Inspection on 10/12/08 for Merrie Loots Farm Residential Home

This inspection was carried out on 10th December 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Merrie Loots Farm Residential Home East Tilbury Road Linford Stanford-le-hope Essex SS17 0QS     The quality rating for this care home is:   one star adequate 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: Michelle Love     Date: 3 1 1 2 2 0 0 8 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. the things that people have said are important to them: They reflect 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 31 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 31 Information about the care home Name of care home: Address: Merrie Loots Farm Residential Home East Tilbury Road Linford Stanford-le-hope Essex SS17 0QS 01375673178 07939456162 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Sharon McCarthy Type of registration: Number of places registered: Chigwell Homes Limited care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 28 The registered person may provide the following categories of service only: Care Home only - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Merrie Loots Farm Rest Home is registered to provide care and accommodation for up to twenty eight older people, who may or may not have a diagnosis of dementia. The building was orginally an old farmhouse and retains much of its old charm and character. There are single and double bedrooms (none have en-suite facilities) and the home offers a choice of lounge and dining areas as well as a conservatory area. All Care Homes for Older People Page 4 of 31 Over 65 0 28 28 0 Brief description of the care home areas of the home can be accessed via a passenger lift. The home is set in its own farmland and has beautiful gardens that overlook the fields and stables. There is a large car parking area with open gates leading to a busy road; a fence has been fitted around the garden area to ensure residents safety. There is a small parade of shops almost opposite the home and it is half a mile from the main line station (Fenchurch Street Line). 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: one star adequate 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 was an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 8.5 hours, with all but one key standard inspected. This was the homes first inspection under new ownership. Prior to this inspection, the registered provider had submitted an Annual Quality Assurance Assessment (AQAA). This is a self-assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises Care Homes for Older People Page 6 of 31 was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for relatives, staff and healthcare professionals were forwarded to the home for distribution and for people to complete and return to us. No surveys were received by us at the time of the site visit or at the time of compiling the report, however people were spoken with at the time of the site visit. The manager and other members of the staff team assisted the inspector on the day of the inspection. Feedback on the inspection findings, were given as a summary to the manager. The opportunity for discussion and/or clarification was given. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 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 9 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. Prospective people moving into Merrie Loots Farm Rest Home are given sufficient information about the home to make an informed choice about living there. People can be assured that they will have their needs assessed prior to admission to ensure that the staff team are able to meet them. Evidence: There is a Statement of Purpose and Service Users Guide in place for Merrie Loots Farm. This provides specific information about the service so that prospective residents have the information they need so as to make an informed choice as to whether or not this is the right care home for them. There is a formal pre admission assessment format and procedure in place, so that the management team of the home are able to meet the prospective residents needs. In addition to the formal assessment procedure, supplementary information is sought Care Homes for Older People Page 10 of 31 Evidence: from the individual residents placing authority and/or hospital. Three care files for the newest people (1 respite and 2 permanent) admitted to the home were examined. Records showed that two people were admitted to the care home as emergency admissions and the rationale for this decision was clearly recorded. Each of the pre admission assessments were noted to be detailed and informative providing good information for staff pertaining to individuals care needs. However, care must be taken to ensure that information recorded within both the pre admission assessment and placing authority assessment are transferred to the individuals care plan. Specific examples relating to this are detailed within the Health and Personal Care section of the report. There was evidence to show that as part of the pre admission assessment process, information had been sought from the resident and their next of kin/representatives. The manager advised that wherever possible she aims to meet the prospective resident in their own home or other care home or hospital. The AQAA details, The individual and their family/advocate is invited and encouraged to visit Merrie Loots and spend some time there-preferably for the day so that they can sample meals, entertainment etc, and speak to other residents and staff. Following the assessment the manager writes formally to the prospective resident to confirm that Merrie Loots is able to offer a service appropriate to their needs. The home does not provide intermediate care. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in care planning, risk assessing and some medication practices and procedures means that residents cannot be assured that their needs will always be met or that their health and wellbeing will be maintained or proactively managed. Evidence: There is a formal care planning system in place to help staff identify the care needs of individual residents and to specify how these are to be met by staff who work in the care home. As part of this inspection, a random sample of 3 care files were examined in full with an additional number of care plans examined, specifically pertaining to the management of individuals medication. In general terms care plan recording was noted to be informative and detailed, however not all areas of identified need were recorded within each persons care plan and in some cases there was limited information recorded as to how staff were to proactively manage the persons specific care needs. Additionally as previously stated, care must be taken to ensure that Care Homes for Older People Page 12 of 31 Evidence: information from individuals pre admission assessments and placing authorities is transferred to the care plan. This refers specifically to the pre admission and placing authority assessment for one person detailing them as suffering from memory loss/disorientation, their dietary intake requiring prompting as a result of their poor appetite/at risk of some weight loss, at risk of self neglect, hiding their medication and wandering. On inspection of their care plan, the only elements recorded related to personal care, mobility and dietary intake. In relation to the latter this did not make reference to the person being at risk of potential weight loss/poor appetite. No other elements were recorded within the care plan and no risk assessments were devised. On inspection of their daily care records, since their admission records showed the person had been noted to wander into others bedrooms at night and had refused one of their meals. The care file for another person was examined specifically in relation to their pressure area care. Information recorded within both the pre admission assessment and placing authority assessment identified the person as having pressure sores to both legs, however on inspection of their plan of care (skin care), no information was recorded in relation to the above information. Additionally several areas of the care plan format were not completed. The care file for the same person recorded them as having a range of healthcare/medical needs (diabetes/renal failure etc), being at risk of falls and at risk of depression/low mood. No risk assessments were noted in relation to these areas. The lack of information as detailed above potentially places people at risk of not having all of their care needs met and provides staff with insufficient information about individual people who live at Merrie Loots Farm. The care file for another person recorded them as requiring encouragement to eat and drink. On inspection of a random sample of nutritional records these evidenced the resident as having a varied diet. While we recognise this as positive, nutritional records were not always completed and the persons weight was not recorded for October and November 2008. The AQAA details, fluid and nutrition charts are kept to highlight any deficiencies and for all residents at risk due to conditions such as diabetes. This did not concur fully with the inspectors findings on the day of the site visit. In general terms daily care records were noted to be informative and in some cases detailed, however recording was inconsistent as records did not always include staff interventions and for some people records were not always completed daily. This is not in line with the homes Statement of Purpose which states, There will also be daily reports kept on each resident which is completed at the end of each shift by a senior carer detailing how the resident has been during that shift. There was evidence to show that all residents within the care home have access to a Care Homes for Older People Page 13 of 31 Evidence: range of healthcare professionals and services as and when required e.g. GP, District Nurses, Optician, Chiropody etc. Additionally we were advised that a weekly doctors surgery is held at the home and the manager liases with the local district nurse team and has 2 monthly meetings with the senior district nurse and the homes link social worker. Rapport between care staff and individual residents was observed to be positive, with care provided in a timely manner and with due care and respect. Staff spoken with demonstrated a good understanding and knowledge of residents care needs. Comments from relatives as recorded within recent quality assurance surveys were positive and included, we are generally happy with the care my [name of relative] is receiving and appreciate the support we are given for managing difficult and distressing situations, staff are very approachable and we are very happy with the care our relative is receiving and their overall wellbeing. The majority of medication is managed through a monitored dosage system (blister pack). Storage systems within the home were appropriate with medication stored securely. The lunchtime medication round was observed and the actual administration of medication by the senior carer to people living in the care home was seen to be appropriate. During the lunchtime medication round, the medication trolley was left open and unattended whilst the senior carer assisted a resident in the lounge and then left the lounge to go to the kitchen. Additionally, some medication was observed to be left on top of the trolley. This is not good practice and could result in other people helping themselves to the medicines available and residents having access to the medication and possibly overdosing with serious consequences. This was brought to the managers attention at the time of the site visit. On inspection of Medication Administration Records (MAR), records were generally noted to be well maintained, however there was one discrepancy noted whereby the quantity of medication (antibiotic) received did not tally with the number of tablets administered and meant that the course of medication was not completed in line with the prescribers instructions. This was confirmed with the manager at the time of the site visit. Records also showed that two peoples medication was not administered for one day as none available was recorded. The MAR record for another person recorded a short course of medication for a period of 7 days, however records showed this was still being administered 5 days longer than should have been. MAR records also showed that several residents regularly refuse their medication. A random sample of 4 care files for the above people were examined and showed that 3 out of 4 people had a care plan (refusal of medication) in place, advising staff that the person could refuse their medication on occasions. There was also evidence to show that the persons GP had been consulted and made aware of the above issues. Care Homes for Older People Page 14 of 31 Evidence: On inspection of training records for those people who administer medication, all staff who administer medication had evidence of up to date training. Records were also available to evidence that competency assessments are undertaken to ensure that staff remain competent to undertake the above task. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Merrie Loots Farm Rest Home have their social and recreational interests met. Residents receive a varied diet which meets their nutritional care needs. Evidence: The manager advised that it is the responsibility of all staff working within the care home to promote and encourage people living at Merrie Loots to participate within a varied programme of social activities. There is a weekly programme available, however this is flexible so as to offer choice to residents. Activities available include bingo, manicure, massage, listening to music/The Archers, games, hoopla, gentle exercises, reminiscence, dominoes and films. In addition to these an external entertainer visits the care home once monthly and residents have regular access to activities within the local community e.g. garden centre, theatre, out for meals etc. Residents comments pertaining to activities provided at the care home were positive. On the day of the site visit residents were observed to participate in a variety of games throughout the morning and several people were noted to read newspapers, books, magazines etc or to chat with others. Mixed comments from relatives as detailed within quality assurance surveys relating to activities were noted and included, are there regular social activities that involve going out from the home. As far as I know, not very many Care Homes for Older People Page 16 of 31 Evidence: and not as far as I am aware, it would be good if staff could spend more time with residents, including my [name of relative] would appreciate 1-1 and social events organised by the staff are always very enjoyable and friendly. The manager and other members of the staff team are looking to liaise with other homes within the organisation to share ideas and information about possible future activities, in particular activities for those people who have severe dementia/poor cognitive development. The manager is currently looking to source training for staff with particular emphasis on activities. The manager was advised to consider devising the activity programme in larger print and/or pictorial format so as to enable people in the home to make an informed choice. A newsletter is produced regularly detailing forthcoming events and this is given to both residents and their relatives. Of those individual care files inspected, all were noted to have specific information recorded pertaining to their social care needs. There is an open visiting policy at the care home, whereby visitors can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at the care home are actively encouraged and supported to maintain friendships and relationships. The AQAA details, the manager promotes an open door policy and this is strengthened by family get togethers, parties, newsletters and a general feeling of extended family whereby families and friends feel able to visit the home. The lunchtime meal was observed within the main dining room. The tables were attractively laid and meals provided to residents were attractively presented with portions of food seen to be plentiful. There is a 4 week rolling menu which offers residents a varied diet of home cooking, however this is flexible. In addition to the main choice of meal, several residents were observed to have alternatives to the menu (jacket potato, soup or sandwich) and where residents required assistance to eat their meal, staff were observed to provide appropriate support that was both respectful and sensitive to individual residents care needs. As part of this site visit the cook was spoken with, about individual residents nutritional needs. The member of staff was able to demonstrate a good understanding and knowledge of peoples specialist dietary needs and individuals personal preferences, likes and dislikes. Residents comments relating to meals provided at the care home were positive and included, the food is lovely, I have no complaints, you cannot fault the food and its good home cooking. Care Homes for Older People Page 17 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. Residents can expect that their concerns are dealt with proactively and that they will be listened to. Evidence: There is a complaints policy and procedure in place. Relatives and residents spoken with confirmed that they know how to make a complaint/raise any issues of concern should the need arise. We were advised that people felt assured that the management team of the home would deal effectively with any issues raised. The Statement of Purpose/complaints procedure needs to be amended to reflect that the Commission for Social Care Inspection no longer investigates complaints. The AQAA details under the heading of what we could do better, continue to ensure that smaller complaints are recorded as this will give a broader view of the way in which we deal with incidents and ensure that smaller issues are dealt with. Since being newly registered, the complaint log evidenced 1 complaint. There was evidence to show the specific nature of the complaint and action taken by the manager. Although there was no formal compliments record, a card was readily available and this recorded, to everyone at Merrie Loots. thank you so much for all [name of resident] presents and support you have given. No safeguarding issues have been highlighted. Appropriate safeguarding policies and Care Homes for Older People Page 18 of 31 Evidence: procedures were available within the home and staff spoken with, were able to demonstrate an understanding and awareness of safeguarding procedures. Training records showed that the majority of staff and the manager have received safeguarding training, however training records for the newest staff recruited to the home evidenced they had not received this training as yet. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safe, comfortable, homely and well maintained environment which meets their needs. Evidence: A partial tour of the premises was undertaken during the site visit and in the presence of the manager. The environment is homely and comfortable and provides people with a safe place in which to live. Signage within the care home needs to be improved so as to aid orientation for people residing at the home, especially for those people who have dementia and/or poor cognitive development. A random sample of residents bedrooms were inspected and all were seen to be personalised and individualised with many personal items on display. The manager advised there are plans by the registered provider to improve the decoration, fixtures and fittings. On the day of the site visit the home was observed to be clean, tidy and odour free, no health and safety issues were highlighted. A maintenance person is employed at the home 4 days a week and currently there is an on-going maintenance programme of re-decoration being undertaken. A random sample of certificates relating to the services gas safety inspection, portable appliance testing, hoists, passenger lift were all serviced in 2008 and remain in date. The electrical installation certificate was noted to be out of date and in need of a reCare Homes for Older People Page 20 of 31 Evidence: inspection. The manager was advised to write to us once the re-inspection had been undertaken. We have since been formally advised in writing that the electrical installation at the home will be reinspected in February 2009. Records relating to the homes fire risk assessment, regular testing of the fire alarms/emergency lighting and fire equipment were inspected and deemed satisfactory. Care Homes for Older People Page 21 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. Residents are supported and protected by the numbers, skill mix of staff and by the homes recruitment procedures to ensure their safety and wellbeing. Evidence: We were advised that the staffing levels at the care home are 4 members of staff from 07.00 a.m. to 20.30 p.m., 3 members of staff from 20.30 p.m. to 22.00 p.m. and 2 waking night members of staff from 22.00 p.m. to 07.00 a.m. each day. The managers hours are supernumerary and in addition to the above, there is sufficient ancillary staff deployed (domestic, cook, kitchen assistant and teatime person) each day. On inspection of 4 weeks staff rosters these evidence that staffing levels as detailed above had been maintained and that the deployment of staff within the home is appropriate for the numbers and needs of existing residents. Residents spoken with confirmed that staff support throughout the day is appropriate in meeting their care needs. We observed individual people throughout the site visit being given personal care and other support in a timely manner and with due care and respect by staff. The manager advised that staff currently work a set rota that does not alter from week to week. This enables staff to create stability and provide continuity of care for the people living in the care home. Care Homes for Older People Page 22 of 31 Evidence: The staff files for 2 newly employed people were examined. Records showed that the majority of records as required by regulation were evident, however it was noted for one person that one of their written references was dated and received after they had commenced employment and there was no record of induction available for one person. The member of staff was spoken with and confirmed they had received an induction upon commencement of employment at Merrie Loots Farm. The AQAA details that within the last 12 months, we have introduced a formal induction package for all new members of staff and present feedback suggests that the staff are benefiting greatly from this. On inspection of staff training records these showed training provided to staff since being newly registered included, infection control, moving and handling, fire awareness, safeguarding, continence awareness, deprivation of liberty and mental capacity act. The manager also advised that dementia awareness training is planned for all staff in January 2009 and food hygiene training is planned for February 2009. The training matrix submitted to us following the inspection also records additional training planned for 2009 in relation to COSHH and Health and Safety within the next 6 months. The manager advised that 9 staff have attained NVQ Level 2, 4 staff have achieved NVQ Level 3 and 1 staff member is currently undertaking NVQ Level 2 (a further 2 people to commence this in due course), 1 member of staff is undertaking NVQ Level 3 and another member of staff is due to start this shortly. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and in the best interests of the people who live at Merrie Loots Farm Rest Home. Evidence: The manager has been at Merrie Loots Farm Rest Home for the past 20 years (under previous ownership) and has experience working in care both within the private sector and within social services. The manager has achieved the City and Guilds certificate in Community Care Practice and in Management for Care and has completed the Registered Managers Award in Management in March 2006. The manager advised that the ethos of the home is, to provide the best possible care within a peaceful, secure environment and to respect residents rights, values, diversity and opinions. To continually seek to improve the quality of the service and delivery of care, whilst ensuring it provides value for money. The Statement of Purpose and Service Users Guide details the philosophy of care as, to provide our residents, who Care Homes for Older People Page 24 of 31 Evidence: are in need of support due to age or illness, a standard of care that they would choose for themselves. This will be offered in a safe, caring, warm and homely environment in which the residents care and well being is of prime importance. This will be planned and managed in such a way as to enable our residents to maintain their individuality, personal dignity and privacy; to exercise their personal preference and choice wherever possible; and to stimulate, promote and maintain their residual abilities. Staff spoken with were complimentary regarding the management of the home and felt that the manager was approachable and supportive. There was evidence throughout the day of the site visit to show that the manager is hands on and has a good relationship with the people who live at the care home. Relatives spoken with also confirmed that they had confidence in the management team of the home to ensure good care practices were maintained at Merrie Loots Farm. It is evident from this inspection that while there are many positive outcomes for people living at the care home, some further development is required in relation to care planning/risk assessing and some aspects of medication practices and procedures so as to ensure positive outcomes for people. There is a quality assurance system in place and records showed that surveys were sent to all residents next of kin/representatives in October 2008. Comments received were generally very positive and included, [name of resident] always looks well cared for, in particular their clothes are clean and they look smart, I have complete confidence in the management team. There is always someone available to talk to if you have a query/problem to discuss, even though there has been a change of ownership, the staff have remained and that is reassuring to us, in general very good, nice informal attitude by staff to residents. Friendly may be a better word and the staff really are dedicated to the residents. Merrie has a homely, relaxed feeling and was definitely the best choice of home for my [name of relative]. Records were available to show that since being newly registered, staff meetings/resident meetings have taken place. Regulation 26 visits have been undertaken by the area manager and registered provider. On inspection of the staff supervision tracker, this recorded 19 staff as having received formal supervision and 4 members of staff had received an annual appraisal. All sections of the Annual Quality Assurance Assessment (AQAA) were completed and the document returned to us when requested. Information recorded was informative and detailed, providing information about the service. The AQAA provides a list of policies and procedures currently available within the home. Care Homes for Older People Page 25 of 31 Care Homes for Older People Page 26 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 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Risk assessments must be 10/02/2009 devised for all areas of assessed risk so that risks to residents can be minimised. Records must be explicit, detailing the specific area of risk, how this impacts on the person and steps taken to reduce the risk. This will ensure that risk areas are identified and staff aware of the associated risks to individuals health and wellbeing. 2 7 15 Care plans for individual people must identify all of their assessed care needs. To ensure that residents are cared for safely and in a way that meets all of their care needs. That information recorded provides sufficient information to staff, enabling them to offer residents assistance and consistent care. 10/02/2009 Care Homes for Older People Page 28 of 31 3 9 13 Ensure that a sufficient supply of medication is available for residents. To ensure peoples health and welfare. 10/02/2009 4 9 13 Residents must be protected 10/02/2009 from harm by having their medication administered safely and in accordance with the prescribers instructions. So as to ensure residents safety and wellbeing. 5 9 13 Ensure that the medication trolley is not left unattended and medication easily accessible to residents and others. This will ensure unnecessary risks to residents health and wellbeing is averted. 10/02/2009 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 3 Information recorded within the pre admission and placing authority assessment to be transferred to individuals care plans. Daily care records should be written daily detailing staffs interventions and evidencing how people in the home spend their day. Consider devising the activity programme in larger print and/or pictorial format so that people at the care home can make an informed choice. Nutritional records for all residents should be completed so as to determine the food provided and whether or not their diet is satisfactory. Amend the complaints procedure to reflect that the Page 29 of 31 2 7 3 12 4 15 5 16 Care Homes for Older People Commission for Social Care Inspection no longer investigates complaints. 6 19 Consider appropriate signage within the care home, to aid people living within the care home who have dementia/poor cognitive development to orientate themselves within the home environment. Care Homes for Older People Page 30 of 31 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. 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