
Staff were evident throughout the home during the inspection. Most people chose to spend their day in the lounge and dining rooms which were adjacent to each other on the ground floor. This enabled staff to observe people for any risks, such as unstable walking, or becoming upset with each other. Staffing numbers included three care staff throughout the twenty four hours. The registered manager and deputy manager carried out management and supervision responsibilities.
Staff showed people respect and spoke to them in a friendly manner. Most interaction was evident when staff were assisting people with daily tasks, such as giving them drinks or assisting them to the toilet. There was little interaction apart from this during the morning as staff were busy attending to people’s physical care needs, and some people dozed in their armchairs for periods during the morning. An activities co-ordinator spent time with people in small groups during the afternoon, and we saw that people enjoyed her company and were animated in conversations and reminiscence. There was a general lack of items in evidence to stimulate people when the activities person was not on duty, apart from the television, music playing, and magazines. There was no signage or colour coding on doors or walls to assist people with finding their way (for example, to the toilet); but people’s bedroom doors had their names on them, and a picture that would help them to find their room.
The service had reliable staff recruitment procedures in place. Applicants were assessed as suitable for their job roles, and new staff were provided with a detailed induction programme, which included training in essential subjects. Refresher training was provided at regular intervals.
Staff had daily handovers when they were updated with any changes in people’s care needs. They confirmed that they had individual supervision every three months, or more often if this was needed. Staff meetings were carried out, and all staff had yearly appraisals. Staff were given training in essential subjects when they commenced employment, and were able to develop their knowledge and skills through further training courses, and formal qualifications.
Staff demonstrated their understanding of the Mental Capacity Act 2005 and how to apply this, by encouraging people to make individual choices about their daily lifestyles, and respecting their decisions. For example, people were given a choice of biscuits and drinks during the morning; and were able to sit where they wanted to.
People showed their enjoyment of the food, by smiling when food was given to them, and saying things such as “This is good” and “I like this”. We saw there was little food wasted at lunch time, and portions were a satisfactory size. The menus showed there was a wide variety of food, providing a nutritional diet. Food was attractively presented. People were encouraged to eat together at dining tables, so as to provide social inclusion and the enjoyment of interacting with other people at meal times. Two people needed assistance to eat and drink, and we saw that staff were attentive to them and sensitive to their requests.
People and their relatives were involved in their care planning, depending on the wish of the person receiving care, and their ability to understand the information. Care plans showed that their health needs were assessed, and were monitored accordingly. Records showed that staff contacted people’s GPs or other health professionals as needed, and health care was given appropriately.
The registered manager had received one formal complaint in the last year, and records showed that this had been dealt with appropriately and resolved. We received mixed views from relatives about response to concerns. Some said that they had talked to the registered manager but were not satisfied that their concerns had been listened to; while others said they “Could not fault the manager or staff”, and that they always responded promptly to any concerns. The registered manager agreed with us that it would be helpful to document smaller concerns as well as any formal complaints, so that the action taken in response could be clearly evidenced.
The registered manager had a daily visible presence in the home and led the staff in caring for people. We observed that people responded to her and showed that they knew her well and felt comfortable in her presence.
Improvements had been commenced in the service since the administrators had been put in charge of the overall management. Audits such as health and safety, and infection control had been carried out, and action had been taken in response to the findings.
Relatives said that they knew the manager had an open door policy and they could ask to speak to her at any time. Relatives’ views were sought through the use of twice yearly questionnaires, as well as on a day to day basis. Some relatives contacted the manager through phone calls or e-mails and told us that the manager always answered their questions. A suggestions box and suggestions paper forms were available in the entrance hall. These had been implemented in response to someone’s idea, and were used occasionally. The registered manager read these and assessed if any improvements could be made to the home in accordance with any appropriate changes.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.