Inspection on 08/04/10 for More Hall Convent

This is the latest available inspection report for this service, carried out on 8th April 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

More Hall Convent 28/02/06

More Hall Convent 23/11/05

More Hall Convent 16/02/05

More Hall Convent 02/11/04

More Hall Convent 25/02/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Key inspection report Care homes for older people Name: Address: More Hall Convent More Hall Convent Randwick Stroud Gloucestershire GL6 6EP     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: Janice Patrick1     Date: 0 8 0 4 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 31 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 31 Information about the care home Name of care home: Address: More Hall Convent More Hall Convent Randwick Stroud Gloucestershire GL6 6EP 01453764486 01453764486 moorehallconvent@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Grace & Compassion Benedictines Name of registered manager (if applicable) Sister Elsy Poonoly Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of servcie users who can be accommodated is 12. The registered person may provide the following category of service only: Care home providing personal care - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category:- Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home The Sisters of the Order of Grace and Compassion Benedictines run this care home. Although the Order is Catholic, any denomination is welcome. The Sisters care for the elderly person who requires help and supervision with their personal care and daily activities. The home is well maintained and run in a way that takes into account the wishes and preferences of those who live there. A programme of refurbishment is now Care Homes for Older People Page 4 of 31 Over 65 12 0 Brief description of the care home almost complete and the accomodation has been vastly improved so that most bedrooms now include en suite facilities. There are comfortable communal rooms, including bathrooms and toilets. Appropriate adaptations have been made both internally and externally to accomodate wheelchairs and the needs of the older person. There is a passenger lift to the first floor. The gardens are extensive and include a more secure area to sit. There is plenty of car parking space. From April 2010 the fees range from four hundred and fifty pounds to four hundred and eighty pounds per week. Additional charges are made for hairdressing, chiropody, newspapers and toiletries. Information about the home can be provided by the home on request. Care Homes for Older People Page 5 of 31 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: Before we visited the service we considered all the information we had gathered since the last key inspection which was carried out on 16th May 2007. This included considering the last Annual Service Review and any outstanding requirements. It also included notifications from the home which inform us of any accidents, deaths and occurrences that affect service users. It also included any additional information we may have received from professionals, service users and members of the public. We considered the most recent information sent to us by the home in their Annual Quality Assurance Assessment, AQAA. This document is completed by the registered manager/provider and tells us what the home feels it does well, how they evidence this, what improvements have been made and those that are planned. Prior to our site visit we forwarded questionnaires to the people who live in the home and to their relatives so that they could give us their views on the services and care Care Homes for Older People Page 6 of 31 provided. We received six completed by the people who live in the home. We also sent questionnaires to staff asking them for their views on the service and we received four back. Two inspectors then visited the home and spoke to the people who live there, the staff and the manager. We spent one day in the home between the hours of 10am and 8pm. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The environment has been vastly changed and improved since 2007. All bedrooms in the newer part of the home, which is where the majority are, now have en suite facilities, two of which have spacious showers. All bathrooms and toilet areas have also been refurbished and where one bedroom has not got an en suite, a new bathroom was created next door at the persons request. Both the lounge and quiet room/library have been refurbished with a new feature fire and soft furnishings, resulting in comfortable rooms to relax in. The library now has a computer and Internet access for the use of those who live in the home. Bedrooms have been redecorated, new curtains have been hung and new radiators fitted. There is now a fitted sluice room for staff use which will help to promote good infection control. Although the home has always provided social activities we understand there have been some improvements in the opportunities provided, particularly in relation to trips out. Care Homes for Older People Page 8 of 31 The Charity have employed key people who are now able to support the manager in the smooth running of the home and business. Some improvements have been made to the homes fire safety arrangements. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 31 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 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being provided with appropriate information to help them, first make a decision about the home and after admission, what they need to know including that relating to finances. Peoples needs are identified well and time and a lot of support is given to help the individual person settle. Evidence: The home provides information to help people make a decision about their future care. The Sisters welcome anyone who wishes to look around the home at any time. All returned questionnaires confirmed that people had been given enough information to help them make this decision. On admission everyone is given a copy of the homes Service User Guide. This contains information about the services provided, the homes general ethos and important guidance such as the complaint procedure and peoples rights. Care Homes for Older People Page 11 of 31 Evidence: Irrespective of how people are meeting their care fees i.e. paying privately or receiving funding everyone is provided with a residency agreement/contract. We saw these for the two people who had been recently admitted. Before anyone moves into the home their care needs are assessed, usually by the manager. This is so that the manager can be sure that More Hall Convent can meet these needs. Sometimes a trial period will be suggested. The home will try to find out as much information as they can at this stage and will consider the funding authorities assessment of needs (if the person has been referred by a County Council), information from other care/health services such as a hospital or care home, information from individual health care professionals and from a carer or family member. Where possible the manager will visit the person in their home or in hospital. If this is not possible or practicable then the above information will be relied on. They may suggest the person visits the home. We could see from three peoples records that a mixture of all of of the above had been used when completing the pre admission assessment process. One assessment was not dated or signed by the person completing it. Once admitted a more thorough assessment is carried out, which we saw examples of and staff aim to get to know the person as an individual and help them settle. The staff clearly have an understanding that this may be a difficult and emotional time for those moving in and support is given to help people come to terms with this. We spoke to both people who had been recently admitted. One person confirmed that the manager had visited her at home and asked about her needs. It was not possible for the staff to visit the other person but information was gathered before the persons arrival and they confirmed that questions were asked about their needs once they had arrived. We spoke to another person about moving in to the home and settling. Many of this persons memories originate from events that took place in their country of birth, so English is not their original language. The manager has asked the person to help them learn some of their own language and the time taken to do this has clearly been valued by the person. This person explained that staff spend time with her looking at recorded events of her life and said she felt blessed to be in the home. One returned questionnaire said you are made to feel so welcome. Care Homes for Older People Page 12 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the homes records do not always demonstrate it, people in this service are very well very cared for. They are given support to have their health needs met and the overall outcome for people is very positive. People are included in any plans made about their care and along with improvements to the environment this ensures that peoples privacy, dignity and wishes are upheld. Excellent. Evidence: People who live at More Hall Convent tell us they are extremely well cared for and they are very happy to be living there. They also told us on the day of this inspection and through their returned questionnaires, that they are very involved in any decisions made about their care. When we inspected a selection of care plans these gave an indication of the support required but tended to lack specific detail and guidance for staff to follow. We know that people are receiving very individualised care and that the result of this is very positive outcomes for people. We know this because of what people have told us, how staff describe to us what it is they do for people and by our own observations. The Care Homes for Older People Page 13 of 31 Evidence: care plans are however the written agreements and guidance for staff in how an individual persons needs will be met. So, in order for the home to demonstrate that this care is being delivered with the persons consent (or the consent of their representative if they are personally unable to give this) the care plans must be dated and signed. This was very inconsistent during this inspection. And, in order for staff to receive adequate and appropriate guidance in how to meet these needs, the guidance in the care plan should be specific and detailed. Again in several places it was not. The AQAA tells us that the home is considering altering the care planning format and this was discussed a little during this inspection. The format to be chosen is entirely the homes choice but it must now also demonstrate that peoples mental capacity is being considered. This is now required as a result of the Mental Capacity Act and the Deprivation of Liberty Safeguarding (DOLs) guidance which now accompanies this Act. Peoples records told us that external health care professionals, such as General Practitioners (GPs), Community Nurses, representatives of the mental health teams and other care specialists all visit the home when needed. People were also being supported to attend health care appointments and had access to foot and eye care. In the records of one person foot care had been refused by the person but because they are diabetic the staff are monitoring their feet very carefully and will encourage the person to accept chiropody care again in the future. One person was particularly at risk of developing pressure sores because of their frail state. The home had correctly involved the Community Nurse and arrangements were in place to help prevent any deterioration of the persons skin. However, when we looked at the mattress which had been supplied for pressure relief it was not adequately inflated to be of any use. Arrangements were made for a member of staff to rectify this during this inspection but we suggested that this was an example of where the care plans need to be more specific in what staff need to do i.e in this case the importance of keeping this mattress appropriately inflated. A very good example however of the time and individualised care afforded to people in this home was seen by this person having a specific Sister allocated to sit with them in the lounge so that they would not be alone in a frail state of health. It was explained to us that all the staff are flexible and provide time or additional support if needed but the Sisters of the Convent will provide the kind of extra support described above as and when it is needed. Records told us that particular risks are identified and managed as in the example of one persons history of falls when they were previously living in their own home. Again Care Homes for Older People Page 14 of 31 Evidence: arrangements had been made with external health care professionals to have this person correctly assessed and specific equipment had been organised. This person confirmed that their confidence was growing and that they had not had a fall since living at More Hall Convent. The staff confirmed that special attention is given to the persons mobility and encouragement given to walk a little further as and when the person is able. The home recognised that improvements needed to be made to the environment to improve care delivery and peoples comfort (see Environment outcome of this report for more detail) but from a care perspective these improvements are helping not only physically but are enhancing how peoples privacy and dignity is upheld. An example of this was discussed in relation to one persons toilet needs. The staff explained that now each room has en suite facilities with adaptations, in this case, the person can use their own toilet which is close by rather than needing to rely on a commode by their bed at night. The same goes for meeting this persons washing and bathing needs, which can all be met in the privacy of their own room, which in this case includes being able to take a shower. We were informed that peoples appetites are monitored and the records told us that peoples nutritional risk is assessed and then appropriate referrals are made to address this. We inspected a selection of medication administration records (MARs), the records and arrangements in place for the safe storage of medicines, records pertaining to the receiving of stock and any stock returning to the supply pharmacy. The MARs were well maintained with no signature gaps, indicating that people were getting the medication that is prescribed for them. One handwritten MAR required staff initials to confirm who had written the guidance and who had witnessed this but generally this was being done. All bottles and packets of medicine were being dated on opening, which included any eye drops. Arrangements were in place for the application and signing for creams and ointments. Individual MARs for this purpose were seen in peoples bedrooms and were being signed by the person applying the treatment. Records were being kept of what was returned to the pharmacy and the pharmacy were signing the records, indicating receipt of the stock returned. There were no controlled medicines being used at the time of this inspection hence none in stock. Since the last inspection a locked and designated walk in space has been built for the storage of medicines. This felt to be a comfortable temperature but it is small and we did not observe a thermometer in use. We would recommend that one be put in place so that the temperature of this space can be monitored (some medicines need to be kept below a certain temperature otherwise they deteriorate). The general stock being Care Homes for Older People Page 15 of 31 Evidence: kept was at a minimum and only a small stock of homely remedies were being kept with the agreement of the local GP for their use. A record of staff signatures was being kept and only staff who have received accredited safe administration of medicines training, administered medicines. Two members of staff had also completed an advanced course in safe administration and recording of medicines. The medication system is audited monthly. We saw a selection of audits and made a suggestion that during this a medicine is selected and the stock counted to see if the records then correspond with the stock balance. This would help to make the audit more robust and could be specifically done for any anti biotics, night sedation or controlled medicines, when in use. One person keeps their stock of homeopathic medicines that they self medicate in their bedroom. We observed that this was stored beside the persons armchair and some tablets were in a pot on the bedside table. These had been specifically prescribed for this person and must be securely stored at all times as any other medication would be. The homes Service User Guide explains that everyone is entitled to privacy and to have their dignity maintained. We did not observe or hear any situation or incident that would make us think that this was not happening. On the contrary we observed staff speaking to people in a very respectful manner, there was a clear understanding of the need to maintain peoples privacy and relationships between staff and people in the home were clearly relaxed and happy. Care Homes for Older People Page 16 of 31 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. People benefit from living in a care home that is able to be flexible and which recognises that people need meaningful relationships and activities and the freedom to make choices in order to maintain their well being. Evidence: People living in More Hall Convent are recognised as individuals within the home and as citizens of the wider local community. The home itself is well integrated in the local community and this results in people having opportunities to use and be part of the community as a whole and the local community coming in to the home. There is a well established friends of More Hall Convent who help in providing social activities and one to one support for people. We saw several recent pictures of social events that had been held within the home. People told us about the recent Easter celebrations and fun and several had had family members visiting over this time. Most people have very involved family members and for those that do not particular attention is given in recognition of this gap in their lives. We spoke to one person who confirmed that she enjoyed joining in the various activities provided in the home. The AQAA tells us that after seeking the views of those who live in the home, more outings needed to be organised. We understand this was acknowledged and the last group of outings included a trip on an adapted narrow boat. Care Homes for Older People Page 17 of 31 Evidence: The staff are very keen to ensure that peoples equality and diversity rights and needs are recognised. Although the Sisters are Catholic, all religious denominations are welcome including those who do not have a particular faith and the manager confirmed that all are treated and cared for in the same way. We spoke to one person who did not have any particular religious needs and another who found it particularly important that she was living where she was and had access to daily prayer. During the time of this inspection there was only one male service user. The manager was very aware that his social needs and interests maybe very different from those of the female service users. The home has acquired a computer and Internet access for the people living in the home so this person has been learning how to email relatives and generally use the computer. He told us about this and confirmed on the day we visited that he planned to take a walk while the weather was good. Another person confirmed that they liked to spend a lot of time in the courtyard garden when the weather was good. Returned questionnaires provided information about a past discontentment with the meals being provided but that action had been taken to address this. Answers still indicated that there were mixed views where food was concerned but this is not unusual when receiving questionnaires back from service users of many care homes. The menu is displayed on a daily basis and alternative choices can be arranged. We noted that there was no information provided on external advocacy services so we recommended that this be provided. Care Homes for Older People Page 18 of 31 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 should feel confident that there are arrangements in place to protect people from abuse and to respond to any concerns and complaints they may have. Some minor adjustments have been suggested which will help make these processes even more robust. Evidence: The home has a policy with procedures which outlines how complaints will be managed. People are given a copy of the service user guide on admission which contains a summary of this procedure. The procedure is also on the notice board in the lounge but this version reads differently to the one in the service user guide which we understand was updated in 2009. This was pointed out to the manager during this inspection. Both versions tell us that complaints will be acknowledged and responded to within 28 days. We were shown the complaint book where all complaints are recorded. We noted that all issues raised with the home are recorded, so some entries were of a very minor nature. There were no complaints referring to the care of people or of a serious nature that would cause us concern. All entries followed the guidance within the policy but the actions were not dated so it was impossible to fully determine if these were completed within the stated 28 days, although the manager assured us they were. We noted that this book did not have numbered pages and because of its ring binder style, pages could be torn out without trace. We recommended that a Care Homes for Older People Page 19 of 31 Evidence: bound book be used and the pages numbered. All returned questionnaires indicated that people know how to make a complaint if needed. The CQC have not received any complaints about this service. There are arrangements in place to protect people from abuse. These are underpinned by several policies and procedures and staff receive appropriate training in relation to the protection of vulnerable people. This training was last received in 2007 by staff employed then and the manager is organising an update, this year, for all staff. One member of staff has been working alone at night without any evidence of relevant training in this area. This is not good practice of which the manager assured us would be rectified immediately. There is a adult protection policy with procedures which was reviewed in January of this year. The policy and procedures contain all that is required but some additions have been made over a period of time since its creation in 2002, such as the guidance on procedures to be followed in the case of suspected abuse. This currently sits as a separate document and really needs to be fully included in the main text so that staff receive clear guidance on what is now required of them, in the correct order. This mainly relates to the order of events before staff embark on their own investigation. A policy on whistle blowing is included and explains to staff that if they raise concerns in good faith about other staff that they will be protected against any reprisals. The policy asks that staff read this and sign it but there were no signatures on this document. This policy also refers to the previous Commission (Commission for Social Care Inspection, CSCI) so this now needs altering. Comments in returned questionnaires included the staff are always cheerful and all people spoken to during the inspection made comments about how kind and caring staff were. The questionnaires also confirmed that people know who to speak to if they are unhappy about something. Four people confirmed that the staff always listen to them and act on what they say, one person felt staff sometimes listen to them and one answered do not know. Care Homes for Older People Page 20 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are benefiting from the many improvements made to the environment and the fact that the home is always kept safe and clean. Evidence: Internally the home has undergone huge improvements since the last inspection in 2007. It is now able to provide en suite facilities to each bedroom, which has enhanced peoples comfort, privacy and dignity. Two of the en suites have large shower areas. Communal bathrooms and toilets have also been upgraded and a separate shower room has been created. The main communal rest rooms have been refurbished and soft furnishings have been changed. Some bedrooms have been reconfigured to accommodate en suite facilities and all in the extension to the main building, have been redecorated. One bedroom needs attention in the older building but will need to be addressed when the occupant is on holiday. Some carpets have been renewed including that in the guest room. At the time of this inspection the home were waiting for new curtains for the main hallways. Now that the major building work has been completed the AQAA tells us that refurbishment will continue for the next 12 months and will include the replacement of old curtains. One persons specific wishes for washing and toilet facilities were taken in to Care Homes for Older People Page 21 of 31 Evidence: consideration at the time of this refurbishment and have been provided. All people living in the home at the time were consulted and their views taken in to account. During the refurbishment new radiators were fitted in bedrooms that needed these and these can be individually regulated. There are extensive grounds that people enjoy, which have hand rails at strategic points. The courtyard garden was being made more secure at the time of this inspection. Arrangements are in place for the daily maintenance of the home and urgent issues are dealt with in a timely fashion. The home has been awarded four stars by the Food Safety Officer for its high standards of record keeping and cleanliness. At the time of this inspection the kitchen and separate washing up area looked clean and organised. The fire safety officer has recently carried out a review of the service and is satisfied with the fire safety arrangements currently in place. Some adjustments are required to the fire risk assessment which are being addressed. Basic adaptations are in place to help make peoples lives easier such as toilet hand rails, corridor hand rails, external ramps, a bath hoist and mobile hoist. Any additional specialist equipment is sourced through the Community Nurse when required. People are encouraged to personalise their own bedrooms and we saw many examples of this. We spoke to one person who had requested that all the homes furniture be removed from the bedroom they had booked because they wanted to bring all of their own furniture. This was organised and the result has been a very personalised space that the occupant is very at home in. If people wish to have a television, telephone and their own Internet access this is all possible at their own expense. Specific cleaning schedules are in place and Sisters of the Order and other staff all have responsibilities in maintaining a clean environment. A sluice room for staff use has been created, which will help promote good infection control. The home has an infection control policy which was last reviewed in January 2010. This links to other procedures that promote safe working practices. Staff do complete infection control training and have just attended a refresher training. We visited the laundry area, which was tidy and clean. The AQAA tells us that there Care Homes for Older People Page 22 of 31 Evidence: are arrangements in place for the safe management of soiled linen/clothes. All questionnaires returned to us confirmed that the home is kept clean. Care Homes for Older People Page 23 of 31 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. People benefit from being cared for by people who have gone through a good recruitment process, who are usually experienced and who have received relevant training. However, a robust induction process for new staff cannot be demonstrated and this has the potential to put people at risk. Evidence: More Hall Convent is slightly different in how they support peoples needs. Although there are specific staff allocated and trained to provide care, all the Sisters in the Convent are able to give support in many additional ways. An example of this is described in the Health and Personal Care outcome of this report where a Sister, not allocated to care was providing company to a frail person. On the day of our inspection we were greeted by a person whose task it was on that day to specifically welcome people on their arrival. We also know that similar and special arrangements are made to sit with people when they are at the end of their life. Staff designated to specifically provide care are allocated by the manager and consist of both Sisters within the Order and people from outside of the order. All are experienced and hold a qualification in care such as the National Vocational Qualification (NVQ). At busy times of the day, such as mealtimes, additional Sisters will help in the dining Care Homes for Older People Page 24 of 31 Evidence: room. In the morning the manager is extra to the number of staff allocated to care for people. A Sister who is a registered nurse now works in the home and although she does not provide nursing care, because this care home is only registered to provide personal care, she is able to use her knowledge for the benefit of those living there. We were informed that all new staff attend a two day mandatory course where basic health and safety related trainings are delivered by an external training provider. This also includes training related to the protection of vulnerable adults. We are aware that More Hall Convent also organise additional trainings and refreshers through a local college. These include dementia awareness, infection control and safe moving and handling. We looked at the personnel files of two staff employed since the last inspection. One was employed in 2009 and one more recently. One had evidence of all the above trainings, which had either been completed before employment at More Hall Convent or since employment. The staff member had also attended the initial two day external training. The more recently employed person had evidence of some trainings but not of other basic trainings that we would have expected to have seen completed, particularly as this person works predominantly unsupervised at night. We asked for one particular training to be completed before they return to work for their next shift. The manager referred to the two day external training as being the staffs induction training. There did not appear to be a further period of induction provided by More Hall Convent where staffs competency in care and other related subjects were signed off. The home must be able to demonstrate that it is providing adequate induction training for all staff and demonstrate a process by which they know people to be competent in their work. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in such a way that respects and acknowledges the wishes of those who live there and arrangements are in place to ensure their health and safety. Evidence: There has been no change to the immediate management of the home since the last inspection in 2007. The manager is registered with us (the Care Quality Commission) and applies an open and inclusive style of management. She is very involved with all the people who live in the home and has an open door policy. The Order of Grace and Compassion Benidictine, of which the care home is part of, is a registered charity. The Order have made some improvements which help the manager manage the home smoothly. These include a personal assistant to the manager who organises and manages the majority of the office based work within the care home. The manager also has access to a care home consultant who helps the Order ensure compliance with the Care Home Regulations. A Solicitor is also now employed by the Order and advises on all personnel issues. Care Homes for Older People Page 26 of 31 Evidence: The responsible person complies with regulation 26 of the Care Home Regulations by carrying out a monthly visit to the home to ensure the home is meeting the required standards and regulations. We were able to see examples of the reports written after these visits during this inspection. We have every confidence that the home is run well and for the benefit of those living there. However, for the home to be confident that it can fully evidence compliance in the future, care must be taken to keep good records in order to evidence this. A brief discussion was had about how the home will need to do this under the Health and Social Care Act 2008 which comes into force on 1st October this year. Various audits are already completed and the views of those living in the home and who visit are sought on an annual basis to help the home improve its services. This years questionnaires were due to be sent out to various stakeholders soon. Small amounts of personal money can be kept safely for people but people also have the option of keeping this safe within their own rooms if they prefer. If people wish to and are able to do so, they are supported to manage their own finances. The manager is aware of who holds Power of Attorney. Individual amounts and records were not checked during this inspection. Staff are provided with supervision and support which helps to identify any training needs or particular support if required. The home has various policies and procedures which help to ensure peoples health and safety. The AQAA tells us that these are adequately and appropriately reviewed. All utilities and equipment within the home is serviced and checked on a regular basis through contracts with external specialists. We saw some records relating to this during this inspection. Staff are trained in safe moving and handling are due a refresher course this year. As reported on previously within this report, all arrangements relating to fire safety meet with the current fire regulations and staff receive regular training in fire safety. Care Homes for Older People Page 27 of 31 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 31 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 9 13 All medicines must be securely stored at all times. This is to prevent potential risk to other service users who may find access to medicines that are not prescribed for them. 30/04/2010 2 30 18 You must provide all staff with a structured induction programme which results in the home being able to demonstrate that all new staff are competent. This is so that people living in the home are not put at risk through staffs lack of awareness or poor practices. 31/05/2010 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 7 Care plans should offer more specific guidance to staff, be Page 29 of 31 Care Homes for Older People 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 signed and dated by the person who is receiving the care (or their representative if they are unable to do so) and demonstrate consideration of the persons mental capacity and consideration of the deprivation of liberty safeguarding (DOLs) guidance. 2 16 Action taken in response to a complaint/concerns should be dated. The complaints book, which records all complaints made, should be a bound book with numbered pages to avoid any tampering with records made. The policy and procedures for the protection of adults from abuse should full in line with the local County Councils protocols. We would strongly recommend that staff do not work alone unless they have completed a full and robust induction training, which should include updated safeguarding adult training and fire training which is relevant to More Hall Convent. We recommend that further care be taken to ensure that good records are maintained to be able to demonstrate full compliance with all regulations. 3 18 4 30 5 37 Care Homes for Older People Page 30 of 31 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. 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