Inspection on 30/01/09 for Mayfield

This inspection was carried out on 30th January 2009.

CSCI 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

Mayfield 01/03/10

Mayfield 24/06/09

Mayfield 18/01/07

Mayfield 11/10/05

Mayfield 18/04/05

Mayfield 01/11/04

Mayfield 07/06/04

Mayfield 20/05/04

Mayfield 14/04/04

Mayfield 05/06/03

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mayfield Mayfield 99 Nursteed Road Devizes Wiltshire SN10 3DU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alison Duffy     Date: 1 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Mayfield 99 Nursteed Road Mayfield Devizes Wiltshire SN10 3DU 01380723720 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : mayfieldcarehome@yahoo.com Miss Sharon Anne Cooper care home 20 Number of places (if applicable): Under 65 Over 65 0 17 dementia old age, not falling within any other category Additional conditions: 1 0 No more than 20 service users to be accommodated at the home at any one time of which 2 service users may fall within the category DE(E). One named female service user, as detailed in the application dated 26th January 2006, may be accommodated at the home falling within the category DE. Date of last inspection Brief description of the care home Mayfield provides personal care and accommodation for up to 20 older people. The service first opened in 1983. It is privately owned and the current owner, Miss Cooper, has been in place since 2000. Miss Cooper employs a manager to run the home. At present, there is an acting manager. The registered manager left in October 2008. The home is a short drive from Devizes town centre. It is a detached Victorian residence with many period features. The home has been extended to include additional bedrooms. There is a stair lift to the first floor. One end of the first floor is Care Homes for Older People Page 4 of 33 Brief description of the care home split level and only accessible by another short flight of steps. Peoples bedrooms are located on the ground and first floor. Two could be shared rooms, but all are currently occupied as singles. Bedrooms have handbasins but no other en-suite facilities. There are bathrooms and toilets on both floors. One ground floor bathroom has an assisted bath. There is a dining room and separate lounge. The home has large gardens surrounding three sides of the property. There are a number of off street parking spaces at the front of the building. Staffing levels are maintained at two carers throughout the waking day. There is also a senior carer, deputy manager and/or the manager on duty. There is a housekeeper, a cook and an activities organiser. Care Homes for Older People Page 5 of 33 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: This key inspection took place on the 30th January 2009 between 9.30am and 4.15pm. The manager was on annual leave so a second day to complete the inspection was arranged. This took place on the 10th February 2009 between 9.25am and 1.15pm. On the second day, Miss Cooper and the acting manager were both available. Miss Cooper, the acting manager and deputy manager received feedback. We met with people who use the service in their own rooms and within communal areas. We spoke with the staff members on duty. We observed the serving of lunch and looked at the management of peoples personal monies and the medication administration systems. We looked at care-planning information, training records, staffing rosters and recruitment documentation. We toured the accommodation and Care Homes for Older People Page 6 of 33 saw bedrooms and communal areas. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys to be distributed by the home to peoples care managers, GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Miss Cooper an Annual Quality Assurance Assessment (AQAA) to complete. Information from the AQAA is detailed within this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the care home does well: What has improved since the last inspection? What they could do better: All care plans are very comprehensive yet a summary sheet may be useful in informing staff of key aspects. A description of the persons pressure sore should be fully documented. Documentation should detail regular monitoring and the healing process. Associated aspects such as Care Homes for Older People Page 8 of 33 nutrition in relation to healing should be identified within the care plan. While food and fluid charts are being completed, the evaluation of the charts should form part of the care plan. Staff should countersign any hand written instructions on the medication administration sheet. Consideration must be given to ensure the controlled drugs cabinet complies with current legislation. A refurbishment plan is in place yet redecoration of the main corridors would significantly enhance the environment. All clinical waste units should be foot operated. Staff should ensure that they empty the units and the commodes on a more regular basis. Consideration should be given to whether the existing window restrictors meet current legislation. While a quality auditing system is in place, the findings should be coordinated within an annual development plan. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 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. A clear admission procedure is in place, enabling people to be assured that their needs will be met, within the home. Evidence: Staff told us that people considering using the service, are always assessed before being offered a place at the home. They said the owner and/or manager would visit the person to assess their needs and gain information about their likes, dislikes and preferred routines. Staff told us that they were informed about peoples needs through reading the original assessment and during handover. They said they would never be expected to support a new person, without being given information about them. The AQAA stated a full assessment is undertaken by the manager or senior carer consulting with relevant third parties. We always ask social workers or equivalent to fax a copy of their assessment before completing our own assessment, which covers Care Homes for Older People Page 11 of 33 Evidence: all information for future care plan development. Miss Cooper and Ms Ling confirmed robust admission procedures were always followed. They said at present, there are eight vacancies within the home. Miss Cooper told us that a clear admission criterion and the lack of Social Services funding had impacted upon this. Miss Cooper told us we are very clear about whether we can meet a persons needs and if they will fit in with people already living here. We will not take anyone just because we have vacancies. It has to be the right person, to make the home work. Miss Cooper told us that a respite care service is offered. This introduces people to the home and enables familiarity, if the person decides or is able to stay. One person using the service told us yes, I looked at the home before moving in. They were so friendly and lovely to me. They showed me around and showed me this room. They even told me about the bedding I could have. They asked me lots of questions. I knew instantly that this was the place for me. The person continued to tell us that they had been given written information about the home. We saw that a copy of the Statement of Purpose and the Service Users Guide was in the persons room. Another person told us that they had connections with the home years ago. They said they looked around out of interest. They told us I realised I didnt have to look at everything, as I was happy from the start, about what I saw. All the staff were very welcoming. Within surveys, people told us that they had received sufficient information about the home before moving in. One person said I was happy to come. Miss Cooper told us that she was planning to further develop the information given to people before their admission. She said she wanted to include more photographs and aspects such as menus. We looked at the assessment documentation of the person most recently admitted to the home. The documentation was detailed and fully reflected the persons needs. Preferred routines such as how the person liked to spend their day and meal preferences were clearly stated. Standard 6 is not applicable to this service, as intermediate care is not provided within the home. Care Homes for Older People Page 12 of 33 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. Care planning is of a good standard and reflects peoples needs. People have regular access to health care intervention, which ensures their health care needs are met. Medication administration systems are well managed. People are treated with respect and have their privacy upheld. Evidence: People told us that they were entirely happy with the care they received. One person said they just cant do enough for you. They are all so lovely and are there for you. I dont need much help but they will help me with a bath whenever I want one. Another person said they are always singing. Its a happy place. They treat you well. You couldnt get anything better anywhere. I love it here. One person told us about how staff gave them time. They said they are very patient and wait for me to do things myself. They know me well and understand what I need. Within a survey, a relative told us Mayfield exceed all expectations. The physical care, Care Homes for Older People Page 13 of 33 Evidence: mental stimulation and food provided are of a very high standard. The care home does make every effort to make it a home rather than an institution. Each person has a detailed, comprehensive care plan in place. Aspects such as the management of health conditions and the support needed with personal care routines were stated. The care plan also highlighted the persons individual preference for social activity, food and drink and general routines. As the care plans contained a high level of information, we recommended that a summary sheet be included, which highlighted key aspects of each persons current care. This would enable staff to have a quick reference guide to support the detailed information in place. Within surveys, one staff member told us on any shift we are always advised to read through the care plans to up date ourselves as well as information given at shift handovers. Another staff member said we have a handover at the beginning and end of any shift which is invaluable to maintain the quality of care provided to users. They said we continually strive to promote independence for uses whilst supporting their individual care needs. I believe the service listens to the users well so we can provide the best possible care. People had good access to health care personnel. Within surveys, people told us that they always received the medical support they needed. Miss Cooper confirmed that good support from local surgeries was received. She said staff could ring up for advice and regular visits were made to the home. We saw that one person was admitted with a significant pressure sore. We advised that documentation should reflect the severity of the wound. Aspects to promote healing such as a high calorie diet should also be stipulated. Charts to reflect the assistance given to people to change their position were in place. However, on some occasions these were not clear. The care plan and the turning chart gave conflicting information regarding the timing of when the person needed to be turned. One person needed to sit on a special cushion. We saw that staff moved the cushion with the person so that they could use it at the dining room table and during social activity provision. A number of people had food and fluid charts in place. As good practice the charts had been totalled at the end of each day. We recommended that this information should be evaluated as part of the care plan, to demonstrate an adequate intake. We saw that some care plans contained an Advanced Statement detailing whether the person wanted to be resuscitated or not. Miss Cooper asked our advice about these, as she said she was not entirely happy with the documents. We said Advanced Care Homes for Older People Page 14 of 33 Evidence: Statements must only be a directive between the person and their GP. Staff must not be involved in any way and must promote emergency aid. Miss Cooper told us that she would remove the documents and talk to family members, as required. Ms Ling told us that only staff trained to do so, administer medication to people. Refresher training in the safe handling of medicines has recently been undertaken. We saw that all medication was stored in a locked cupboard and trolley. Both were secured to the wall. Ms Ling told us that there is currently no controlled medication prescribed. We said the controlled drugs cupboard must be checked to ensure it complies with current legislation. At the last inspection, we made a requirement that all records in relation to the administration of medication must be maintained fully and accurately. This had been addressed. Staff had signed to demonstrate they had administered each persons medication. The AQAA confirmed that an audit system was now in place, to ensure accurate recording. We advised that another member of staff should countersign any handwritten medication instruction. All medication was receipted appropriately when it arrived into the home. We observed a member of staff administering peoples lunchtime medication. This was done in accordance to the homes polices and procedures. As required medication was detailed within the persons care plan. We advised that greater detail regarding what triggered an administration be documented. One person told us that they had great pain when getting out of bed in the morning. We saw they had their pain relief at breakfast time. We suggested that this could be given earlier, before the person started to get up. As good practice, medications with a short shelf life had been dated when opened. There were labelled topical creams within peoples rooms. As identified in other parts of this report, we saw that staff interacted well with people. All interactions were polite, attentive and respectful. Peoples preferred form of address was used. We saw that staff knocked on bedroom doors and waited to be asked in, before entering. Staff told us that one person was having a day in bed. This was respected. We saw staff offer regular refreshments to the person. Within care plans we saw that practices to promote privacy and dignity were addressed. This included the appropriate use of towels during the provision of intimate personal care. We saw that one bedroom door contained a panel of frosted glass. We advised that a curtain or blind be applied for privacy. Miss Cooper said she would address this. Care Homes for Older People Page 15 of 33 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 are provided with opportunities to undertake social activities in line with their preferences and abilities. People are able to maintain contact with family and friends. People are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. Evidence: Miss Cooper told us that social activity provision is given priority in order to enable people to live fulfilling lives. An activity organiser is employed between 10am and 3pm on a Monday to Friday basis. Within this time, activities are organised in relation to peoples individual wishes. During our visit we saw that people were playing bingo, dominoes, skittles and baking cakes. Some people were colouring and doing jigsaw puzzles. People told us that they were happy with the social activity provision offered to them. One person told us there is always something on. You can join in if you want to but they dont mind if you just want to be quiet. Another person said I like to keep busy so I do odd jobs. I lay the tables. Care Homes for Older People Page 16 of 33 Evidence: Staff told us that having the activities person was invaluable. They said we all get involved with activities but having Jo [the activity organiser] enables us to spend more time with people on a one to one basis. Theres more time to chat to people. Within surveys, people told us that they were satisfied with the social activity provision provided. One person said I like to join in but I also like to do my knitting. People told us that regular trips out are organised. One person told us about going to the local garden centre. Another person said I cant go out on my own but I have a walker [a member of staff.] They take me into town whenever I want to go. Miss Cooper told us that people using the service, relatives and staff went to a local pub for a Christmas meal. She said people also go into town for shopping and/or a coffee on a regular basis. The local market is particularly enjoyed. Staff told us that with the better weather approaching, more external activity would be organised. One member of staff raised the importance of getting out and about. They said people often accompany staff on errands, such as collecting prescriptions. We saw a regular newsletter is distributed to people. The December edition detailed an old fashioned sing along, a trip to Butterfly World and a Christmas pantomime. It also gave people information about new staff and a recent environmental health inspection. Throughout our visit, we saw that staff interacted with people using the service well. General conversations were taking place and positive relationships were evident. One person said they really care about us. They have some nice touches. One member of staff told us that they try to make Mayfield a real home to people. They said thats what I like about it here. We respect what people want to do and how they are feeling. Miss Cooper confirmed this ethos. She said its peoples lives and often its the little things that matter. She told us about Christmas, when people released balloons in memory of loved ones. People told us that they made choices about how they spent their day. One person said they like you to do exactly what you would do at home. We are woken with a cup of tea if you want one but then you can go back to sleep. You stay in bed until you feel like getting up. One person told us that they thought they had missed breakfast but when they got downstairs, staff immediately got them something. Another person told us you can spend time in your room if you want to. They will bring you your meals. We saw one person throughout the first day of our visit, in the dining room and lounge in their dressing gown. They said they did not feel like getting dressed. Staff told us that individual views were respected. People told us that visitors are welcomed at any time. One person told us that they Care Homes for Older People Page 17 of 33 Evidence: were able to have visitors in their room. They said staff provide you with a tray of tea. They are very accommodating. We saw during our visit that hospitality was evident. Another person said my XX just pops in. S/he takes me out when I want to go. They dont mind what time you get back. Another person said they are very good at passing on messages, when my XX rings. This person told us that they would like their own telephone. Miss Cooper told us that some people have a telephone in their room. She said she would arrange this for the person and would check if there were others who would like the facility. The cook told us that the home has a formalised menu yet this is regularly changed, according to peoples wishes and produce available. We saw that traditional food such as casseroles and pies were available and there were some alternatives, such as stuffed peppers. The cook told us that Miss Cooper undertakes the shopping at a local store. She said Sharon [the owner] often comes home with special things, which she thinks people might like. Through discussion, the cook showed us that she was aware of the importance of food both nutritionally and socially. She said people can really have what they want. They just need to give me enough notice. We saw at lunchtime that one person did not want their lunch. Staff offered a range of alternatives. They then asked the person, what do you fancy? The person wanted a banana. This was sliced and given to the person in a dish. The person was told that they could have something else later. Staff told us that the person has a poor appetite and therefore they try to tempt the person to eat. This information was identified within the persons care plan. Within the kitchen there was a wide range of fresh fruit and vegetables. The cook told us that all meals are prepared from fresh ingredients, if possible. She said frozen food was minimal. We saw that food stocks in the fridge were appropriately labelled. Fridge, freezer and temperatures of hot food before serving were taken and fully recorded. We saw that the meals were plated in the kitchen according to individual wishes and then immediately served to people. The activity organiser ate with people using the service. Engagement was evident throughout. We saw that the cook served desserts. She said she often spends time with people to enable feedback about the meals provided. People told us that the food was very good. Comments included its excellent, very well cooked and presented, its always very good, we get a choice and have two roasts in a week, its always good, theres variety and we get good cuts of meat and no complaints about the food whatsoever, its always good. We have a good cook. We chose what we want and write our choice down. The staff were also positive about the Care Homes for Older People Page 18 of 33 Evidence: food provided. Within surveys, people told us yes they are good, old fashioned foods, I am enjoying my meals very much, always hot and good and Ive never had to send it back. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are aware of how to raise a concern and a positive approach to complaints is in place. There are clear systems to safeguard people from abuse. Evidence: People were very clear about the process of making a complaint. All said they would tell a member of staff if they were not happy about any aspect of the service. One person said I wouldnt have to make a complaint. I would just mention it to one of the staff and they would sort it for me. Another person said a complaint, I dont think there would be any need. I cant see it happening. There is nothing here that you could complain about. Another person said Id have no hesitation in mentioning anything. They are all so good. Within surveys, people told us that they knew how to make a complaint. A relative commented any concerns I have are dealt with well, more than expected consideration to our concerns. Staff told us that they would try to resolve any issue, which was brought to their attention. They said they would immediately inform the manager or Miss Cooper of any form of complaint. One staff member said I think its good that people say how theyre feeling. We need to know if people arent happy, then we can put it right. Complaints are a good thing although nobody likes them. Care Homes for Older People Page 20 of 33 Evidence: People have a copy of the homes complaint procedure in their room. The procedure and complaint reporting form, demonstrate a positive approach to complaints. Documentation states thank you for telling us about your concern. This gives us the opportunity to put things right. You are helping us make improvements for the future. While a record of formal complaints is maintained, we recommended that aspects addressed on a daily basis, be recorded. Ms Ling told us that recording could be improved upon. She said we ask for peoples views and act on them but we are not very good at recording it. We asked one member of staff a hypothetical question about adult protection. They said they would have no hesitation in reporting any allegation of abuse. They said they had done this in the past. They talked about how the allegation could be unfounded but this was not their decision to make. They said they would have no choice but to immediately inform the manager and owner. Within a survey, a member of staff told us we have the No Secrets policy. We have all been told about and how to use whistle blowing. Documentation showed that staff had been given a copy of the local Wiltshire and Swindon adult protection policies, No Secrets. Staff had signed to state that they had received this information. We saw that all staff had had adult protection training. Ms Ling told us that abuse is also discussed on a regular basis within staff meetings and supervision. Miss Cooper said that she felt assured that staff were aware of their responsibilities in safeguarding, due to the focus that it is given. An incident regarding medication was managed appropriately, within the safeguarding protocols in 2008. Care Homes for Older People Page 21 of 33 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 clean, comfortable, well-maintained environment yet some decoration would enhance the standard of the accommodation. Evidence: Mayfield stands in its own grounds, set back from one of the main routes into Devizes. The property is towards the outskirts of the town, but within a residential area. It is a short drive from all local amenities. The original part of the home dates from Victorian times and retains some period features. There is also a more modern two storey extension at the rear. Bedrooms are located on the ground and first floor. There is a stair lift available although one area of the first floor can only be accessed by a number of additional steps. As identified at the last inspection, we saw that some areas of the accommodation would benefit from redecoration. This particularly included the ground and first floor corridors. Miss Cooper agreed with this. She said there was a programme of refurbishment in place. Some bedrooms were being redecorated and a bathroom had almost been refurbished. The bathroom was much improved. Miss Cooper told us the dining room and lounge were to be given the next focus. The corridors would then be Care Homes for Older People Page 22 of 33 Evidence: addressed. We saw that peoples bedrooms were personalised with various ornaments, pictures and general possessions. People commented favourably about their room. One person said I like the position, as I can see people coming and going. Another person said its very comfortable. I have everything I need. Automatic self closing devices were fitted to some bedroom doors. These enabled people to prop their door open safely and for the door to close in the event of the fire alarm sounding. We saw that restrictors had been fitted to the windows on the first floor. These prevented the windows from opening fully and minimised the risk of a person falling from the window. We advised Miss Cooper to check that the restrictors fully comply with current health and safety legislation. We saw that all areas of the home had been cleaned to a good standard. All toilets and bathrooms except one, contained hand pump soap dispensers and paper towels. The one toilet without these facilities was very small. Miss Cooper told us that due to its size, the room was rarely used. People had access to other facilities within the corridor. We saw that the bathroom on the first floor did not have an assisted bath. Staff told us that people used the downstairs bathroom. We advised that consideration should be given to this. Miss Cooper told us that this was within the homes general refurbishment plan. A walk in shower was also planned. Within one bathroom there was an old hand operated clinical waste bin. We advised that this be replaced. Another bin was half full yet was odorous. Miss Cooper told us that she would ask staff to empty the bins more regularly, rather than waiting for them to become full. We advised that staff also empty commodes more frequently as on the first morning of our visit, some commodes contained small amounts of urine. People told us that there was a good laundry service. One person said everything comes back quickly. Things rarely get lost. At the last inspection, a requirement was made to ensure that the floor and wall surfaces in the laundry and sluice rooms be kept clean and in good condition. The AQAA stated that this had been addressed. Within surveys, people told us that the home is always fresh and clean. One person said cleaner does a good job. Care Homes for Older People Page 23 of 33 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. Peoples needs are met through a committed, well-trained staff group. Robust recruitment procedures are in place to safeguard people from abuse. Evidence: Staff told us that there are generally two carers on duty during the day with the deputy manager and/or the manager. Staff told us that the deputy manager and manager assist with peoples support as required. There is also an activity organiser, a housekeeper and a cook. The housekeeper currently works on a Monday to Friday basis. However, a new member of staff has been appointed to work at the weekend. Staff told us that they believed staffing levels to be sufficient to meet peoples needs. At night there are generally two waking night staff. On occasions due the current number of people using the service, this may reduce to one waking night staff member and another providing sleeping in provision. Staff told us that their working shifts were generally from 8am to 8pm. They said the shifts worked well. One member of staff told us that the length of the shift gave people continuity. They felt it positive that they could monitor a persons condition throughout the day, if they were unwell. Care Homes for Older People Page 24 of 33 Evidence: Within surveys, people told us that staff were available when needed. One person said you might have to wait a minute but not long. Other comments included I must say the staff are very good and help you all they can, always staff around and the staff work too hard and never keep me waiting. I feel safe. People told us that staff generally listen and act on what they say. One person said they sometimes do. Other comments were no, depends who it is and depending on their commitments at the time. Miss Cooper was surprised at these views but said she would investigate the areas more fully. Within discussions, people were very positive about the staff team. Specific comments included they are all lovely. Theyre a happy lot and nothing is too much trouble. Each one of them has a special quality. Another person said I look forward to seeing them. They are always so friendly. We talk a lot. Its nice to hear about other things like their family. Staff told us that they felt they had a good team who were very supportive of each other. Miss Cooper confirmed this. She said the staff are excellent. They are very caring and concerned about people. They all go the extra mile. Im very lucky to have the staff I have. One member of staff spoke about the importance of building a relationship with the person and seeing them as a person, before their illness or frailty. Another person told us about the importance of enabling the person to live their life, as they wanted. Miss Cooper told us that she is committed to staff training. She felt it essential as good staff, good service. We saw that a training matrix was in place. Each member of staff has a training profile. These detail the training staff have undertaken and any identified training needs. Ms Ling said training needs are discussed within formal one to one supervision sessions. She said staff are encouraged to give suggestions for training topics. A training session is arranged on a weekly basis. Ms Ling told us that external speakers facilitate some sessions. Other sessions may involve a training package, a DVD or general discussion. Staff told us that training is of a good standard and readily available. One person said training, where do I start, we have had loads. Another staff member told us they had recently completed manual handling, first aid, control of substances hazardous to health, health and safety and National Vocational Qualification (NVQ) level 2. They were now doing NVQ level 3 and planning to attend a dementia care training course. The AQAA stated that all staff had or were in the process of gaining an NVQ qualification. Within surveys, staff confirmed that the training provision available was good. In Care Homes for Older People Page 25 of 33 Evidence: relation to what the home does well, specific comments included provide good training, we have weekly training sessions that cover all aspects of the care that we are providing. Any new ways of working are included in these training sessions and most training sessions the managers attend. We have regular supervisions and the office door is always open for any discussions. One staff member told us I feel privileged to be part of the Mayfield team. We all work together and discuss any issues. I have always felt supported by my colleagues and management. The deputy manager told us that new staff have been recruited and are now in position. Two further applicants have been offered positions pending a satisfactory Criminal Records Bureau (CRB) check. We looked at the recruitment documentation of the three most recently employed members of staff. Each contained the information required. We discussed appointing a member of staff with a criminal conviction. We said the appointment must be risk assessed to ensure the safety of people. The reasons for making the decision to appoint should be fully evidenced. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed yet a registered manager is needed for on going stability. Coordinating quality assurance systems would ensure a more formalised approach to the development of the home. The safe keeping of peoples personal monies is well managed. Systems are in place to promote peoples health, safety and welfare. Evidence: Mrs Tina Manterfield, the registered manager, left the home in October 2008. Ms Ling has taken the role of acting manager since this time. She told us that the position of registered manager is currently being advertised. Ms Ling will continue in the role of acting manager until an applicant is formally appointed. Ms Ling showed a clear awareness of person centred care. She previously had a senior position in the home. Ms Ling and Miss Cooper both demonstrated a passion for managing the home with peoples best interests at the forefront. This involved clear emphasis on enabling people to make choices and decisions within their lives. Care Homes for Older People Page 27 of 33 Evidence: Ms Ling told us that she has NVQ level 3. She is also completing the new Leadership and Management course for managers. She aims to complete this by the summer period of 2009. Miss Cooper told us that she visits the home on a regular basis. Staff confirmed this and said she was available at all other times, as needed. Staff told us that they felt management were very supportive. One staff member said they are very approachable and they listen. Within a survey, a member of staff said there is no them and us, we all get on and work together. Ms Ling and Miss Cooper demonstrated that they had established positive relationships with people using the service and staff members. At the last inspection, a requirement was made to devise and implement an effective quality assurance system, which results in an annual service development plan. Ms Ling told us that quality assurance was an area that had proved a challenge. She said we know we havent got the systems quite right yet, but we are trying. We saw that people are encouraged to give their views and there are regular audits taking place. People have completed surveys and attend regular meetings, in order to give suggestions about the homes development. A feedback book has been devised regarding meal provision. We saw that the audits involved checks on matters such as peoples rooms and record keeping. While acknowledging quality assurance systems are in place, we said the findings should to be coordinated and included within an annual development plan. We said this would give focus and direction to the on going development of the home. The majority of people have given small amounts of money for the home to hold safely. Receipts demonstrated all expenditures. We saw that two staff had signed the balance sheets when undertaking each transaction. Miss Cooper and Ms Ling had regularly audited the systems. They said that bankcards or PIN numbers to peoples bank or building society accounts were not held. We checked three cash amounts. These corresponded to the balance sheets. Ms Ling told us that only senior staff have access to the safekeeping of peoples monies. When we arrived at the home, staff showed us the meeting point if the fire alarm sounded. They told us of the procedure to follow if this were to happen. Records demonstrated regular testing of the fire alarm systems. Staff had received fire instruction and fire training had been undertaken. There had been regular fire drills. We advised that documentation detailed the time of the drill and the participants. We looked at the accident records. These were detailed and a system was in place for accident monitoring. Ms Ling told us that there had been a number of falls although Care Homes for Older People Page 28 of 33 Evidence: there were no trends or particular issues, which appeared contributory factors. We saw that an external company completed a yearly health and safety inspection. Miss Cooper told us that any issues identified had been immediately addressed. Records were in place of other health and safety checks, which staff undertook. These included hot water and fridge and freezer temperatures. We saw there was a range of up to date individual and environmental risk assessments in place. These had been checked, as part of the yearly external health and safety inspection. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 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 7 In the event of a person having a pressure sore, associated aspects to promote healing, such as nutrition should be identified with the care plan. The care plan of the person with a pressure sore should detail the complexity of the wound and identify the healing process. A summary sheet of peoples needs, which supports the detailed documentation within the care plan, should be devised for easier access of information. Consideration should be given to ensuring the controlled drugs cupboard complies with current legislation. Greater detail should be recorded in the care plan to show the triggers of when as required medication should be administered. The administration of pain relief should be reviewed in terms of the time the iperson would benefit from it most. Another member of staff should countersign all handwritten medication instructions on the medication administration record. To ensure privacy, a curtain or blind should be applied to Page 31 of 33 2 7 3 7 4 5 9 9 6 7 9 9 8 10 Care Homes for Older People the window in the identified persons bedroom door. 9 10 11 12 13 16 19 26 26 29 Any complaints dealt with on a day-to-day basis should be recorded for monitoring purposes. All window restrictors should be checked to ensure they comply with current health and safety legislation. Staff should ensure that commodes are emptied on a more regular basis. The identified hand operated clinical waste bin should be replaced with a foot-operated unit. In the event of employing a person with a criminal conviction, the decision to appoint should be fully documented. Findings from quality assurance systems in place should be coordinated and form an annual development plan. The time and participants within a fire drill should be recorded for monitoring purposes. 14 15 33 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!