Inspection on 10/12/09 for Hatchmoor Nursing Home Ltd

This inspection was carried out on 10th December 2009.

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

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

Other inspections for this house

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Poldhu

Queensmount

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Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: Hatchmoor Nursing Home Ltd Hatchmoor Common Lane Great Torrington Devon Devon EX38 7HP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Susan Taylor     Date: 1 0 1 2 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: Hatchmoor Nursing Home Ltd Hatchmoor Common Lane Great Torrington Devon Devon EX38 7HP 01805625721 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Hatchmoor Nursing Home Ltd Name of registered manager (if applicable) Mrs Margaret Myers Type of registration: Number of places registered: care home 32 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 service users who can be accommodated is 32. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Hatchmoor is a modern, detached two-storied purpose built building situated in Torrington in North Devon that is designed to have the least impact on the environment as possible. It is currently registered to provide care with nursing for up to 32 older people (the Commission is processing an application for the category of dementia to be added to the registration). In time, the provider plans to increase this to a total of 64. The home is owned by Hatchmoor Nursing Home LTD, which is a Care Homes for Older People Page 4 of 31 Over 65 32 0 Brief description of the care home family business operated by Mr. John Singh (Director), and his son Mr. Solomon Singh (company Secretary). There is level access throughout the home with a passenger lift to the first floor. Hatchmoor has single bedrooms, all with en-suite facilities, double/shared rooms are available if requested. Each group of eight bedrooms has its own lounge/dining room (four on each floor) with quiet areas where people can eat, relax and spend time together. Communal spaces are open plan. Externally there is a garden area, with raised beds that are yet to be planted up. There are also plans to develop a sensory garden that will provide a safe area for people with dementia. The home has a car park and is surrounded by fields and countryside. The home is situated in an area which is served public transport with links to Bideford, Barnstaple and Okehampton. The fees range from £650 - £750 per week for a single room. Chiropody, hairdressing, personal toiletry items and newspapers/magazines are not included in the fees. The home also makes a charge of £10 if any people need a member of staff to escort them anywhere. 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience GOOD quality outcomes. This was the first key inspection of Hatchmoor Nursing Home since it opened in the summer 2009. We (the Commission) were at the home with people for 7.5 hours. We looked at key standards covering; choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. During this visit we spoke with or observed the majority of people living here. We could not speak with some people because they have communication difficulties such as dementia. We looked closely at the care, services and accommodation offered to 3 people living here. This is called case tracking and helps us to make a judgement about the standard of care, and helps us to understand the experiences of people who live Care Homes for Older People Page 6 of 31 here. We looked at the care and attention given by staff to these people and we looked at their assessments and at their care planning records. We looked at the environment in relation to their needs and how their health and personal care needs are met. We also spoke with visitors to the home, with staff, the manager and with one of the owners who is the Responsible Individual. We visited all of the bedrooms of the people we case tracked and saw all service and communal areas of the home. Prior to the inspection the provider sent us their Annual Quality Assurance Assessment (AQAA) which gave us information about the home and its management and about the needs of people living here. This document asks for evidence in relation to what the home does well and what they think they can improve upon. In addition, we sent surveys to 10 people living here and 5 were returned. We sent 10 surveys to staff and 1 was returned. Their comments are included throughout this report. Feedback and comments are included in the report. In December 2009, the fees ranged between £650 - £750 per week for a single room. Chiropody, hairdressing, personal toiletry items and newspapers/magazines are not included in the fees. The home also makes a charge of £10 if any people need a member of staff to escort them anywhere. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk 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: People living in the home, should be able to access their care plan in a format that is accessible to them, for example in braile, pictures or large print versions. This will ensure that care is person centred. Peoples mental capacity should be assessed so that the team are clear about whether a person is able to make decisions about their care and life at Hatchmoor. This will ensure that individual rights are promoted. The diverse needs of people should be taken into account when organising individual and group activities so that everyone leads a full and stimulating life. Peoples independence would be better promoted if best practice guidance is Care Homes for Older People Page 8 of 31 implemented to ensure that the needs of people with dementia are taken account of and gives them the best chance of orientation to the environment they live in. Staff should receive 1:1 supervision six times a year and a record be kept of it. This will ensure that staff follow best practice and are supported when caring for people living in the home. 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 are fully involved in the assessment process and information is gathered from a range of sources to ensure that individuals needs are met. The home does not offer intermediate care at the moment; therefore no judgement has been made about this. Evidence: The home has a brochure and information pack for prospective residents and new people moving into the home. This provides detailed information about what people should expect from the service and facilities that are available to them. In a survey 100 percent of people responding [5] had a contract for their residency and had been given sufficient information before moving into the home that enabled them to make a decision about moving into the home. However, some people that we met told us that they were unable to read this information due to disability. The manager verified that the information is not yet available in other formats. Therefore, accessibility to this information is limited for some people with sensory disabilties for example and we have made a recommendation about this. Care Homes for Older People Page 11 of 31 Evidence: The manager told us that she meets people before they move in to the home to do an assessment. A newly admitted resident told us that the manager had been asked about their needs and said they are very pleased and extremely well cared for. We looked at the assessment template for a person we were casetracking. A lot of information had been obtained about the diverse needs of the individual, in particular about the persons physical disability. A social and economic history had also been completed. Additional information about this persons needs had been obtained from the local authority supporting the move into the home. Hatchmoor has a computerised care management system onto which all of the information about a persons needs are inputted to create an individualised care plan. We were shown a tablet mobile computer device that staff can take to an individual to discuss their assessments and care plan with them. This information provided the team with a good picture of peoples physical and psychological needs and includes social networks, hobbies and interests. We looked at another electronic care file for a person living in the home and casetracked their needs. Assessments completed covered how to move the person and what risks there were. Additionally, the potential risk of falls had been assessed. A person with parkinsons disease was highlighted to be at high risk of choking and a nutritional assessment was seen on their file. We were shown other information that had been obtained from the speech therapy department that was being followed. Staff have access to detailed information about the types of and presentation of foods that are appropriate for a person with swallowing difficulties. The manager verified that intermediate care is currently not provided at Hatchmoor. 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. Peoples health and welfare needs are well met at Hatchmoor Nursing Home. They are generally treated as individuals in their own right and their dignity is respected. Evidence: In a survey, 100 percent (5) people responding verified that staff listen and act on their wishes. We observed interactions between staff and people living in the home. Staff responded well to people and engaged them in conversation when otherwise they might have been isolated and withdrawn due to the nature of their disabilty. People said the staff all treat you lovely...no matter who you are they all treat you the same. A number of people made positive comments about the quality of their care, for example one person said nothing is ever too much trouble when they described the help they need, which is delivered in a sensitive way to the person. We looked in depth at the care plans of 3 people, 1 person had been transferred from another home. All 3 people had an electronic plan of care and a number and range of documents relating specifically to their care needs. We case tracked a person with complex physical care needs who was at risk of malnutrition. The persons weight had Care Homes for Older People Page 13 of 31 Evidence: been monitored regularly and a record kept showing a steady increased in weight, which was the desired goal for the individual. Reviews had taken place and the most recent highlighted that the known level of risks for this person had remained the same. We observed that plate guards were in situ on the persons plate at lunch and staff were seen gently encouraging the individual to feed themselves. The known risks for this individual are being minimised, whilst at the same time the persons independence is promoted. Therefore, the person experienced good outcomes of care because their health needs are met. People are assessed to see if they are at risk of developing pressure sores. One of the people we case tracked was assessed as being a high risk. All of the bedrooms have a dual profile pressure relieving mattress, providing the option of medium or high pressure relief. The person we were casetracking had a pressure mattress and the high side was uppermost, which corresponded to the known risks for the person recorded in their care plan. The person was sitting on a pressure relieving cushion. Records demonstrated that the person was free from pressure sores, therefore the care outcomes were good for the individual and the stated goals were being met. The home uses a monitored dosage system. Senior staff are responsible for stock taking. Records of ordered drugs and a register of controlled drugs were seen and tallied with those being stored. All medication was kept in a secure place; controlled drugs were stored in accordance with legislation. The system was easy to audit and we tracked medication given to 2 people. Records accurately reflected medication having been given as prescribed. We observed medicines being administered during lunch, which was done safely by the registered nurse on duty. People told us tablets are all dealt with right, always on time and we observed this to be the case. One of the people we case tracked needed a lot of prompting to take their tablets and we observed a relative making decisions for the individual who was unable to do this for themselves. We spoke to the relative who told us that they themselves tended to be the person who makes important decisions about their spouses care needs and has to advocate on her behalf. We looked at the electronic care records to see whether this arrangement was formalised as part of a mental capacity assessment of the person who lacks capacity. We spoke to the manager about assessment systems, in particular assessment of mental capacity, and we were told this is not currently available in the electronic care records. However, we did see evidence indicating that some aspects about a persons mental capacity are considered in relation to specific needs. The manager verified that staff had not yet had any training about the Mental Capacity Act or Deprivation of Liberty Safeguards. Additionally, through discussion we established that at the time there were no issues which would require a referral for a Care Homes for Older People Page 14 of 31 Evidence: best interests assessment to be completed. Therefore, whilst there is some consideration of peoples mental capacity in relation to specific issues this does not go far enough to ensure that decisions are always made in a persons best interests. We observed that staff always knocked on doors before entering peoples rooms. People told us that care was always done in the privacy of their room and that staff treated them with respect and kindness. For example one person said I can have a bath or shower when I want to, lovely. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines are flexible for people and they are listened to regarding the choice of daily activity. These could be individualized further to take account of the diverse needs of people living there to ensure that everyone leads a full and stimulating life. People are encouraged to maintain contact with friends and family in the community, which demonstrates a commitment to the principles of inclusion. Evidence: Information provided by the manager verified that 100 percent of people living at Hatchmoor are of christian faith. However, none of the current residents are said to have a desire for religious services at the moment. The manager told us that this would continue to be monitored and that the home could set up connections with places of worship according to individual needs. The atmosphere in the home was festive, with a large Christmas tree lighting up the entrance hall and communal areas decorated with also with trees and cards. Information sent to the Commission tells us that communal areas are equipped with a loop system, enabling people to converse more easily and improves the television sound system, for people that use hearing aids. Care Homes for Older People Page 16 of 31 Evidence: According to information sent to the Commission, 1 person currently living at Hatchmoor has dementia. We wanted to establish how this persons needs were met with regard to meaningful activity. An hour was spent in the lounges observing how staff interacted with the individual. This highlighted examples of good practice. During the period of bservation, staff engaged with individual continuously at the right speed and demonstrated genuine warmth and attention, which the person appeared to respond to and enjoy. One person we spoke to said most people do their own thing, many dont have their faculties. Im disabled so cant do a lot. We asked the same person if they had something to look forward to and they said were having a quiz at some point. Staff said that it was difficult to sometimes know what people could actually do or wanted to do. We were told that one person, whose care we tracked, was known to like classical music and had classic fm on in the background when we met them. We looked at this persons electronic care records, under social history it highlighted that the persons interests were music and reading [talking books] both of which the person had access to in their room. The manager told us that the person also had a keen interest in entemology and there are steps to try to find a volunteer with a similar interest but said its so specialist it might be difficult to meet this. The manager verified that person centred activity is an area that needs further development due to the home only being open for a few months. The Commission is currently processing an application to vary the registration of the home to include the category dementia. We discussed the importance of assessment in ensuring that activities provide sufficient mental stimulation and are person centred. Some people might be more responsive to sensory activities such as painting or aromatherapy. Alternatively other people might be more responsive to cognitively based activities, such as a reminiscence quiz. We discussed specific tools that might be useful to gain in depth information about individual capability and interest such as the Pool Activity level instrument. This would also ensure that activities are person centred and pitched at the right level for people. The Home has a menu that rotates on a weekly basis. The manager verified that menu is discussed every day with every individual, who is then encouraged to make a choice. We joined a small group of people in one of the lounge/dining rooms for lunch, which was shepherds pie with cabbage and peas. We observed people being asked whether they would like a glass of wine or another non alcoholic drink with their lunch. We asked people about the quality of food served and people made comments like, better quality of food could be provided. Also more choice. 50 percent of surveys received verified that people usually like the meals provided. The dining tables are set out hotel-style, covered with linen tablecloths, with place settings and condiments at each table. One person said I like to go to the dining room normally but if I am not Care Homes for Older People Page 17 of 31 Evidence: feeling too good, they bring my meal to me. Another person told us that friends are visiting today and having lunch with me. All of the people we spoke to [5] told us that visitors are made very welcome. The manager told us that peoples families had been invited to join them for lunch on Christmas day and most had accepted the invitation and would be a great party atmosphere on the day. 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. Hatchmoor Nursing Homes policies ensure that people are protected and able to voice their concerns, safe in the knowledge that these will be acted upon. Evidence: Information sent to us by the manager tells us that there is a complaint procedure, which we looked at. The contact address for the Commission was incorrect, which the provider said would be amended to reflect the new contact address. We were shown a system, which demonstrates that complaints will be consistently recorded and acted upon. Similarly, people are also encouraged to make suggestions about how the service can be improved. In surveys, 100 percent of people living in the home tell us that they are satisfied that the home listens to them and deals with any concerns in a timely way. The Commission received no complaints before or during the inspection. The manager verified that they have a copy of the Alerters guide. The Commission has received regular notifications from the home since it opened in the summer, which demonstrate that concerns about the wellbeing of people are appropriately acted upon in a timely way. Most of these have related to the care people received prior to being admitted to Hatchmoor and have necessitated Hatchmoor staff to advocate on behalf of certain individuals. For example, one person was found to have severe pressure sores on admission. Concerns about the development of these were raised with the appropriate authorities for further investigation. Records demonstrated appropriate treatment pathways had been implemented by the team at Hatchmoor and significant Care Homes for Older People Page 19 of 31 Evidence: healing has taken place. The outcome for the individual is that their comfort and wellbeing has been significantly improved as a result. The home has a whistle blowing policy, which all of the staff we spoke to understand and are confident that if they did have any concerns would be acted upon. Kind and caring interactions were observed throughout the day between staff and people living in the home. Staff engaged positively with people and demonstrated genuine warmth. A relative told us that the staffs are kind and caring. Another visitor commented that their friend was very content. Information sent by the provider told us that 50 percent of the staff have a NVQ in care, part of which is about safeguarding people. Every shift is managed by Registered Nurses. Staff told us that policies and procedures had been discussed with them during the induction process. We looked at training records and saw that Safeguarding Adults training is also being arranged for staff. We observed that people are treated with respect and encouraged to see Hatchmoor as their home. People made comments like, the staff all treat you lovely...no matter who you are they all treat you the same and I can do what I want to and nothing is too much trouble. In surveys a relative wrote she is happy here. We looked at 4 staff files, all recruited within the last 6 months. Recruitment practice was robust and all checks had been undertaken correctly. Therefore, the provider is assured that suitable staff have been appointed to care for people living in the home. 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 live in a modern, comfortable home that is exceptionally well equipped to meet their needs. Evidence: Information sent to the Commission as part of the registration process tells us that sustainable building techniques have been used and the premises have been designed to have as little impact on the environment as possible. For example there is underfloor heating and recycling systems for all waste. We were shown 3 wings of the building, 2 of which are ready to be or already occupied by people needing care. Fire exits were clear and accessible. We looked at six bedrooms all of which were spacious, clean, individualised and comfortably furnished. There is a large ensuite wet room attached to every bedroom. People living in the home told us that there is always a housekeeper on duty. All of the wcs and bathrooms had locks on the doors. Communal areas were comfortable and people felt at home leaving their possessions there or helping themselves to fruit left in bowls for them. All of the equipment in the home is new and certificates were seen for the installation of assisted baths, electrical, central heating and fire alarm systems. Surveys from people living in the home and relatives verified that the home is kept fresh and clean. One of the people we case tracked was assessed as being a high risk. All of the bedrooms have a dual profile pressure relieving mattress, providing the option of Care Homes for Older People Page 21 of 31 Evidence: medium or high pressure relief. The person we were casetracking had a pressure mattress and the high side was uppermost, which corresponded to the known risks for the person recorded in the care plan. The person was sitting on a pressure relieving cushion. Records demonstrated that the person was free from pressure sores, therefore the care outcomes were good for the individual and the stated goals were being met. The Commission is processing an application to include the category dementia on the registration. The provider and manager told us that a unit on the ground floor will be used to provide accommodation for people with dementia. The manager told us that further adaptations are being looked into, to ensure that best practice is followed with regard to signage for example. This will assist people to orientate better and also help them remain as independent as possible. Information sent to the Commission by the manager verified an audit using the department of health guidance had been carried out and there is an action plan in place to prvent and control the spread of infection. 21 staff had received training about the prevention of infection and management of infection control. The manager showed us a training programme run by the local college that covered infection control, which the service has signed up to and will enable all of the staff to update their knowledge and experience in this area. Hand towels and soap dispensers were seen in wcs, bathrooms and bedrooms. Good hand washing practices were observed by staff as they delivered care to people. The laundry was clean and well organised. We observed good infection control measures being followed when staff were dealing with soiled linen and staff had access to gloves and aprons. 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. Recruitment practices at Hatchmoor are robust and therefore protect the people living there. The training and development programme will ensure that competent and knowledgeable staff care for people. Evidence: In a survey 100 percent of people tell us that staff are always available when they need them. One person wrote they always come when I need them. Similarly, staff verified that there are always enough staff to meet the individual needs of people who use the service. We examined duty rosters for four weeks up to the week of the inspection. On the day of the inspection there was 3 carers, a registered nurse and the manager on duty during the day looking after 11 people in the home. Additionally, there were 2 cleaners, a kitchen assistant and chef on duty. Staff we spoke to told us that they were busier in the mornings but did not feel rushed. We observed that people were attended to promptly and appeared relaxed. Their comments tell us that people feel extremely well cared for. Staff are described as being wonderfully kind and caring and they all treat you lovely, no matter who you are they all treat you the same, its lovely. All of the staff had been recruited in the last six months since the home opened. We Care Homes for Older People Page 23 of 31 Evidence: examined the files of 4 of the newest staff. Two satisfactory written references had been obtained for all of the staff prior to employment. We recommended that space for a date to be added to the reference template so that the effectiveness of recruitment practices can be fully auditted. Independent Safeguarding Authority checks had been undertaken and criminal records bureau certificates had also been obtained before employment commenced. The home had a written procedure about recruitment and retention of staff and it was clear that these had been followed to protect the people living in the home. Records demonstrated that 50 percent of the care staff have the NVQ level 2 award in care or above. Induction records seen demonstrated that training meets the appropriate standards set out by the Skills for Care. We spoke to staff about their experience and training opportunities in the home and people verified that this was regularly offered to them. A training and development plan for the home is being developed for example training about Safeguarding Adults and the Mental Capacity Act had been arranged for staff. Therefore, systems are in place to ensure that staff skills and experience match the needs of people being cared for at Hatchmoor. 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 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 well run home, where their views count and improvements are made. Health and safety is promoted and ensures that people living and working in the home are protected. Evidence: The Registered Manager has 5 years experience in running a nursing home. She is a Registered General Nurse and holds the NVQ level 4 Registered Managers Award. She told us that she uses the internet extensively, in particular the Commissions professional website, to keep up to date thus ensuring that the care delivered is best practice. During the registration process we looked at certificates showing that the manager holds an orthopaedic nursing certificate, is a key trainer manual handling, and has kept up her practice by doing a 3 day mentorship workshop, safeguarding, medication handling, 2 day therapeutic activities course for dementia care, integrated care pathways (for palliative care) and the Mental Capacity Act (MCA) & Deprivation of Liberty Safeguards (DOLS) training. Care Homes for Older People Page 25 of 31 Evidence: Throughout the inspection we found that she had a clear understanding of her role in meeting the stated aims and objectives of the home. Similarly, she sent the Commission the AQAA (Annual Quality Assurance Assessment) when we asked for it. In it she outlined how the new service at Hatchmoor is being developed and how quality assurance will be measured in the future. We observed that there are clear lines of accountability within the home. People told us that the registered provider is also very much hands. We observed people being asked for feedback about lunch, their care and activities during the inspection. There is an open door policy that also allows people living there, visitors and staff to speak with the Registered Manager whenever they wish to do so. We toured the premises and saw that the certificate of registration was displayed in a prominent position where people living in the home and visitors could see it. Evidence was seen of systems to monitor the quality of the service provided. This included questionnaires and audits of health and safety for example. The home has a policy, which discourages any involvement in the management of peoples personal allowances. Instead, people living in the home are encouraged to have their relatives do this for them. Therefore, we are unable to make a judgement in respect of standard 35. All of the staff have been appointed in the last six months since the home opened. We were shown a staff development system, which will incorporate annual appraisal of the performance of all staff. Staff told us that the manager and provider were always approachable. We looked at 4 records and none of the staff had had a 1:1 since starting employment. Information sent to the Commission also verified that the manager works alongside staff every day. A more formal approach to supervision had been identified as an area for improvement. This will ensure that staff consistently follow best practice when caring for people and also have the opportunity to reflect and identify any gaps in their knowledge and experience. Comprehensive Health & Safety policies and procedures were seen, including a poster stating who was responsible for implementing and reviewing these. In information sent to the Commission, the manager verified that risk assessments are carried out. We saw various examples of this with regard to audits done, which included medicines, fire safety and first aid equipment. As we toured the building we observed cleaning materials were stored securely and used with by staff wearing gloves. Data sheets were in place and staff spoken to understand the risks and strategies to Care Homes for Older People Page 26 of 31 Evidence: minimise those risks from chemicals used in the building mainly for cleaning and infection control purposes. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place since the home opened. Similarly, the fire alarm had also been regularly checked since being commissioned. People living in the home, and staff told us that the alarm was regularly sounded to check it is working. First aid equipment was clearly labelled and there was a first aider on duty. Risk assessments for the environment had been completed and there is a system in place for the regular review of these. Therefore, we concluded that the health and safety of people living, working and visiting the home is maintained. 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 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 2 People living in the home, should be able to access their care plan in a format that is accessible to them, for example in braile, pictures or large print versions. Peoples mental capacity should be assessed so that the team are clear about whether a person is able to make decisions about their care and life at Hatchmoor. If they are unable to do so, the assessment should clearly highlight who will be involved in the process and the issues that need to be addressed for the individual. For example, this may include the need to consider whether a person is able to consent to taking medication. Staff should also have training about the Mental Capacity Act and Deprivation of Liberty Safeguards to ensure this is applied in a consistent way. The diverse needs of people are taken into account when organising individual and group activities so that everyone leads a full and stimulating life. For example, use an assessment tool like the Pool Activity level instrument to establish exactly what individuals are able to do and indentify suitable activities accordingly. Future decoration and refurbishment should be done to Page 29 of 31 2 9 3 12 4 22 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 best practice to ensure that the needs of people with dementia are taken account of. Resources such as Designing Interiors for People with Dementia ISBN 1-85769-179-2, University of Sterling. Tel:(01786) 467740 E mail: m.t.marshall@stir.ac.uk/dsdc 5 36 Staff should receive 1:1 supervision six times a year and a record be kept of it. This will ensure that staff follow best practice and are supported when caring for people living in the home. 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. 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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