Inspection on 06/11/09 for Mountfield

This is the latest available inspection report for this service, carried out on 6th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mountfield 04/10/05

Mountfield 07/07/05

Mountfield 17/02/05

Mountfield 08/09/04

Mountfield 09/03/04

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Ashville House

Bilney Hall

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Mabbs Hall Nursing Home

Henrietta House

Claremont House

Oak Ridge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Mountfield Millcroft Norwich Norfolk NR3 3LS     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: Judith Last     Date: 0 6 1 1 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 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) 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 31 Information about the care home Name of care home: Address: Mountfield Millcroft Norwich Norfolk NR3 3LS 01603416201 01603409621 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.norfolk.gov.uk Norfolk County CouncilCommunity Care care home 39 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Mountfield is a care home providing personal care and accommodation for 39 older people and is owned by Norfolk County Council. There are thirty-seven permanent placements and two respite care beds. At the time of our visit there were 35 people living in the home. Mountfield is a purpose built home that was first opened in 1975 and refurbished in 1996. It stands in its own grounds in a residential area in the north of the city and is close to all local amenities. The home is a two-storey building that is divided into 6 units. Each unit has its own lounge and separate dining area. There is also a communal lounge on each floor as well as a conservatory on the ground floor. The main dining areas have counters for a restaurant type service at mealtimes. There is a shaft lift giving access to the first floor. Care Homes for Older People Page 4 of 31 Over 65 0 39 39 0 Brief description of the care home All service users have their own bedroom and two of the bedrooms could be shared if service users chose to do so. Several of the bedrooms are rather small. The manager is aware of this and uses larger rooms to accommodate people who need larger pieces of equipment to aid with moving and handling them safely. There are adapted bathing and toilet facilities for people with mobility issues or at risk of falls. The gardens offer further communal space in the summer months. People have a financial assessment to determine how much it will cost them to live in the home and whether they will need to make a contribution. information about the full, current fee level is available in the guide to the home. Additional costs include chiropody, hairdressing, newspapers, magazines and personal spending. 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 home we reviewed all the information we had about it. This included the information the manager was asked to send us on the Annual Quality Assurance Assessment (AQAA). This tells us what the manager thinks about the quality of the service and also gives us some numerical information about it. We also look at the history of the service, including the results of previous reviews or inspections, and the things the manager has told us about what has happened. These are called notifications and are a legal requirement. We looked at comments returned to us on surveys by six people living at the home, by six staff and by three visiting health or social care professionals. We visited the home unannounced and spent nearly 8 hours there. Care Homes for Older People Page 6 of 31 During our visit, the main method of inspection we use is called case tracking. This means we look at records and try to find out from observations and discussion, how well people are being supported and how their needs are being met. We use all the information we gathered, and the rules we have, to see what outcomes there are for people in their daily lives. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: The manager has already identified where she could make further improvements so we have not needed to make many suggestions for this. However, we did have concerns about the way the administration of medicines is recorded and have made one requirement about this, as well as a recommendation. This is to ensure that records are accurate, comply with the law, and demonstrate systems for administering medicines are as safe as possible. Care Homes for Older People Page 8 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People (or their representatives) have access to the information they need to make an informed decision about whether the home will be able to meet their assessed needs. Evidence: Everyone who completed a survey told us they got enough information about the home. The manager showed us a folder of the information she gives to people who are making enquiries about moving to the home, and during our visit someone turned up to look round, bringing part of the information with them. This shows that in practice, the information is given to people or their representatives, so they know what services the home can offer. Records seen show that peoples needs are assessed, and for planned admissions, the information is gathered before people move to the home. We had information from three visiting health professionals who say that the home always ensures accurate information is gathered and the right service is planned for people. This confirms what Care Homes for Older People Page 11 of 31 Evidence: Mrs Harley told us in information she sent before our visit. This helps ensure that people are not admitted to the home if their needs cannot be properly met. Where appropriate, we could see peoples capacity to make an informed decision about where they want to live, is assessed - involving other professionals. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive support with their personal care as they need and prefer, and with regard to their dignity, privacy and independence. Peoples physical and emotional health is promoted well. systems for the management of medicines need some work to show these are as safe as possible. Evidence: We looked at support plans for four people. These are consistently organised so that staff should know where to find out about how to support people properly. There are regular reviews when needs change and where people are able to, they sign their own care plans showing they are involved in decisions about their care. Action sheets in care plans show what staff need to do to support people properly. These provide guidance about diet and nutrition, risks and help with personal care. In one case there is specific guidance about the persons spiritual needs and how staff are to support the person with this each day. In another case, we saw clear indication that the person is able to manage a lot of their personal care for themselves and what staff might need to help with. This shows that people are encouraged to retain Care Homes for Older People Page 13 of 31 Evidence: independence where possible, and an holistic approach to meeting peoples needs. People have their nutritional needs assessed, recorded, and reviewed regularly. At each review, the level of risk to peoples nutrition is not always written down on the form, although the interventions staff need to make to keep the person healthy are recorded. Records seem for one person show they are at risk of choking. There is clear guidance for staff to follow about thickening drinks. We saw staff doing this at mealtime to make sure that the risk to people was minimised. The home has signed up to the Good Hydration Charter. One relative visiting said that they had noticed how staff are always going round offering drinks. This helps show the home minimises the risk of urine infections developing, helps promote continence and minimises the risk of falls. There is no formal assessment of peoples risk of developing pressure sores, although care plans note that if there are any concerns the district nurse would need to be involved in assessment and for advice. Records show staff have training to help them understand about maintaining peoples skin integrity and the manager says no one at the home currently has a pressure sore. The people we spoke to and who wrote to us say that they always receive the care and support they need, and also that the home makes sure they see the doctor if they need to. A relative told us they felt that the staff treat people really well. Another was very happy with the standard of the service people received and added if there are any issues they always phone. We had comments in writing from three health professionals who all felt that the service alway seeks advice and acts on it to meet peoples health and social care needs and improve their wellbeing. One made an additional comment that the home provides a high standard of care. Another wrote that I have had no concerns regarding standards of care during my visits. We spoke to one visiting health professional who told us that if we advise something like to monitor and refer back to us in three weeks, they always do. We looked at systems for handling medicines in the home. Records contained some omissions of signatures so it was not clear whether the medicine had been given as prescribed or why it might have been withheld. This means that full and accurate records were not held and the home could not demonstrate people were always offered the medicines prescribed to keep them well. Care Homes for Older People Page 14 of 31 Evidence: We identified some occasions where the administration record had been initialled by one member of staff, then crossed out, marked error and then signed by someone else. This shows that the procedure for administration of medicines and checking of records is not always followed. There had been a change in the Warfarin prescription for one person as the result of routine blood tests. The change in dosage recorded on the fax with the results, was not implemented on the persons medication chart until one week later. The manager has acted to confirm with the surgery that this did not present a risk to the persons health, but effectively they did not get the required dose until a week after it was prescribed. Controlled drugs were stored safely and recorded accurately so we could see that management of these was safe. We noted that staff authorised to administer medicines keep the keys on their person so that access was restricted and safe storage arranged. Following our visit, and before the manager had the report, she arranged some refresher training for staff to help address concerns about how medicines were being recorded and coded, and so that they would be reminded about safe procedures. We observed during our visit, that staff approached people and spoke to them in a respectful manner. People told us that the staff are very good. Care Homes for Older People Page 15 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the opportunity for a fulfilling lifestyle and have a healthy and enjoyable diet. Evidence: There is staff time allocated for running activity groups and this is divided between the main unit and the dementia care unit. Five hours each day are allocated. Most people who wrote to us feel there are activities they can join in with. People told us when we visited that they liked the things on offer. Five people we spoke to when we arrived at the home were joining in an activity based around the alphabet and naming plants. Two told us it was fun and one person said, Its good to do something to keep your mind active. One agreed, It makes you think. Peoples religious beliefs are recorded in their support plans together with anything particular staff might need to do to support them. Religious services do take place in the home and the manager says that the monthly communion service is a result of a suggestion from a resident. There is also an art group and this is run by one of the people living in the home. Care Homes for Older People Page 16 of 31 Evidence: People joining in have art work displayed and hand made greetings cards were for sale. There are items to be used when reminiscence sessions take place in the home, and one small lounge area is decorated in a manner to promote this for people with dementia. Peoples friends and family came in and out during the course of our visit. Relatives told us that they always felt welcome in the home and that staff were always friendly and polite. One told us that they were included in an outing planned before Christmas. People have the opportunity to join residents meetings if they so wish, where they can discuss the way the home is running and what they would like to see changed. Records of these show that they have not always been held regularly but this has improved recently so people have more opportunities to express their views. They told us they can have personal things in their rooms and we could see that people had brought in pictures or ornaments to help make their rooms more homely. People have also chosen pictures or photos to go on their bedroom doors so that their own room is clearly marked out for them. The manager told us that the rotary dryer out in the garden had been fitted because one person likes to do some of their own hand washing of small items of personal clothing. These things show that people are able to exercise some autonomy within the home. Dining rooms operate like a restaurant and we laid out with cloths, napkins and condiments. Each table in one of the dining rooms had a menu displayed. We asked two people about the food and were told it is very good. It is Friday so I expect there will be fish. Its very yummy. The menu for the day showed that people could select options from fried or baked fish, sausages, chips or creamed potatoes, peas, or an egg salad bowl. Desserts included a baked tart, or yoghurts and fruit. One persons care plan sets out that they are to have their food pureed. At lunchtime when we checked we saw this happened and that the main components were pureed separately so that the person was able to benefit from the different tastes, colours and smells. Care Homes for Older People Page 17 of 31 Evidence: Staff in the dementia care unit offered support to those who needed it and offered people choices. 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. Peoples concerns are taken seriously and there are measures in place to help protect them from abuse. Evidence: Everyone who completed a survey for us, says that there is someone they can speak to informally if they have concerns and that they know how to make a formal complaint if they need to. There is information in the pack given to people thinking about moving into the home. Relatives also told us that they know how to make a complaint should they need to. One person living in the home describes the manager as fair in dealing with problems and issues. Records from residents meetings show that complaints and concerns are on the agenda so people are given opportunities to raise anything that they would like to see changed or improved. People have a record sheet in their rooms that relatives can write comments on if they wish. These are then responded to by staff on the same sheet so people know they have been addressed. This helps prevent issues from escalating. One visiting health professional wrote to us that they had not needed to raise any concerns. Two others say that anything they have raised concerns about has always been dealt with appropriately. We asked four visitors to the home if they had any Care Homes for Older People Page 19 of 31 Evidence: concerns. None did, and one added, absolutely not, no. They treat people really well. Another said that they have never had any issues or observations that meant I needed to raise any concerns. Visitors to the home clearly know the manager and she was spoken by name throughout our visit. The managers office is by the front door and visitors and people living in the home say she is very approachable so they can go to her if they have any concerns. She keeps proper records where people have raised any issues, writes down information about any investigations made and conclusions drawn. These things help show an open approach to dealing with concerns so that the service can learn from these and improve. Training records show that staff have training in recognising and responding to abuse and there is guidance about whistleblowing so they know their responsibilities to raise any concerns about the way people are treated. The homes records show that proper checks are made before people start work, to ensure they do not present a risk to vulnerable people. This means there are systems in place to help protect vulnerable people. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and homely environment with aids and adaptations to suit their needs. Response to faults in fire detection equipment could be improved. Evidence: We looked around shared areas of the home and at some bedrooms. While we were there, a lot of maintenance and redecoration work was taking place. This was improving the decor so that it was less dated, brighter and in better condition. Redecoration that has already taken place, has involved use of colours and improved signage to help people orientate themselves. The manager had told us that the fire alarm panel had a fault intermittently and when we visited, this was still awaiting replacement despite this being due in August. (However, it had been tested to make sure it would work if needed.) Just after our visit she told us this had been done. Records show that fire alarm points, emergency lights and extinguishers are tested regularly so that people could be confident they will work properly to detect and raise the alarm should a fire break out. New windows have been fitted to improve ventilation. Some of these have also improved the view for people. One person told us they liked sitting by the larger windows because I enjoy the view and seeing what is going on. Care Homes for Older People Page 21 of 31 Evidence: The main unit and dementia unit provide for a range of facilities for people, including large lounges and smaller rooms where people can meet in smaller groups or receive visitors. This gives them a choice about where they spend their time. People have a choice of three garden areas to use when the weather allows. There is a secure garden at the centre of the home and this has been planted with edible plants and herbs to that people who may be confused are not at risk, and so people can benefit from the scent of the plants as well as enjoying the fresh air. There are aids and adaptations around the home to assist people with orientation, mobility and to promote their safety. People can wear pendants or wrist bands so that they can call for assistance should they need it. The system is also linked to equipment that can provide an early alert to staff about people moving round in the night who might be at risk of falls, and continence detectors so that people can be assisted promptly with changing and personal hygiene. The manager says in information she sent to us, that all of the staff have training in infection control. Additionally, one staff member has completed a specific module on infection control as part of other training. They say that they have already made some changes as a result of this. This has included the provision of protective equipment (gloves and aprons) in peoples rooms so that staff always have access to them when they are assisting people with their personal care. It has also include the essential and basic precaution of ensuring staff know how to wash their hands thoroughly. We were told that the staff member will be putting together some more training for staff and that they already raise issues as they occur to make sure people are protected from any outbreak of infection spreading - so far as is practicable. Care Homes for Older People Page 22 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 are supported by an effective and competent staff team. Evidence: Our observations lead us to conclude there are sufficient staff to meet peoples needs, when agency staff are included. Staff were busy attending to peoples needs but the print out from call bells and response to exit alarms shows that staff are available to deal with peoples needs. Two people who wrote to us say staff are always available when they need them and the rest say usually. This indicates that people feel that most of the time they are able to get assistance as and when they need it. One person adds that the carers work hard and I think they are wonderful. A visiting health professional also adds that they have always found staff helpful and caring. Information from the manager is that although agency cover is needed, they try to ensure that the same people come so they get to understand peoples needs and can support permanent staff effectively. During our visit, we observed hand over for one agency staff who had been to the home before. They were given clear information about the needs of people they were allocated to support and what they needed to look out for. This helps ensure people receive consistent care. Staff told us that it can be a problem when staff are allocated to work at the home who have not been there previously, as it means they have to spend a proportion of Care Homes for Older People Page 23 of 31 Evidence: their time checking and making sure agency staff know what they are supposed to be supporting people with and how. However, a staff member told us that mostly it is not a problem, confirming what the manager says about trying to get regular agency staff to cover where it is needed. We know from the manager that some of the reliance on agency staff is the result of increased funding for one to one supervision, where this has been identified as necessary to support someone properly and safely. Information the manager sent to us shows that 22 out of 38 staff have National Vocational Qualifications at level 2 or above. We sampled some staff files and looked at the computerised training records to see this was the case. Staff also have access to a range of other training to help them understand and meet peoples needs. This includes access to training in dementia care to support them with understanding more complex needs. Two out of three visiting health professionals feel that staff always have the experience and skills they need to support people properly with their health and social care needs. One says this is usually the case. Staff made positive comments to us about the training they have, feeling it helps them understand peoples needs and keeps them up to date. The manager acknowledges that induction could be delivered to new staff more promptly. However, five out of six staff feel that the induction they had, covered very well what they needed to know, and one said it mostly did so. We looked at recruitment checks made for staff who are new to the home. These show that proper checks, employment histories and references are obtained to make sure staff appointed are suitable to work with vulnerable adults. In one case, where one of the two required references was very sketchy, and third reference had been requested and obtained. This helps show a robust recruitment process, which contributes to safeguarding vulnerable people. Care Homes for Older People Page 24 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is based on openness and respect. It is run effectively and competently in a way that takes into account peoples views and promotes their safety and welfare. Evidence: We know from our previous visits to the service that the manager has the necessary qualifications and experience to fulfil her role. The training matrix also supports that she undertakes other periodic training to ensure her knowledge and skills are kept up to date. This includes training in dementia care. This helps her guide the staff team and share underpinning knowledge to support people effectively. We asked people what they thought about the manager. People living in the home say they can go to her and one clearly appreciated the support and comfort we saw she offered when they were anxious about a relatives visit. One person wrote to us that the manager she is fair and completes her tasks well. A staff member also wrote to us that the management is good. Another responded to the question about what the Care Homes for Older People Page 25 of 31 Evidence: home does well by adding that it supports staff. Additional comments also support that the home is well led and managed - for example there is a really good team at Mountfield and we all work well together which I think shows in the care that we give to the residents. The manager completed the information we asked for by the due date. In it she set out clearly what she felt the service did well and we were able to check and confirm a range of the evidence that she cited for this. She also showed us where she felt the service could do better and what plans she has for improvement in the next 12 months. This shows she is personally taking responsibility for monitoring and developing the quality of the service people receive. Because of this, we have limited our recommendations as we know the manager has already identified what needs to improve and how she is going to go about it. The Council owns the home and has systems for checking and monitoring the quality of the service. Some of this is by internal checks and audits, some by visits on behalf of the provider and people are asked for their views. This helps the manager to be clear about what other interested parties feel she needs to develop and improve. The manager has increased the regularity of residents meetings to help them have a say more often about how they think the home should be run. We looked at records for finances that the manager and administrator hold for safekeeping. These show properly what monies are received into the home and how they are managed on behalf of people living there. We found that receipts matched expenditure and also that people or their relatives were given receipts for monies held for safekeeping. The manager does not act as appointee for benefits for any of the people living in the home. These things help support that people are protected from financial abuse in the home. The manager recognises that there is a need to continue to monitor and ensure that all staff receive regular supervision about their work and development needs. We looked at records which show people have support from more senior staff and regular opportunities to discuss their work, areas of good practice or concern, and training needs. We could also see that the manager carries out annual appraisals to monitor staff performance. She recognises in information sent, the need to use the probation period robustly to ensure that new staff fully understand their roles and the organisations expectations. Care Homes for Older People Page 26 of 31 Evidence: We asked for and were shown, a range of records during our visit, as part of case tracking, following up individual issues, and auditing against evidence the manager says is available in the home. We did not identify shortfalls in statutory records, with the exception of those to do with medication, and covered in a previous section. Staff have access to training to enable them to work safely. This includes training in first aid, infection control, food hygiene and moving and handling people safely. Accidents and incidents are recorded and the manager follows these up to make sure there are no developing patterns of concerns or hazards which need to be addressed. There are risk assessments covering working practices for staff and for individuals. During our visit, maintenance affected potential safety in the home and notices were clearly displayed in the entrance foyer showing how this was being managed (for example not to use the stairs and hazards from equipment). A sample of maintenance and testing records was checked. This showed that equipment was tested regularly to make sure it worked properly and was safe to use. These things help show the safety and welfare of people living in the home is promoted. (We have commented about the fire panel under the environment section of this report.) 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 17 The administration of medicines must be fully and accurately recorded. This is to show that medicines have been given as intended by the prescriber, to keep people well. This is so that records are clear when medicines have not been given and for what reason. Regulation 17(1)(a), Schedule 3, number 2(i) sets out that the dates on which medicines are administered must be recorded. Breach of this regulation is an offence. 27/11/2009 Care Homes for Older People Page 29 of 31 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 9 The frequency of audits of medication and associated records should be increased. This is so the manager can check whether staff are following expected record keeping standards and implementing changes promptly when these are needed. The manager (or other senior staff attending) should provide feedback at residents meetings about any action that has been taken to address their suggestions. This is so people can see what has been done to follow up their ideas. 2 14 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. 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