Inspection on 27/10/09 for Merrivale

This is the latest available inspection report for this service, carried out on 27th October 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Merrivale 14/11/07

Merrivale 29/05/07

Merrivale 02/03/07

Merrivale 26/04/06

Merrivale 01/09/05

Merrivale 25/04/05

Merrivale 09/11/04

Merrivale 02/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Merrivale 90 East Road Burnt Oak Middlesex HA8 0BT     The quality rating for this care home is:   two star good 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: Julie Schofield     Date: 2 9 1 0 2 0 0 9 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 35 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Merrivale 90 East Road Burnt Oak Middlesex HA8 0BT 02089527639 02089515310 manager.merrivale@fremantletrust.org www.fremantletrust.org The Fremantle Trust Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Joanne Head Type of registration: Number of places registered: care home 56 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is:56 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Ole Age, not falling within any other category - Code OP, Dementia - Code DE, Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Merrivale is registered to provide care to fifty-six older people, who may also have a mental health diagnosis or a diagnosis of dementia. The home has transferred from Care Homes for Older People Page 4 of 35 Over 65 56 56 56 0 0 0 1 3 1 1 2 0 0 8 Brief description of the care home local authority responsibility to being run by The Fremantle Trust. The home is divided into eight units and includes two dedicated respite units one of which is for people with dementia. The units accommodate between five and nine service users and have lounge, dining room and kitchenette. The building has three floors. The ground floor has one respite unit and one mainstream unit. The second floor has one respite unit and two units for people with mental health needs. The third floor has one mainstream unit and two units for people with dementia. There are mature gardens to the front and rear of the premises. The overall aim of the home is: To provide a high standard of care and support that is tailored to meet individual needs taking account of each persons right to exercise choice and self-determination in pursuing their own lifestyle.. For information about the current level of fees please contact the manager of the home. Care Homes for Older People Page 5 of 35 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: two star good 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 inspection was carried out over 3 days in October, on the 27th, 28th and 29th. The first visit started at 8.30 am and finished at 4.30 pm. We returned on the next day and started at 2.45 pm and finished at 5.15 pm. The final visit started at 3.15 pm and finished at 6 pm. During the inspection we carried out a tour of the premises. We also examined records, which included residents records, staff records, medication records and records associated with the running of the home. Policies and procedures were checked. The serving of a midday and an evening meal were observed. Discussions took place with the manager, deputy manager and members of staff. We spoke with residents about the quality of the service provided and observed care practices. We would like to thank everyone for their assistance with the inspection and for their participation. Care Homes for Older People Page 6 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Fourteen statutory requirements have been identified during this key inspection. Five were in respect of the administration of medication and highlight a need to check before administering and to check when recording so that errors do not occur. A record of the residents consent to assistance from members of staff in the administration of medication and a record of the assessment of competence of members of staff that are responsible for administration were lacking. The company has been working on a new format for care plans for some time and this needs to be completed and implemented, after the necessary training for staff. Provision must be made for including a mental capacity assessment. Training in respect of dementia care needs to progress from a basic level of awareness and when the manager and dementia care adviser complete the training that enables them to deliver in house dementia care training a programme of sessions will be needed. Keeping the training matrix up to date will enable monitoring of who needs what training and when. Although much work has been done to improve the environment in the home the age and size of the building mean that the maintenance programme needs to be robust and keep pace with the need to upgrade so that standards do not deteriorate below an acceptable level. Appearances both inside and outside the building are important and first impressions of the home are spoiled if the area near the front door is untidy. Care Homes for Older People Page 7 of 35 Staffing levels must be kept under regular review as any change in the dependency levels of current residents or if new residents are admitted to the home with high dependency needs may result in staffing levels not meeting the residents needs. Increasing opportunities for residents to take part in activities taking place in the community will stretch staffing levels further. The report format of the Regulation 26 visit needs to be more comprehensive if the trustees are to monitor the performance of the home against legislative requirements and the complaints procedure must contain the up to date contact details for the Care Quality Commission. 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 8 of 35 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 9 of 35 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. Carrying out an assessment of the resident, prior to admission, ensures that the needs of the resident are identified and that the home is able to determine whether these can be met. Building on the dementia care awareness training that forms part of the induction would enhance the skills and knowledge of the carer and the quality of service provided. Evidence: We selected 3 residents case files to examine. The 3 residents had been admitted to the home recently and included a resident that had been admitted for respite care. Each file contained a information provided by the placing authority including a copy of the FACE rapid assessment document, a health and social care plan and a mental capacity assessment. We saw that the process included a visit by the manager or the duty officer to the prospective resident. The visit was made to the prospective residents home or to the hospital where they were staying. The Freemantle Trust assessment is in addition to the local authority assessment that is supplied as part of Care Homes for Older People Page 10 of 35 Evidence: the referral process. Although the prospective resident is invited to view the home prior to admission the manager said that this rarely happens, although quite often the residents relatives visit. Welcome packs containing the Service User Guide and the Statement of Purpose were on display in the entrance hall of the home. Referrals are not always accepted and one reason for refusal is if the care needs of the prospective resident are not compatible with those of the residents already living on the unit. If the referral is accepted the social worker notifies the prospective resident and the family and the placement is made, subject to a 4 week trial period. We looked at whether the home could demonstrate that it met the needs of the residents. There are many residents in the home that have dementia and an audit of the dementia care service was carried out in February 2009. It was thorough and whilst acknowledging good practice it also identified the need for further development in terms of care planning, nutrition, biography, personhood, social psychology, staffing, environment and service development. We discussed dementia care training for members of staff and the manager said that this forms Day 6 of the induction training package for new members of staff. In addition there is also in house training for staff and the manager gave examples of the Look Again and Stop and Listen training packages. Currently the manager and the dementia care adviser in the home are undertaking a training the trainer course organised by the Alzheimers Society. When this has been successfully completed a programme of training for carers will be rolled out. This will give carers a more in depth understanding of dementia. The service does not provide intermediate care. Care Homes for Older People Page 11 of 35 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. Assessing the needs of a resident and identifying these in a care plan enables the resident to receive a service tailored to meet their needs. However care plans lack an assessment of capacity. The health and well being of residents is promoted through regular health care checks and appointments. Residents are supported in taking their medication, as prescribed by their GP, in order to maintain their general health and the administration of medication must be careful and correct to avoid mistakes being made. Discreet and caring support is given to residents by staff so that the privacy and dignity of the resident is respected. Evidence: A statutory requirement had been identified during the previous key inspection of the home and this was in respect of the need to complete the work of assessing each residents needs dependency profile. When this was done the information must be analysed and if necessary staffing levels adjusted. We discussed this with the manager and she told us that the process of assessment was now complete. The analysis of information had taken place and although staffing levels had remained the same the analysis had highlighted the need to deploy carers more flexibly and this has been Care Homes for Older People Page 12 of 35 Evidence: implemented. She said that dependency levels have changed over time and that at the moment levels were not excessively high but are being kept under review. The previous key inspection had also identified the need for care plans to be kept up to date and for them to contain a clear record of the needs of the resident and how staff will work with the resident and meet these needs. The manager said that the senior team were now reviewing all care plans and that evaluations were taking place on a monthly basis. She said that care plans were gradually becoming more person centred and contained more detail. The company is developing a new care plan format, although this has been an ongoing task for some time. When we examined 3 residents case files, primarily to look at the pre-admission assessment process, and then a further 5 residents case files we noted that files contained a personal lifestyle summary, a summary of the care plan assessment and a recently completed or updated care plan. Only 1 file contained a mental capacity assessment. There was evidence that care plans were reviewed on a regular basis and that when review meetings took place the resident was supported at the review by their family, where necessary. We saw that monthly evaluations were up to date. Care plans included risk assessments in respect of fire evacuation, manual handling, nutrition, falling and ones that were linked to the individual needs of the resident e.g. leaving the care home, refusing to take medication etc. Case files contained information regarding access to health care services. We saw appointments with the GP, the dentist, optician and chiropodist. Residents were able to have a flu jab, if they wished. There were also appointments at out patient clinics including audiology . Residents had routine screening e.g. blood tests and where necessary, residents had support from the District Nursing service. One resident had a tissue viability care plan and files contained a risk assessment in respect of pressure sores. Where a resident had a sacral pressure sore the District Nurses were providing nursing care. An air flow cushion and special mattress had been provided to make the resident more comfortable and to assist healing. At present none of the residents in the care home self medicate although the manager said that occasionally a respite care resident might do this and that there was a lockable drawer in the bedrooms where the residents medication could be kept safe and secure. The home did not have consent forms for residents that needed assistance with their medication. Medication is given either by the duty officer or by members of staff that have received medication training. The home does not have a form where the assessment of competence for a member of staff to administer medication is recorded although the manager said that an assessment is carried out. Controlled drugs are administered by the duty officer with a member of staff that has Care Homes for Older People Page 13 of 35 Evidence: received medication training acting as the second person. We saw the storage and recording of the administration of controlled drugs and these were satisfactory. We checked the stock balance and this was in accordance with the balance noted in the records. We checked medication practices on 2 of the units in the home, selecting a unit accommodating permanent residents and a respite care unit. Records were up to date and complete. Where blister packs were in use the blisters had been correctly popped according to the day of the week and the time of day that they were examined. However, where a resident had been in hospital and not in the home when medication was administered the person had initialed the boxes on the MAR sheet instead of using the code that denoted hospital. Prior to the inspection 2 incidents had occurred in respect of a medication error. We discussed these during the inspection and reviewed with the manager the action plan to ensure that these errors did not occur again. One error was in respect of a resident being given another residents medication. The other error was in respect of booking in medication for a respite care resident without taking care to ensure that the same medication, with slightly different names, was identified. Members of staff have been reminded about the importance of careful checking of names and of the need to report any problems with medication that may arise. The manager is monitoring medication carefully. We discussed privacy and dignity with residents and they confirmed that these were respected when carers assisted them with personal care tasks. During the inspection we saw that assistance was offered by carers in a manner which was discreet and tactful. We noted that members of staff used the term of address preferred by the resident. There was a good rapport between residents and members of staff. Care Homes for Older People Page 14 of 35 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. A programme of activities provides residents with opportunities for stimulation and enjoyment. Residents said that they enjoyed the company of their visitors, who were made welcome by the staff when they visited the home. Residents had opportunities to exercise choice in their daily lives. Residents nutritional needs are met through the provision of a diet that is wholesome and varied and which meets their needs. Evidence: A statutory requirement was identified during the previous key inspection that residents must be provided with a range of activities that reflect their needs and wishes. We spoke with the activities co-coordinator, which has been a new appointment. She provided us with a copy of the 2 weekly activities programme. It included quizzes, reminiscence, sensory sessions, get up and go, relaxation, arts and crafts, cooking and free choice sessions. We were told that each day there is a group activity and that the location changes but residents from other units are welcome to attend. Entertainment and parties have taken place and the day centre is used for popular events, including a Halloween supper and celebrating the UK Older Persons Day. In addition group outings have taken place to Buckingham Palace, a trip on a London river boat and lunch at a restaurant. The activities co-coordinator works 25 hours per week over 5 days and this includes alternate weekends. There are also Care Homes for Older People Page 15 of 35 Evidence: some opportunities for individual outings to the shops or to a cafe, depending on staffing levels. Some residents enjoy taking part in occupational activities and helping with washing up or laying tables is encouraged. Although we were told that members of staff encourage residents to use the garden in fine weather no record is kept of when residents use the garden. While we were there we were told of a visit which involved farm animals coming to the home for residents to see and we saw photographs of this. A resident told us about entertainment that was taking place in the home on the day after the inspection. They were looking forward to this. One resident said that they would like to go out but cant. We spoke with the manager about the residents use of resources in the community and she said that residents used shops, cafes and restaurants. Two residents attend a day centre in the community and 3 residents attend the on site day centre, that is run independently from the home, if there are any spare places each day. We saw these residents in the on site day centre during the inspection. Residents names are entered on the electoral roll and they are able to vote, if they wish, either in person or by using a postal vote. Residents told us that their visitors were made welcome when they arrived at the home and that residents could either entertain visitors in their own room or in the communal areas. Residents can choose whether they want to see a visitor and if a visitor is present when meals are served they can join the resident and have a meal During the inspection we saw that residents had some opportunities to exercise choice in their day to day lives e.g. choice in what they ate, choice in whether they took part in activities, choice in whether they socialised with others etc. They were able to spend time n their rooms, if they wished, without unnecessary interruptions and were able to bring personal possessions with them to personalise their rooms and to make them more homely. We saw that the home has a 4 week rolling menu that is adjusted on a seasonal basis and were provided with copies of the menus. They demonstrated that a varied menu is provided. The lunch menu includes alternatives e.g. a vegetarian option, salads or a jacket potato etc. The teatime menu consists of soup, a selection of sandwiches, malt loaves or crumpets or a light snack e.g. eggs or beans on toast. As part of the quality audit of the home a food audit was carried out. We saw a copy of the information that the home had been asked to supply, as part of this audit, in August 2009. We saw that residents whose views had been surveyed as part of the audit were satisfied with Care Homes for Older People Page 16 of 35 Evidence: the menus and the food served. When we spoke with residents one person told us that the food was good and that they had enjoyed their meal. They confirmed that an alternative was available if the resident wished. Another resident said that they always enjoyed their dinners, which were different every day. One resident said that the food was excellent. During the inspection we saw the serving of the midday meal and the evening meal. The lunch that we saw consisted of sausages and onions in gravy with peas and mashed potatoes. The dessert consisted of rice pudding with jam. We noted that portion sizes were good and that sufficient food had been brought to the unit to allow for residents to have a second serving, if they wished. We noted that for the evening meal in one unit tomato soup was served and some residents had chosen to have sandwiches and one resident was having cheese on toast. In the kitchenette was a laminated list of choices or ideas for the evening meal and the kitchenette was supplied with a toaster, microwave and cooker. In another unit a different selection of sandwiches had been requested and some of the residents had chosen spaghetti hoops or baked beans instead. We spoke with the assistant chef and discussed special diets that may be prepared to meet a residents dietary, religious or cultural needs. The home also prepares pureed meals and we were told that care is taken in their presentation to make them look appetising. Care Homes for Older People Page 17 of 35 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. A complaints procedure was in place to protect the interests of the residents. Protection of vulnerable adults training for staff and familiarity with the homes procedure and with the whistle blowing procedure contribute towards the safety of residents. Evidence: We saw that a copy of the Freemantle Feedback procedure, for compliments and complaints, was on display in the entrance hall. However, the contact details for the Care Quality Commission need updating. Timescales for the resolution of a complaint are included in the information and the various stages are outlined. Since the last key inspection the home has recorded 6 complaints under their complaints procedure. We noted that there was a record of the details of the complaint, the investigation carried out and of the resolution and subsequent contact with the complainant. One of the complaints was anonymous and had been made to the CQC and then forwarded to the home. It was currently being investigated. As the complaint included comments about the catering arrangements in the home these were checked during the inspection and were found to be satisfactory. The manager told us that 1 safe guarding referral had been investigated by the local authority after a respite care resident made comments to their social worker about an alleged incident. A strategy meeting was held and the manager was asked to investigate. The matter is now resolved. A copy of the inter agency guidelines in the Care Homes for Older People Page 18 of 35 Evidence: event of an allegation of incident of abuse was available in the care home. When we spoke with residents one person said that they feel safe and another resident told us that they didnt feel lonely. One resident said that they would talk to the manager if they were unhappy with something but they had not had any problems so far. When we spoke with members of staff three of the carers explained their duties and responsibilities in the event of an allegation or disclosure of abuse being made and demonstrated their awareness of the whistle blowing procedure. One of the carers said that they had covered pova as a topic during their recent induction training. Care Homes for Older People Page 19 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home where, due to its size and age, the ability of the maintenance programme to keep pace with the need for refurbishment is kept under review so that standards do not deteriorate. A choice of communal areas gives residents the opportunity to socialise or sit quietly according to their wishes. Residents live in a home where standards of cleanliness are good and provide residents with hygienic surroundings. Evidence: This key inspection included a site visit. During the previous key inspection a statutory requirement was identified that all outstanding work remaining from the Health and Safety audit of the home that was carried out in May 2008 must be completed. The manager confirmed that the works had been done and as we walked around the home she pointed out the redecoration and refurbishment that had taken place. There are new curtains and carpet and bathrooms have been upgraded by new tiling, new flooring and a new bath where needed. There is a programme of replacing beds and bedside cabinets. Ten bedrooms now have new flooring. Although there is an ongoing programme of upgrading the accommodation there are still areas where attention is needed e.g. where paintwork is scuffed and where woodwork is chipped or has gouges etc. The home needs to review its maintenance programme to ensure that it keeps pace with upgrading parts before deterioration results in poor standards. Care Homes for Older People Page 20 of 35 Evidence: We noticed on our arrival at the home that there were items that had been delivered and were being stored in the area outside the front door and others that were waiting for collection. As this is the visitors first sight of the home thought should be given to the impression that may be formed. When we spoke with residents one person said that the rooms are very nice and that they are kept clean. We noticed that the heavy curtains in one of the rooms were absent and the manager said that the resident had pulled these off the rail. It is recommended that a system using velcro is tried so that curtains are in place but no damage is caused if they are pulled and become detached. A resident told us that they liked to sit in their room rather than join others in the main lounge. With the bedroom door open they could see people walking past and confirmed that members of staff called to check if there was anything the resident needed and to make sure that the resident was alright. During the site visit we saw the laundry and noted that 1 of the 3 washing machines was out of service. However, the manager said that surplus equipment from another of the companys homes in Buckinghamshire is to be brought and fitted in the laundry room as the surplus washing machines are newer models than those currently in use in Merrivale. We noted that COSHH leaflets were on display to provide guidance to members of staff in the event of an emergency. There had been complaints about items going missing after been sent to the laundry and it was identified that this happened when the laundry person was not on duty. The items were not returned to the correct resident. Problems have been resolved by name tags being attached to items of clothing and after laundering these are put into the residents individual named basket. We noted that the home was clean and tidy and free from offensive odours. The manager said that members of staff receive training in respect of infection control procedures initially when undertaking mandatory training and then as refresher training on a 2 yearly basis. Care Homes for Older People Page 21 of 35 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. Staffing levels were sufficient to meet the current needs of residents but must be kept under review. Residents benefit from staff that have developed their understanding and awareness through NVQ training . Recruitment procedures are thorough and this promotes the safety and welfare of residents. Keeping training records up to date would allow the home to demonstrate that care staff have received the appropriate training and at the recommended intervals. Evidence: We discussed staffing issues with the manager and with the deputy. A statutory requirement had been identified during the previous key inspection that a review of the deployment of staff within the home was needed and that a review of the supervisory arrangements in place must be carried out so that in future senior staff have time to supervise the day to day care arrangements in the home. The deputy told us that the deployment of senior staff on a day to day basis has been changed so that there is now a more even presence on a daily basis. This enabled carers to be more effectively supervised and care arrangements to be monitored. The manager also said that another senior has been appointed and the tasks that seniors were carrying out has been reviewed and some tasks have been taken over by the manager and deputy manager. We discussed staffing levels. There are 3 units on the 2nd floor, 3 units on the 1st Care Homes for Older People Page 22 of 35 Evidence: floor and 2 units on the ground floor. Doors between adjoining units are now kept open and we saw that residents moved freely between adjoining units. The manager said that this enabled staff to be allocated to work across 2 units, giving greater flexibility and a better service to residents. In total there are 11 carers on duty. However, as this provides minimum staffing cover staffing levels in the care home need to be reviewed on a regular basis to ensure that they match the dependency levels of the residents and support residents having access to activities within the community, either on an individual or group basis. When we spoke with residents one person said that the staff are wonderful, very nice and can take a joke. They have a sense of houmour. They also said that the manager was very nice. Another resident said that the staff are all very kind to me. One resident said that the staff were excellent and that they always come when you call. The carers are supported by a duty officer and the deputy manager and manager. In addition there are domestics on duty, a cook, a chef manager and kitchen assistants. The progress towards meeting a minimum target of 50 of carers achieving an NVQ level 2 qualification was assessed. We noted that approximately half of the team of carers have now successfully completed their NVQ level 2 studies. There are also several carers in addition to these that are currently studying for a level 2 qualification. Freemantle Trust have made the completion of NVQ level 2 training a priority and so staff who still need to undertake this training will do so before other members of staff move on to level 3 training. We examined 3 staff personnel files to check recruitment practices. We noted that each file contained an application form containing a health declaration and declaration regarding any cautions or convictions. Each file contained proof of identity (passport details), 2 satisfactory references and an enhanced CRB disclosure. Where necessary the right to reside or to work in the UK had been established. The home uses a training matrix, which is a computer programme, to plan and monitor training provided so that members of staff receive training in the areas needed to support residents needs and to work in a safe manner. The training matrix for this year still needs some data to be loaded although training attendance certificates have been received. The matrix includes individual training profiles for members of staff. A 6 day, comprehensive induction training package is in place for new members of staff. Members of staff confirmed that they had access to training and gave examples of NVQ level 2, medication, manual handling and protection of Care Homes for Older People Page 23 of 35 Evidence: vulnerable adults training. Care Homes for Older People Page 24 of 35 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. By continuing her personal development, through further training, the manager ensures the efficient and effective running of the home. Quality assurance systems in place enable the future development of the service to reflect the views and needs of the residents although the format of the Regulation 26 visits is brief. Support is given to residents who need assistance in managing their finances so that residents financial interests are protected. Training for staff in safe working practice topics promotes the health and safety of residents, staff and visitors to the home and the testing/servicing of equipment in the home demonstrates that it continues to be safe to use. Evidence: We spoke with the manager and she informed us that she had been appointed to manage Merrivale in June 2008 and has since been registered by the CQC. She has been employed by Freemantle Trust for 7 years and began in an Assistant Manager post. Prior to this she has worked in domiciliary care and in a respite care setting for younger adults with physical disabilities. She has an NVQ level 2 and a level 3 Care Homes for Older People Page 25 of 35 Evidence: qualification and is currently studying for a level 4 qualification. She is also currently undertaking training to enable her to deliver in house training in respect of dementia care. She is a manual handling trainer and a dementia care mapper. Since the previous key inspection she has undertaken some short training courses, including training in the Mental Capacity Act, and attended managers workshops in respect of the forthcoming changes in registration. Throughout the inspection we looked for evidence of quality assurance systems being in place and were provided with copies of the Food and Nutrition Quality Audit that took place in August, a copy of the Audit for Dementia Care Services that was carried out in February 2009 and the previous years annual quality audit against the National Minimum Standards. Each section of the annual quality audit contained an action plan, which identified who would be responsible and the timescale for completing the task. The Director of Care carries out the monthly Regulation 26 visits to the home and there is an annual visit to the home by the link trustee. Regulation 26 report formats are brief and certain areas are selected each month to inspect. Each year there is a relatives consultation meeting. We sat with the member of staff that handles residents finances and noted that there are clear procedures in place with audits and checks to protect the interests of residents. We discussed the support that some residents had with their finances e.g. Court of Protection and appointeeships. While some residents are supported in the management of their finances by their relatives the home encourages relatives to leave a small float so that minor items can be purchased by the resident. We saw both paper records and those kept on the computer. A print out of records kept on the computer is made each week and we saw a copy of the most recent one. Accounting systems are good within the home and receipts for items of expenditure are kept when transactions take place. Accounts are audited by members of the company and by an external firm of accountants on an annual basis. In addition spot checks are carried out and the manager checks the records on a monthly basis. A statutory requirement was identified during the previous key inspection that members of staff are to receive individual supervision sessions on a regular basis. The manager said that the policy is for members of staff to have an individual supervision meeting 6 times per year. A member of staff confirmed that she has regular supervision meetings with her senior. In addition general staff meetings are to take place every 2 months and smaller group meetings (2 units together) are to take place 3 or 4 times per year. The manager attends a monthly managers meeting. A statutory requirement was identified during the previous key inspection that the Care Homes for Older People Page 26 of 35 Evidence: home must ensure that fire safety devices are fully operational, including door guards and emergency lighting. The manager told us that this work had been carried out after the inspection and we noted that as we walked around the home that the door guards were operational. The emergency lighting had been inspected again, just prior to this key inspection and although some repairs were needed, authorisation has been given to carry this work out. We noted that a valid certificate of insurance was on display in the entrance hall. Training in safe working practice topics is given to members of staff and risk assessments are present on residents case files and are subject to regular reviews. A health and safety policy is in place. Care Homes for Older People Page 27 of 35 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 28 of 35 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 4 18 A programme of dementia 01/04/2010 care training, that builds on the basic awareness training given during induction, must be included in the annual programme of training. This will enable carers to offer support based on a greater understanding and knowledge of the needs of residents with dementia. 2 7 12 When the new care plan 01/02/2010 format is completed it must be implemented in the care home, after training for staff in the content and usage. This will assure residents that the format of the care plan is person centred, detailed and comprehensive so that all their individual needs are identified, recorded and addressed. Care Homes for Older People Page 29 of 35 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 3 7 14 Mental capacity assessments 01/04/2010 are carried out as required and are recorded with a copy kept on the residents case file. This will assure residents that an assessment of capacity has informed the support needed by the resident. 4 9 13 When recording the receipt of medication brought into the home by a respite care resident any queries regarding the names of medication or whether 2 names are actually for the same medication must be brought to the attention of the duty officer, deputy manager or manager. This will assure residents that any queries can be checked and resolved with the GP or with the pharmacist. 08/12/2009 5 9 12 When the assessment is carried out prior to the resident being admitted to the care home consent is given and recorded for assistance with medication, where this is required. This will assure the resident 08/02/2010 Care Homes for Older People Page 30 of 35 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 that the need for assistance has been fully identified and any special needs in relation to this have been addressed. 6 9 18 When assessing the 08/02/2010 competence of a member of staff in carrying out the task of administering medication the assessment must be recorded. This will assure residents that the member of staff has demonstrated that when carrying out the task of administration of medication the safety and welfare of the resident are promoted and protected. 7 9 13 When administering medication the blister pack selected must be the one with the correct residents name. This will assure residents that they are given the medication that has been prescribed for them. 8 9 13 When using the MAR sheet the correct code for signifying why medication has not been administered must be used. This will assure residents that an accurate record is 08/12/2009 08/12/2009 Care Homes for Older People Page 31 of 35 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 kept in respect of any medication that the home is responsible for administering to the resident. 9 16 22 When the complaints 08/12/2009 procedure is amended the up to date contact details, including a telephone number, for the Care Quality Commission are included. This will assure residents, relatives or representatives that their concerns are listened to and acted upon. 10 19 23 The area outside the home in the vicinity of the front door must be kept clear at all times. This will assure residents that this area presents a tidy and pleasant view to visitors to the home. 11 19 23 The home must review its maintenance programme and programme of upgrading residents private accommodation. A copy of the revised programme of works for 2010 must be forwarded to the Care Quality Commission. This will assure residents that maintenance and upgrading is carried out in a 01/03/2010 01/01/2020 Care Homes for Older People Page 32 of 35 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 timely manner to avoid excessive deterioration in the environment. 12 27 18 A system of regular reviews of staffing levels must be in place to check that they match dependency levels of residents and adjustments made to staffing levels as required. This will assure residents that there are sufficient members of staff on duty to meet their needs and to respond to calls for assistance in a timely manner. 13 30 18 In order to maintain an up 01/02/2010 to date training matrix that can be used to identify the need for training or the need for refresher training information must be loaded on a regular basis. This will enable the home to ensure that training is carried out if and when required so that care practice is based on an understanding or current best practice. 14 33 26 The format of the Regulation 01/02/2010 26 report must be reviewed and a more comprehensive format developed. 01/01/2010 Care Homes for Older People Page 33 of 35 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 This will enable the care home to keep a comprehensive record of the areas inspected and of the findings so that this report informs the trustees of how well the home is operating and whether it is achieving the standards required by regulation. 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 12 That a record is kept of when residents use the garden to ensure that all residents have reasonable access to sunlight. That a review of the activities that take place in the community, both on a group and on an individual basis takes place so that more opportunities are available to residents. That where curtains are pulled down by the resident any further damage is prevented by installing a velcro system where curtains can be reattached easily if they are pulled. That the company continues to support carers to achieve an NVQ level 2 qualification so that the home increases the percentage of staff with this qualification above the recommended minimum. That the company supports carers that have achieved an NVQ level 2 qualification to progress onto level 3 studies. 2 12 3 19 4 28 5 28 Care Homes for Older People Page 34 of 35 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. 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