Inspection on 31/03/10 for Maynell House

This is the latest available inspection report for this service, carried out on 31st March 2010.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Maynell House 30/05/07

Maynell House 01/03/06

Maynell House 29/09/05

Maynell House 30/03/05

Maynell House 30/09/04

Maynell House 17/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Key inspection report Care homes for older people Name: Address: Maynell House High Road East Felixstowe Suffolk IP11 9PU     The quality rating for this care home is:   three star excellent 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: Deborah Kerr     Date: 3 1 0 3 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 32 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 32 Information about the care home Name of care home: Address: Maynell House High Road East Felixstowe Suffolk IP11 9PU 01394272731 01394272731 maynell@pri-med.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Pri-Med Group Ltd. Name of registered manager (if applicable) Ms Janis Albinia Lin Watkins Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Maynell House is a care home registered to provide accommodation and personal care for up to 25 older people. The home is part of the Pri-Med Group Ltd, which is a subsidiary of Healthcare Homes Group and is one of the organisations three care homes for older people in Felixstowe. It stands back from the main road in its own extensive grounds. The house was once part of the independent boarding school for girls and it retains many of its original features, but has been extended to provide additional accommodation, including a pleasant veranda where residents can sit in warm weather. The home is on three floors and access to all but one room is either by staircase or a passenger lift. All rooms are tastefully decorated and furnished. There are two lounge areas and a dinning room. Interesting gardens surround the house, which includes a Care Homes for Older People Page 4 of 32 0 Over 65 25 Brief description of the care home water feature complete with mature fish. The home is staffed 24 hours a day, with two waking night staff. The company has achieved Investors in People Award, initially in 1995 and has subsequently been re accredited three times. The cost to the individual person living in the home is assessed on their individual needs and accommodation, ranging from £362.00 per week to £701.50 per week. Charges do not include hairdressing and chiropody services. This was the information provided at the time of the inspection, people considering moving to this home may wish to obtain more up to date information from the care home. Care Homes for Older People Page 5 of 32 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: three star excellent 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: This was a key inspection, which focused on the core standards relating to older people. The inspection was unannounced on a weekday, which lasted eight hours. The report has been written using accumulated evidence gathered as part of the inspection process. This includes information obtained from residents surveys. Surveys are used as part of cumulative evidence we receive about services in the last 12 months. We received fourteen residents and six staff Have Your Say surveys (these were received the day after our inspection of the service). Information included in the surveys has been used throughout the report to provide evidence of peoples perception of how well the service is meeting their needs. We also used information provided to us in the Annual Quality Assurance Assessment (AQAA) issued by the Care Quality Commission (CQC). This document gives the provider the opportunity to inform CQC about their service and how well they are performing. We also assessed the outcomes for the people living in the home against Care Homes for Older People Page 6 of 32 the Key Lines of Regulatory Assessment (KLORA). A tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication and health and safety. Time was spent talking with the six people living in the home, two relatives, two visitors and two staff. The area manager and manager were present throughout the day and fully contributed to the inspection process. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Although, there has been improvements made to increase activities, feedback in residents surveys, and observations made during the inspection, further improvements are needed, to ensure people are provided with support and activities to ensure their Care Homes for Older People Page 8 of 32 day is spent in a meaningful way and which enhances their well being. The service is taking steps to address this by implementing an Inspiring Better Lives programme in the homes, including buying in Butterfly training for staff from a training provider specialising in dementia and person centered care. Feedback from two relatives visiting the home during the inspection, told us that they thought the home could be better at co-ordinating their relatives care, by being more prompt at asking the GP to call, arranging for GP appointments and transport, if needed as they felt this was often left up to the family to arrange. They also told us they felt the home could keep them better informed, if their relative was unwell. Whilst the service has worked well with residents and families developing a person and family centred approach in the individuals care delivery, the service has recognised and identified in the AQAA what they need to do to further improve the service. They plan to do this by looking at the other ways of engaging with residents and relatives in the care planning updates, increasing activity participation within the home and look at other ways of encourage and supporting families to participate further in the care of their loved ones. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 32 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 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use this service will have their needs assessed and are provided with information they need to help them choose and know if this service will meet their needs. Evidence: The homes statement of purpose and service users guide were not looked at on this occasion, however these have previously been found to meet the requirements, as set out in the Care Homes Regulations 2001. The manager told us they are currently exploring producing the statement of purpose and service users guide in an alternative format and to develop a more personalised brochure. The AQAA reflects all people using and / or proposing to use the service are provided with a statement of purpose and residents handbook, which provides details of what the home provides. Additionally, an open day has been planned for 16th May 2010 to enable the public to visit the home to see what the service offers. Care Homes for Older People Page 11 of 32 Evidence: The AQAA states the home is well respected within the community and is supported by other healthcare professionals. This was confirmed in the homes Quality Assurance survey conducted in August 2009, which reflected 100 of residents currently using this service, stated Maynell House met their expectations, respected their privacy, felt the home provided them with a comfortable and homely environment to live in and stated that they would recommend the home. The AQAA reflects the home has a thorough admissions process in place and that information is gathered from a range of sources, before deciding if they can offer a placement to an individual, so that they can be sure they can meet their specific needs. An aid memoir has been developed as a guide when completing the prospective clients needs assessment to ensure all the necessary information is obtained. The records and care pathways of three people living in the home were tracked, to ascertain how well the service is meeting this objective and peoples individual needs. All three people tracked had a pre admission assessment completed, covering all areas of their health, personal and social care needs. Additionally, where people had been referred through Social Services a copy of the social workers assessment had been obtained, held on file and used to complete the individuals care plan. Current fees were discussed with the manager, these are based on individual need and the accommodation available. Each of the three people tracked had been issued with a contract between the previous company Pri Med or more recently with Healthcare Homes. These set out their fees, terms and conditions of residence at Maynell House, including the roles and responsibilities of the provider and the rights and obligations of the individual whilst living in the home. The home does not provide intermediate care. Care Homes for Older People Page 12 of 32 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 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 this service receive health and personal care, based on their individual needs and wishes. Evidence: The records and care pathways of three people living in the home were tracked to confirm each person has a care plan, in place, which identifies their health, personal and social care needs. The home is in the process of implementing new care plan documentation, which is being used as living document and continues to evolve as peoples needs change. The plans have photographs in place of the individual to identify and personalise their care plan and are divided in to five sections, covering administration and discharge, risk assessment, care support plans, critical care issues and correspondence. An aid memoir / guide has been developed to assist care staff to complete care plans, so that the plans contain the necessary information and ensure consistency in the care provided. Care plans are built around the individual needs of residents, which have been discussed and written in conjunction with them, their key worker and /or family Care Homes for Older People Page 13 of 32 Evidence: and include their preferences, choices and daily routines. These are set out in a way that can be easily used by people unfamiliar with the individual, to deliver a personalised and consistent service. Time was spent with one resident looking through their care plan and discussing the support plans in place. They confirmed that the information in their plan reflected the care and support, they required. We also visited an individual on permanent bed rest, their health charts were located in their room, including regular turning to prevent pressure areas occurring and full details of their fluid and food intake and continence needs. These also reflect that staff spend time with the resident in their room, to prevent them becoming totally isolated. Support plans and risk assessments, clearly identify the risks involved for each of the residents daily living needs. These collectively set out the actions required by care staff to ensure that their needs are met and describe the expected outcomes for the individual. These cover the risks associated with mobility, falls, nutrition, pain and personal hygiene and the action required by staff to minimise these risks, whilst enabling the individual to retain some independence and choice. The home has a visiting sports therapist who promotes well being through gentle exercise and joint relaxation and strengthening therapies, which has proved invaluable in promoting mobility and helped in the prevention of falls. Information provided in the AQAA, care plans and daily records reflect peoples health needs are being monitored. However, discussion with people during the inspection and information provided in residents Have Your Say surveys, told us that this is an area that could be improved upon. Six people felt they always received the care and support they needed, four people told us they usually receive the care and support they need and four people said this was sometimes the case. Eight people told us that the home makes sure they always have access to the medical care they need, four people said this is usually the case, with two people stating this happens sometimes. Relatives commented that the home could be more proactive in knitting problems together and be more prompt at asking the GP to call or arranging for GP appointments and transport if needed. Staff spoken with had a good understanding of the people living in the home and were able to give a verbal account of individual residents needs and preferences. Additionally, the daily progress records provide a good account of how each person has spent their day, including an overview of their general well being, any concerns about their health and their food and fluid intake. The AQAA states residents are able to voice their wishes regarding end of life care and that this is approached in a sensitive manner in strict confidence. Care plans seen Care Homes for Older People Page 14 of 32 Evidence: reflected this has been discussed with individuals and a record had been made of the practical and spiritual arrangements in accordance with their wishes. The home has robust medication polices and procedures in place. A designated senior member of staff has been appointed to take the lead for medication. They have completed a six months distance learning course and has a good understanding and knowledge of the medication system. They have helped to introduce the companys new medication policy and procedure into the home as well as delivering training to designated staff authorised to administer medication. Time was spent with the senior who told us that they monitor, order and administer medication received into the home and confirmed that they and the manager undertake medication audits at regular intervals. The home uses the Monitored Dosage System (MDS), consisting of medication already dispensed by the pharmacy into blister packs. Photographs of residents had been attached to a front sheet in the Medication Administration Records (MAR) folder to avoid mistakes with the persons identity. The practice of administering medication is being well managed. A check of the MAR charts reflected these are being completed properly, with good recording and no gaps. We sampled the MAR charts for the people being tracked as part of our inspection against the stock of medication held, these were found to be accurate. A check of two peoples controlled medication against the controlled drugs register was made and found to be accurate. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of life experienced by people using this service could be further enhanced by developing a culture, which is centered around peoples preferences, daily routines and life experiences, including food choices and the provision of stimulating activities to ensure people spend their day in a way that is meaningful to them. Evidence: Information provided in the AQAA and verified at the inspection confirmed the home continues to have strong links with the local community, holding coffee morning, fetes and other visitor days throughout the year. The AQAA also states action has been taken to improve activities within the home and residents are being encouraged to become more involved with various activities and special events. This has included improving firmer links between the two sister homes, Foxgrove and Mill Lane also in Felixstowe, by way of a Memory Project that enables residents from all three homes to meet on a weekly basis. An activity programme has been developed in the home with exercise and movement groups, physiotherapy, quizzes, reminiscence groups, mini bus outings, music and entertainment. Various Church groups attend during the month. In the summer months residents are encouraged to visit the beach and fish and chip days are organised. Additionally, the home has purchased a range of items to encourage residents to actively participate in arts and crafts and a variety of board or Care Homes for Older People Page 16 of 32 Evidence: card games. A News Letter is being developed so that residents, relatives and staff can contribute. The AQAA reflects the home intends to further develop the activities, especially craft based in small groups to encourage interaction and dialog between residents and to investigate more voluntary helpers to achieve this. Although, there has been some improvements made to increase activities, feedback from people using the service and observation, reflects further improvements are required in this area. Residents Have Your Say surveys, told us that the home does arrange activities, that they can take part in, however seven out of the fourteen surveys returned told us this was always the case, four people told us they usually have activities available they can take part in, with three people saying this is sometimes the case. Comments included, the home could do better at providing more activities, for example, drawing, painting, knitting, simple Yoga, music, speakers and flower arranging and if there were more staff available, more time could be spent with me and better entertainment could be provided and I am satisfied with everything, the staff try to keep you happy and see to peoples individual needs. We spoke with five people individually who shared their experiences with us of what it is like living in the home. They told us, I am happy living at Maynell House and can do what I want to do, when I want, giving examples of how they spent their time, watching television or reading in their room, spending time in the lounge or walking in the garden. People also told us, I enjoy the food, have a nice environment to live in and the staff are lovely and I feel well looked after, the staff respond promptly when I ring for assistance and they are ever so kind and respect my privacy and dignity. Other comments included, the staff know I get embarrassed when helping me with my personal care needs and they are very respectful of this and on the whole things are Okay, but as there is a high level of people needing two carers, things sometimes get forgotten. It is easy to feel isolated and under valued in a residential home, especially when unwell and it would be nice to be acknowledged in corridors and the dining room, even if staff are busy. During the inspection several people were observed visiting friends and relatives. Residents spoken with said that their family often visited and they are made welcome at the home. We spoke with two relatives who commented, the staff appear to be in a bit of a rush and tend to follow task based routines, providing an example that between 10am and 11 am people are taken to the toilet and then taken in for lunch and residents are often lacking in stimulation during the daytime. More positive comments included, my relative is kept quite active during the week, including private physiotherapist Care Homes for Older People Page 17 of 32 Evidence: sessions twice a week, a weekly visit from the hairdresser, keep fit exercises, manicures and regular visits from relatives and my relative has been unwell recently and described the staff as saints whilst looking after them, stating they looked after them very well. We also met with two people who visit the home on a regular basis. They told us, on the whole they felt Maynell House was a good place to live, with lovely decor, gardens, and a good handyman who tries hard to maintain the premises, however they felt their could be a little more in the way of stimulation for the people living in the home. They told us, the people living in the home do receive good services, such as hairdresser and manicurist and commented, Maynell House is a nice place to live and I would choose to live there myself. Following the inspection we received fourteen residents Have Your Say surveys, which provided mixed comments about the quality of the food. The surveys ask people if they like the food in the home. Three people ticked the always box, seven ticked the usually box and four people told us they sometimes liked the food. Comments included, the food quality is inconsistent ranging from poor to good and the home could provide better food, more range of food and better portion sizes. However, people we spoke to during the inspection told us they do get enough food and are reasonably happy with the food and acknowledged, it is difficult to please every bodies tastes. The AQAA states the home offers three meals a day with snacks and drinks on request, throughout the 24 hour period. This was confirmed at the inspection, the menu was viewed, which reflects meals are varied and nutritious. All meals are prepared on the premises using fresh produce and all dietary needs can be catered for. Lunch on the day of the inspection looked and smelled appetizing and people had been provided with reasonable sized portions. People told us they were enjoying their meal and appeared to be enjoying the social occasion. People had been offered a glass of wine with their meal and staff were observed encouraging people to make choices of the main meal and dessert and offering alternatives, where people declined those available. People having their lunch appeared to be enjoying their meal and the social occasion. Care Homes for Older People Page 18 of 32 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 this service have access to robust complaints and safeguarding procedures and are protected from abuse. Evidence: The policies and procedures for dealing with complaints, whistle blowing, deprivation of liberty safeguards, restraint and safeguarding the people living in the home were examined. These reflect the procedures in place to protect people using the service and identifies the actions staff should take if they receive a complaint, believe an individuals liberty is being deprived or if an incident of abuse is discovered or reported to them. The safeguarding procedure includes the process of reporting allegations to internal personnel and the contact details for the local area safeguarding adult protection team. The complaints log reflects seven complaints have been raised about the service in the last 12 months. These have been fully documented, investigated and a full response provided to the complainant and where the complaint has been upheld, action has been taken to prevent incidents occurring again. People using the service and staff confirmed the manager is very approachable and they would feel able to discuss any concerns they may have with them. The AQAA states residents are provided with a copy of the complaints procedure on admission and the Raising a Concern policy is on the agenda at residents/relatives and staff Care Homes for Older People Page 19 of 32 Evidence: meetings. The homes Quality Assurance report for 2009 shows that 100 of residents and relatives felt their concerns and comments were listened to by the home. Feedback in the residents Have Your Say surveys, reflected eleven out of fourteen people who responded to the surveys told us they would know who to speak to, if they were not happy, however only seven people told us they would know how to make a formal complaint. Staff files seen confirmed all staff are subject to Criminal Records Bureau (CRB) checks and Independent Safeguarding Adults (ISA) check prior to commencing employment to protect people living in the home from people who should not be working with vulnerable adults. Information on staff files confirmed the majority of staff have completed Safeguarding of Vulnerable Adults (SOVA training) within the last two years. Two staff spoken with during the inspection demonstrated a good knowledge and understanding about protecting residents from harm, particularly those people who are unable to verbally express their concerns. They also provided a good explanation of what they would do if they observed poor practice, or suspected an individual was being abused. Care Homes for Older People Page 20 of 32 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. Maynell House provides the people who live there with a safe, comfortable and homely environment. Evidence: The home stands in beautifully maintained gardens, which are accessible to all the residents. The AQAA reflects there are plans to provide a raised bed area where the fish pond is situated, so residents can participate in gardening, if they wish. The house itself is nicely presented and decorated in keeping with age of the property, with many homely additions, creating an atmosphere of comfort and quality for the people living in the home. Communal areas are spacious and well furnished with domestic style and age appropriate furniture, lighting, carpets and curtains. Fresh flowers and Easter decorations had been placed throughout the home, creating a pleasant and homely feel. There are sufficient bathrooms and toilets available in the home to meet the needs of the people living there. The AQAA states that people moving into the home are encouraged to bring their own furniture and possessions with them. Rooms seen, were nicely decorated with peoples personal effects, reflecting their individual personalities, hobbies and interests. We visited one individual in their room, who told us, I am happy with my room and have everything I need. They told us, they had chosen the colour scheme and curtain fabrics themselves and has items of their own furniture, pictures and photographs Care Homes for Older People Page 21 of 32 Evidence: from their previous home around them. Discussion with relatives and staff and feedback in surveys told us people feel the home is in need of redecoration. One survey in particular provided less positive comments about the overall decor of the home. We looked around the home and identified that some areas of the home are beginning to require some attention, the paint work around the dado rails and window frames in the lounge is cracking, a pane of glass in one of the windows in the lounge has cracked and needs replacing, the woodwork on the outside windows and the porch way into the garden is beginning to peel and deteriorate in places and is in need of attention. The pink and white striped wall paper in one of the upstairs bathrooms is stained in places and is due for redecoration. People living in the home, relatives and staff commented about the deterioration of the outside of the building, particularly the porch way into the garden, as this is a favorite place for people to sit in the nicer weather. The manager advised us they have been sharing a maintenance person across the three Healthcare Homes in Felixstowe, but due to the volume of work are in the process of recruiting an additional maintenance person. A programme of maintenance and improvements to the home is in place pending funding and recruitment of a new maintenance person. People were observed moving freely around the home, which is generally equipped with aids and specialised equipment to promote mobility and maximise peoples independence. There are a range of hoists, grab rails and other aids available in corridors, bathrooms, and toilets, and where required in residents own rooms. A call system is provided throughout the home, including individuals rooms and all communal areas, so that residents have access to staff when they need them. The environment is maintained by a team of domestic assistants, with additional assistance from carers on a day to day basis. The home was found to be clean and tidy throughout, with no odours. The laundry facilities contain the appropriate equipment to launder soiled linen, clothing and bedding. Appropriate protective equipment, such as aprons and gloves and hand washing facilities of liquid soap and paper towels are provided in the laundry, all en suite and toilet facilities, where staff may be required to provide assistance with personal care. Information provided in the AQAA and verified at the inspection reflects that a member of staff has been designated the responsibility of taking the lead on monitoring infection control in the home. They work in accordance with the homes own action plan to deliver best practice in prevention and control of infection. The Care Homes for Older People Page 22 of 32 Evidence: AQAA states the service employs a total of fifteen care staff and that twelve staff have completed infection control training. The AQAA reflects the manager strives to ensure the environment is safe and that the home is compliant with the requirements of the local fire service. Bedroom doors are fitted with dor guards to ensure doors close automatically to contain the spread of fire in an emergency, however it was noted that the threshold was preventing the door to bedroom 4 from closing, additionally a hoist had been put in the bathroom upstairs preventing the fire door to close. The manager advised us they would deal with these issues immediately. The manager will also need to look into a comment received in a resident Have Your Say survey (received after the inspection), which commented that the fire doors are too heavy to pull and push open in normal times. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A review of staffing levels means people using this service are supported by a staff team in sufficient numbers, who are trained and have the skills and knowledge to their jobs. Evidence: The duty roster reflects the home is staffed 24 hours a day, seven days a week. The normal staffing ratio is three care staff, inclusive of a senior member of staff during the day time hours, with two night staff on duty between 10pm to 8am. The staff rota is prepared by a senior in advance and clearly shows the skill mix of staff on duty and that the set ratio of three staff per shift is being maintained. The senior commented that rotas have been difficult to cover recently due to holidays and staff sickness. The AQAA states that staff offer a wealth of experience and deliver a high standard of care and are committed to the well being of the residents and that there is a good rapport between the staff and the visitors to the home. This was evidenced at the inspection. However, residents, relatives and staff told us, the home could do with more staff so that residents care and wellbeing and quality of life can be maintained and improved upon. Comments in residents Have Your Say surveys included, despite being short staffed, the care staff are good, they are always cheerful and more staff available, so that more time can be spent with me. Staff Have Your Say Care Homes for Older People Page 24 of 32 Evidence: surveys commented, at present the home does not have enough staff on shift (especially in the morning) to care for residents, which has been an issue for sometime and much is expected from staff, we are pulled from one job to another and residents do not get a full service and the night staff get people out of bed very early, likewise in the evening residents are assisted to bed early. People we spoke to during the inspection did confirm they got up and went to bed early, but stated this was their choice. Staffing was discussed with the manager, who confirmed they are in the process of trying to restructure the staff team, to create a head of care post and a shift leader each shift who will be responsible for running and organising the shift and administering medication. The shift leader posts are to be in super numeray capacity to the care team, which will increase the staff ratio to four staff on duty each shift during the day time hours. They also confirmed information provided in the AQAA that they currently trying to recruit to staff vacancies, which has been particularly difficult in the Felixstowe area. The manager is arranging an open day on the 16th May for both for potential users of the service and recruitment of staff. Ten staff Have Your Say surveys were sent to the home for distribution, six completed surveys were returned, which told us what the staff thought the home did well, and where they could improve. Overall, staff told us the home provides a good service to the people who live there, comments included, the home is always improving, we have a new manager and the staff team are brilliant, I enjoy working here, the home has a relaxed and calm atmosphere, no one is stressed, staff, residents or relatives and I feel valued as part of the team, the new manager is good, makes you feel valued and I feel the service is slowly improving under Healthcare Homes. One person commented, we care for the whole person, providing good palliative care, as this is peoples home for life and we try to make it the best we can. The AQAA states Maynell House has a robust recruitment process ensuring they recruit the appropriate people for the job. Staff turnover remains minimal and a number of staff have been at Maynell House for many years. Examination of three staff files confirmed that the relevant documents and recruitment checks, required by regulations, to determine the fitness of the worker had been obtained prior to them commencing work. However, two of the application forms did not have full details of the applicants employment history over the last five years, therefore gaps in employment had not been followed through to ensure they were not a risk to the people living in the home. The manager confirmed they would talk to the staff concerned and obtain the relevant information. Care Homes for Older People Page 25 of 32 Evidence: Of the six Have Your Say surveys returned, five staff confirmed they had been given training relevant to the work they do and four staff told us they received training to ensure they have the skills and knowledge to do their jobs and to meet the different needs of the people living in the home. The staff competency and training folder showed a range of training provided between 2008 and 2009, these included drugs awareness, practical food safety, moving and handling, fire safety, safeguarding vulnerable adults, mental capacity act and deprivation of liberty safeguards, health and safety, food hygiene, basic first aid, nutrition and wellbeing, infection control dementia and person centered care and end of life care. Sixteen staff have completed the appointed persons in first aid, these are all in date. More recent training on falls and osteoporosis was provided on the 19th January 2010. The training folder confirmed staff are receiving training. The manager and area manager told us where previously training was provided by an in house training team, this has been phased out. The company is currently negotiating contracts with preferred training providers, to provide a progamme of rolling training across the eight homes, including Maynell House that fall into the Suffolk Coastal Region. Information provided in the AQAA and verified at the inspection confirmed that care staff receive induction training, which meets the Common Induction Standards (CIS). The induction process consists of completion of a Passport to Care booklet, developed privately for the company. These booklets are being launching at Maynell House, with managers from the eight homes in the Suffolk region who will have responsibility to ensure compliance across all teams. Two new staff are in the process of completing their induction, one of the new staff brought in their Passport to Care book and showed us the work they have been doing to complete their induction, supported by the manager. The AQAA reflects the service currently employs ten full time and five part time permanent care workers. Twelve staff have completed the induction training expected by the CIS and twelve staff have completed a NVQ level 2 or above in Care or Health and Social Care. These figures reflect the home has 50 of staff who hold a recognised qualification, which meets the National Minimum Standards (NMS). Care Homes for Older People Page 26 of 32 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 management and administration of the home is based on openness and respect and is run in the best interests of the people living there. Evidence: Information provided in the AQAA and verified at the inspection confirmed that a new manager has been appointed and they are in the process of making an application to us to become the Registered Manager of the service. They have a wealth of knowledge and experience of working and managing services in the care sector. Staff told us they have an open relationship with the manager and are able to discuss any issues they may have relating to residents care or their work. The AQAA states the home has regular staff meetings on a monthly basis to keep the staff informed about things happening with in the home and to receive input and ideas from them. The AQAA also reflects they could do better to encourage 100 of staff attendance to these meetings particularly the night staff and plan to arrange meetings separately for the night staff at a more convenient time. Care Homes for Older People Page 27 of 32 Evidence: The area manager for this service visited the home during the inspection. Time was spent talking with both the area manager and homes manager about changes to the regional re structuring of Healthcare Homes. They told us the company is in the process of splitting services into three regions. Eight homes including Maynell House fall into the Suffolk Coastal Region. They also told us about the plans they have for Maynell House, with regards to recruitment, training and restructuring for the staff team as already described in the staffing section of this report. The area manager is to hold monthly business meetings with the managers of the eight homes in the Suffolk Region, with a view to implementing an Inspiring Better Lives programme in each of the care homes. They commented this is in its early stages as yet, however they are in the process of buying in Butterfly training for staff from a training provider specialising in dementia care. Information provided in the AQAA and verified at the inspection confirmed that the home has quality assurance processes in place, to monitor how well the service is meeting peoples needs. Peoples opinions are sought through the distribution of surveys. A copy of the outcomes of the most recent Quality Monitoring survey for 2009 was provided at the inspection. Sixteen out of twenty two residents questionnaires sent out and twelve out of twenty relatives returned showed 100 of residents and their relatives felt residents care needs are being met, residents privacy is respected, concerns and comments are listened to, residents are provided with a comfortable and homely environment, enjoy the food and drink and said the cleanliness of the home met their expectations. 88 of people using the service felt the staff in the home were caring and respectful and would know who to raise concerns with, 79 said they enjoyed the activities in the home with 60 saying their care needs were discussed with them regularly. Six stakeholder surveys returned stated staff skills, knowledge and approach contribute to the good care delivery, felt communication between them and staff was effective and would recommend the home. The feedback from the surveys is analysed and used to form an action plan for areas that need to be improved, which is discussed at staff and management meetings. Residents are encouraged to maintain control over their finances where they are able to do so, however the manager advised the majority of peoples finances are looked after by family or a power of attorney. The manager does look after petty cash for five residents. This is kept locked securely and a running balance is logged on a ledger with two signatures for each entry / withdrawal made. Relatives are informed when the individuals petty cash is running low and will pay monies in to top the balance. Care Homes for Older People Page 28 of 32 Evidence: The AQAA states that staff appraisals are carried out yearly and staff supervisions are carried out frequently. The supervision matrix provided confirmed supervisions are taking place, with the exception of six staff who have not had a supervision in last three months. The process includes regular staff meetings, one to one and appraisals. Samples of supervisions seen, confirmed staff were able to discuss their work role, relationships with others, objectives, work concerns and training and development. Staff confirmed they do have supervision and that they are able to approach the manager daily for advice and support and that they feel supported. To ensure the safety of people living in the home, an automatic fire system is in place which links to the fire service. All doors in the home have automatic closures, which close when the alarm sounds to prevent the spread of fire. A weekly test of the alarms was completed during inspection. All radiators throughout the home are guarded with radiator covers, which minimises the risk of people falling against them and sustaining burns. Regular hot water checks are made to ensure these are operating within the safe recommended temperatures. The most recent Gas, Electrical Safety certificates, including Portable Appliance Testing (PAT) were seen. Certificates confirmed the passenger and moving and handling equipment is regular checked and serviced, including Lifting Operations and Lifting Equipment Regulations (LOLER) tests. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 30 of 32 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 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 16 All people using the service should be made aware of the process to make a formal compliant, should the need arise. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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