Inspection on 12/03/09 for Moreton Hill Care Centre

This inspection was carried out on 12th March 2009.

CSCI found this care home to be providing an Excellent 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

Moreton Hill Care Centre 20/03/07

Moreton Hill Care Centre 02/03/06

Moreton Hill Care Centre 15/09/05

Moreton Hill Care Centre 04/03/05

Moreton Hill Care Centre 30/11/04

Moreton Hill Care Centre 13/05/04

Moreton Hill Care Centre 24/02/04

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Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Moreton Hill Care Centre Moreton Hill Care Centre Standish Stonehouse Glos GL10 3BZ     The quality rating for this care home is:   three star excellent 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: Kathryn Silvey     Date: 1 3 0 3 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 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Moreton Hill Care Centre Moreton Hill Care Centre Standish Stonehouse Glos GL10 3BZ 01453826000 01453826001 moretonhill@barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Barchester Healthcare Homes Ltd Name of registered manager (if applicable) Mrs Deanna May Lane Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who may be accommodated is 67. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum of 37 places Physical disability, aged 65 years and over on admission (Code PD(E) - maximum of 5 places Dementia (Code DE) - maximum of 25 places Mental disorder, excluding learning disability or dementia, aged 65 years and over on admission (Code MD(E) - maximum of 2 places Date of last inspection Care Homes for Older People Page 4 of 31 care home 67 Over 65 0 2 37 5 25 0 0 0 Brief description of the care home Moreton Hill Care Centre is situated on the outskirts of the small town of Stonehouse, close to Standish hospital. The home is set high on a hill with magnificent views across the countryside to the River Severn beyond. The building consists of an old farmhouse, which has been renovated and extended. The accommodation is on various levels and is furnished, decorated and maintained to a high standard. The majority of rooms have ensuite facilities. Most rooms are for single occupancy although couples can be catered for. All areas of the home are accessible with two lifts to all floors. There are five reception rooms, which serve all levels in the home. Outside there are various sitting areas, one of which is an enclosed courtyard with raised flowerbeds, plants and shrubs. Three parking areas surround the home and the nearby fields and stables are home to a collection of farm animals. There are level pathways for service users to walk safely or use wheelchairs at their leisure. Two of the wings Severn View and Cotswold Rise have been registered to accommodate residents with dementia. They have their own lounge, dining and kitchen areas, which have been well decorated and furnished to meet the needs of the service users. The service users also have access to an enclosed courtyard and a garden with sensory planting. Current fees are from 830.00 pounds. Hairdressing, chiropody, newspapers, toiletries and outings are charged extra. The home makes information about the service, including CSCI reports available to service users and their representatives through a service user guide and statement of purpose available in the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was 19th March 2007. The judgments 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 views and experiences of people using the service. The inspection was completed by two inspectors one day, and one inspector the following day. All the people living in the dementia care units were seen and spoken to, and some of their relatives visiting them, four people were spoken to individually on the nursing unit Care Homes for Older People Page 6 of 31 to find out how their needs were being met and one relative visiting on the day. We spoke to one relative away from the home and many of the staff during the two inspection days. There was direct contact with the homes registered manager, the Head of Care, the activities organiser, care staff and nursing staff. A number of records were looked at including care plans, risk assessments, health and medication records. The care records of five people accommodated were looked at in detail. We looked at the dementia care units environment and some of the bedrooms and communal areas in the nursing unit. The staff were observed engaging with people living in the home, especially during mealtimes. The registered manager returned the Commissions Annual Quality Assurance Assessment, this is a self-assessment about the home and is a legal requirement. What the care home does well: The home completes a detailed pre-admission assessment, which includes healthcare professionals, when required, before people move into the home to ensure that thier identified needs can be met. The care plans are person centred and include individual specific care and more general care to ensure that peoples diverse needs are well meet. Healthcare needs are met appropriately, and additional support from other professionals is sought when required. A relative also told us that the care was a high standard and the person cared for was also able to communicate to us that she was comfortable. Two other people living in the home together for two years told us; it couldnt be better here , we have everything we need, the food is really good, the staff are polite, we join in with holy communion in the home, and choose not to do any organised activities, and in the summer we go out on trips. The nine completed surveys returned to us indicated that five people always and four usually receive the care and support they need. The home has dedicated activity staff that provide a varied programme of activities where individual tastes are included. The home provide excellent food which is served well and is enjoyed by people living in the home. Eight people told us they usually like the meals provided, one person told us they always liked the meals. One person commented in the survey as follows; I find the standard of cooking good, occasionally i dont like what is served, but they always find an alternative. The home takes complaints seriously and has procedures and staff training that help to safeguard people from abuse. The home is well maintained and continual improvements are planned to ensure a comfortable and safe home for people. People are encouraged to personalise their rooms, and in the dementia care units additions help people recognise their rooms more easily. Warm and welcoming communal areas are throughout the home. People told us that they are pleased with the cleanliness of the home. The staff are well trained and they told us they are also well supported by the manager. Recruitment records were complete and the homes robust procedures help to ensure that vulnerable people are safeguarded. The new manager is experienced and competent and has completed the Registered Managers Award having worked at the home for the last twelve years, the last five years were as the homes training officer. The home has safe working practices and is run for the benefit of the people that live there. Regular meetings and surveys help people to influence the changes in the home. The home has a good quality assurance system where people views, their relatives and Care Homes for Older People Page 8 of 31 professionals views are sought, and detailed actions are completed to continually improve the service. The AQAA completed by the manager was detailed and gave us the information we required. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a comprehensive pre-admission assessment which is completed by competent staff, providing clear information to help ensure that a judgment can be made about the homes ability to meet peoples needs before they move in. Sufficient Information is provided before people move in, which includes the fee structure. Evidence: We looked at a pre-admission assessment in a dementia unit and the records indicated that the assessments were comprehensive and involved other health care professionals. The assessment covered all the the required areas, and was completed by a competent member of staff in the home. Care Homes for Older People Page 11 of 31 Evidence: The new registered manager had updated the Statement of Purpose with details about her qualifications and experience. The AQAA told us that people are given information about the home and the care available when they first make any enquiry. Fee information is included in the initial enquiry including any continuing healthcare payments. There is a brochure giving details of the home, services and facilities and people are always invited to visit before any arrangements are made. A trial period can be arranged before a person becomes a permanent resident. People are assessed before admission to the home and their identified needs are the basis of an individual care plan. The homes welcome pack includes a statement of terms and conditions and a written contract with the home. We received twelve completed surveys from people living in the home, and they all agreed that they received enough information about the home, and the following comments were made; we visited the home and had lunch, the detailed reports of care standards that you make available on-line were extremely useful when we were considering which home to select. The home does not provide intermediate care and therefore Standard 6 does not apply. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The person centred care plans used by the staff help to ensure that individual needs are well met. People have the support of healthcare professionals and the staff have appropriate training to ensure good practice. Medication is generally well managed, however, minor changes to procedures would improve safety. Peoples privacy and dignity is respected through equality, choice and best interests assessments. Evidence: Dementia care units; The peoples health, personal and social care needs were set out in individual plans of care and we saw three examples.The plans are reviewed monthly and we saw evidence of the reviews that had taken place at the end of February 2009. We looked at the individual plans of the advice and guidance from other healthcare professionals for example; dietitian and continence adviser. We can accept that some people have a Care Homes for Older People Page 13 of 31 Evidence: limited capacity over aspects of their lives, however, we noted that wherever possible peoples views and wishes are sought. The relatives/carers views are also sought to ensure that peoples best interests are safeguarded. The dementia Units assess peoples mental capacity to undertake daily task, and the results were recorded in the care plans we looked at. It is recommended that the assessments are reviewed and a date is identified when it should be completed. The two tests (Mental Capacity Act (MCA) 2007,Section 2.1) were applied and as it was found that the person did not have the capacity for this decision at that particular time the best interest test was then applied. The assessments were completed by the home with input from the relative, a doctor and a psychiatrist. It was also pleasing to note that mental capacity was defined in respect of one matter, as the MCA 2007 requires, and this ensures that people are still able to retain as much independence as possible. The records showed us that health care needs are identified and met by healthcare professionals. We looked at individual records of the treatment and guidance given to people, which included specialist medical nursing, dental care, chiropody and other services and care from hospitals and community health services. People also had access to optical and audiology assessments to identify any sensory impairment lessening their ability to communicate effectively. Nursing unit; We looked at two care plans in detail and spoke to the people about the care provided in the nursing unit of the home. We also spoke with other people and their relatives during the day. The care plan system used has fourteen core plans to include, for example, communication, personal care and nutrition. There were good individual actions and outcomes were recorded. Short-term care plans are used for more specific needs for example, where people require assistance when eating with regarding to the risk of choking. We looked at end of life plans for people, risk assessments for falls, and nutrition and manual handling assessments. Skin viability assessments are also recorded to help prevent pressure ulcers. The care plans are reviewed monthly and we looked at a good example of an annual review, which includes the person and their relative. The care plans also contain information about activities people are involved in and each person has a weekly plan which is reviewed monthly. Healthcare professional records were very clear and all aspects of peoples needs were assessed and planned to include the support of other healthcare professionals, for example, the Community Psychiatric Nurse. The daily records were detailed and the reason for an identified bruise was recorded, an intravenous cannula had caused the bruise. This is good practice and indicates that staff are aware that people must be Care Homes for Older People Page 14 of 31 Evidence: safeguarded from any abuse and possible issues recorded. We looked at the records of a person with insulin controlled diabetes who was well supported and any changes were noted and acted upon, this person also regularly attends a diabetic clinic for additional professional support. The person told us that she was very happy in the home, the food was good, the staff were respectful and that there was a choice of activities which she joined in with. A person recently admitted with high dependency needs had care charts in the bedroom to record the change of position and the intake of food and fluids both were completed well. An additional chart regularly recorded the safety of the bed rails to help prevent a fall. The relative told us that at times her mother felt isolated and would welcome more one to one contact apart from when care was given, and communication and sensory needs were apparent. The relative also told us that the care was a high standard and the person being cared for was able to communicate to us that she was comfortable. Two other people living in the home together for two years told us, it couldnt be better here , we have everything we need, the food is really good, the staff are polite, we join in with holy communion in the home, and choose not to do any organised activities, and in the summer we go out on trips. A person living in the home told us that the home was a very happy home to live in and that she joined in with activities provided and felt respected by the staff. The daily records were detailed and meaningful, care staff are also encouraged to record daily care, however the nursing staff complete the care plans. We looked at an example of a wound care plan, the record included photographs and was well recorded and reviewed. The nursing staff have completed wound care training and access other healthcare professional advice when required. The nine completed surveys returned to us indicated that five people always and four usually receive the care and support they need. We looked at medication records and storage in a dementia care unit and samples in the nursing unit. We looked at the medication policy and procedures, which are reviewed every two years. There was no procedure for as required medication with regard to what action to take when the medication is used regularly. We recommend this is added to the homes procedures. Short-term clear care plans for individual as required medication were seen indicating to staff in what circumstances to administer them. The medication storage was secure and a secure trolley is used for Care Homes for Older People Page 15 of 31 Evidence: administration. The homely remedy policy is agreed more frequently by the doctor and was signed by the GP in February 2009. We recommend that the units have a copy of the Royal Pharmaceutical Society The Handling of Medicines in Social Care. The room where medication is stored is air-conditioned and the temperature in the room is regularly recorded to ensure medication is stored correctly. When liquid medication is opened it is dated, and medication not on the monitored dosage system is also dated when opened. A new external medication was not being stored separately to the internal medication to help ensure safe and hygienic administration. The medication records seen were well recorded and contained a picture of people and whether they had any allergies. The carer on duty told us that before aperients are given for constipation the persons chart of bowel movements is always looked at, as people are usually unable to communicate that themselves. This is good practice and we looked at an example of when aperients were given. We saw a record of a medication review by the consultant psychiatrist, and the local doctor visits the home weekly and reviews medication as required. Medication audits are regularly completed, however, a tablet count is recommended as we completed a spot check which was incorrect. The amount in the box may not have been correctly carried forward on the medication chart and tablets appeared to be missing. The manager agreed to improve the auditing system. A medication error since the last inspection had been dealt with correctly, and we were informed. Two medication administration records on the nursing unit were well recorded, one with regard to insulin where blood glucose levels were monitored appropriately. Medication training is provided in house and externally. We observed the that the vulnerable people in both dementia Units were treated in a manner which respected their right for dignity and privacy. Staff were engaging with people, and without exception staff were seen to be ensuring that everyone, irrespective of their degree of disability were treated with respect. Everyone has a single bedroom and the majority have ensuite facilities, and this helps to ensure that their privacy is not compromised. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Various activities are provided, including trips out to provide an interesting and engaging quality of life for people in all the units. Contact with family, friends and the local community is encouraged and people are able to maintain choice and control over their lives. The meals provide a variety of choice and the quality of ingredients has improved further helping to ensure that meals are well balanced and satisfying. Evidence: People enjoy flexibility in their daily lives and are able to exercise choice, for example, people are able to get up and go to bed when they choose. Staff offer some guidance over the advisability of getting up late and very early bedtimes in an attempt to offer some flexible boundaries over these aspects of life. We looked at the records of peoples interests and the activity boxes prepared, based on the needs of the individual. This enables staff to access the activity boxes when it is appropriate, and on a one to one basis engage with people. People in the dementia unit can access the activities in the nursing unit. Care Homes for Older People Page 17 of 31 Evidence: A number of relatives were seen and spoken to and they told us that staff made them feel welcome and that their friends/relatives were well cared for. It was evident that they looked forward to visiting as a result of the warm welcome given and visitors can make drinks in the Seven Counties lounge. We spoke to people and relatives in the nursing unit and they all agreed that the staff were pleasant and that they had a flexible lifestyle, excellent food, and a clean and comfortable home. Our visit coincided with the Cheltenham Races and staff and people in the home were celebrating the occasion by wearing clothes that reflected what racegoers might wear, for example, hats for the ladies. The staff had clearly made great efforts to ensure that people had the opportunity to enjoy the week, however, the rules of the exercise ensured no cash went to the bookmakers. The home had provided prizes for the lucky winners and this included wine and chocolates. People living in the home can access their bedrooms easily when they have visitors, and this provides privacy. In the dementia unit we found that people were able to express themselves, and a number of bedrooms we looked at provided evidence of the efforts staff had made to ensure the rooms reflect individual interests and memories. The AQAA told us that activities staff are employed solely to provide activities in the home and in the community, using the homes minibus. The home has visits from outside agents, for example; clergy, entertainers and schoolchildren, which helps to bring the community into the home where people less able to go out can enjoy the benefits. A gardening club has been introduced after requests from people living in the home and there are donkeys, chickens, a cat and a goat that people who wish to are encouraged and assisted to visit. Five people out of the nine that responded to our surveys told us that there were usually activities they could take part in, two people said there were sometimes activities they enjoyed and one said there was never any they enjoyed. The following comments were made in the surveys; rather than going out in the minibus I would like to be taken for interesting walks and the Xmas get together were nice. During the inspection we saw meals being served and this was completed in an unhurried manner with support offered by care staff. In the dementia unit meals were prepared individually by care staff, and this meant that that the amounts provided were what people wanted. The main meal of the day provides lots of choices to include a choice of three main courses. People had the choice of a fish, meat or vegetarian meal, and in addition if something else is requested, as it was on the day of the inspection (scrambled eggs), it is provided. Care Homes for Older People Page 18 of 31 Evidence: There is also choice in respect of the starter and dessert. The meals were plated carefully and their presentation seemed to encourage people in the dementia units to sit and enjoy them. Whilst there are mealtimes we saw residents choosing to wait or delay their meals and staff were able to accommodate them. There was also choice about where meals are eaten, although this may be restricted by the availability of staff. Where there are concerns over peoples poor appetite, the dietitian is consulted. We looked at correspondence from the dietitian that offered guidance to staff in respect of one person, and we were pleased to see that this person ate all of the lunch that day. The AQAA told us that special diets are catered for and assistance given to those who need help at meal times. Residents are consulted on their food preferences and offered another choice if the menu is not to their liking. People are given time to complete their meals in a relaxed manner and are encouraged to feed themselves where able. There are visits from the homes Hospitality Team to discuss ethnic and seasonal menus and advise staff if they have any concerns. The AQAA also told us that in the last twelve months the home has employed a hostess trained to help people that require help to eat. The menus have been reviewed and people have been consulted to help improve the choice. The manager told us that some finger food is provided in the dementia units and will be increased as peoples needs change. The new manager has also decreased the use of convenience foods, with the catering staff using more recipes. Eight people told us they usually like the meals provided, one person told us they always liked the meals. One person commented in the survey as follows;I find the standard of cooking good, occasionally i dont like what is served, but they always find an alternative. Care Homes for Older People Page 19 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a clear complaints procedure and takes complaints seriously protecting peoples legal rights. People know how to complain and staff know how to help them make their views known. The home ensures people are safeguarded from abuse with appropriate staff training and whistle blowing protection procedures. Evidence: We looked at the complaints procedure, which is given to all people in the home and their relatives. The AQAA told us that the staff encourage people to report any concerns or issues they may have as soon as possible so that these can be addressed promptly. Complaints are taken seriously and those who wish to complain or to refuse a service can do so without concern. The AQAA recorded that the home had two complaints in the last twelve months both were responded to within twentyeight days and one was upheld. We looked at a recent complain, which was well recorded, and the action by the home was to employ additional cleaning staff. There has been one safeguarding incident regarding personal monies, currently being investigated. Care Homes for Older People Page 20 of 31 Evidence: The AQAA also told us that the home supports people to express any religious, cultural or sexual preferences. The home works within the framework of the adult protection procedure and a copy of the guidance is available in the home. The staff attend safeguarding adults at risk training and the home has a whistle blowing policy. In the last twelve months more thought provoking training on safeguarding adults, by discussing scenarios, and answering questions has been introduced to staff. The nine surveys returned to us from people in the home indicated that they knew how to make a complaint and that six of the seven staff surveys told us that they knew what to do if someone raises a concern with them. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a well maintained, clean and welcoming home where their rooms are personalised, indicating that they are valued as individuals. Evidence: The AQAA told us that the systems and equipment in the home have been serviced or tested as recommended by the manufacturer or other regulatory body in 2008. All people have single bedrooms and the majority are ensuite. One dementia Unit is to be redecorated this year, and since the last inspection some of the communal furniture has been replaced. We saw a number of the bedrooms and were pleased to note that each one was different and reflecting the interests of the individual through pictures and photographs. The communal corridors are pleasantly decorated with pictures and this includes some work by the people living in the home. One dementia unit is on the third level, however, the back entrance could open straight onto outside areas. We were told that it is anticipated that changes will be made to create an outside garden that can be accessed directly from the Unit. Staff were excited by the prospect and we are sure it will improve the quality of life for the people living in the home. Care Homes for Older People Page 22 of 31 Evidence: The other dementia Unit has recently been decorated, and the communal areas and corridors have murals and paintings. There is a feeling of warmth and belonging in the unit. The bedrooms had been personalised and were seen as private spaces that belonged to each individual person. There is an additional area where residents can enjoy looking at and using items from their generation and during our visit we saw residents using this space. There is a small courtyard and garden and work was in progress in the courtyard to erect a pergola, this will further increase the options for people. One person we spoke to in the nursing unit had adaptations to aid communication, which included a telephone with loudspeaker access, large print newspapers and an anglepoise lamp for reading. The manager has recently completed an audit to identify people that need lockable storage in their rooms for any valuables, and had ordered some safes. The AQAA also told us that the Environmental Health Officers inspection required minimal adjustments and in a recent fire inspection the home had complied with previous recommendations. A recent Barchester maintenance audit recorded that the home achieved a very high score. The home continues to be well maintained and improvements are continually planned. Since the last inspection there are new curtains on two levels of the home. New fixtures and fittings have been added to communal areas and en suites. Several rooms have had new carpets. The laundry area has had improved flooring and new products for cleaning have been introduced to improve the smell of the home and all other areas of cleaning the home. The home was clean and fresh smelling throughout. The surveys returned to us indicated that all people were pleased with the cleanliness of the home. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally peoples needs are well met by the numbers of staff, however there may be a shortfall at mealtimes in the dementia units. The staff are well trained and supported, particularly when they are new, which helps to ensure that people are in safe competent hands at all times. The recruitment procedures are robust to help ensure that vulnerable people are safeguarded. Evidence: We spent the morning and lunchtime in Cotswold Rise dementia unit. During the waking day there are two members of care staff on duty during the morning and afternoon shifts. This is increased between the hours of 10:00 and 14:00 by an additional carer, and at the time of the inspection there was also a student present. At lunchtime one carer left the Unit and went to Severnview as we were told that the needs of the people in that Unit were greater. This left two carers and a student in Cotswold Rise at lunchtime, a period of high activity with eleven vulnerable and dependant people. One carer was plating the meals with the other was busy with one person that kept leaving the table. Students can of course assist but must not be seen as a substitute for carers. We felt that the loss of the one carer reduced the level of Care Homes for Older People Page 24 of 31 Evidence: support and supervision and that the level was not what would be considered the minimum standard. We do not feel that the assessed needs were being met at this mealtime. The staff, in spite of this perceived shortfall, responded to the many needs during our visit in a sensitive manner, and we were pleased and impressed by their calm and assured manner. The question of what staff are required to meet the assessed needs at mealtimes should be reviewed and identified shortfalls remedied. During our visit we noted that at all times staff were seen as good listeners, and always engaged with the people, resulting in a relaxed and pleasant atmosphere. There is an extra member of staff in the evenings shared between the two dementia care units to help get people ready for bed. We visited Severn View dementia Unit in the afternoon and sat with people and staff in a lounge. During the visit staff were presented with many demands and they responded in a measured and sensitive manner ensuring that people were treated in a dignified and individual manner. Staff were seen to be good listeners and at all times wanting to engage with the people living in the home. The Unit had a pleasant and relaxed atmosphere. It is anticipated that NVQ Level 2 dementia care training will be undertaken by all staff The general nursing unit has eight care staff and and two nurses in the morning and six care staff and two nurses in the afternoon and evening shift. The Head of Care is supernumerary. During the night there are three care staff and one nurse in the general unit and one carer in each of the dementia units. Six of the seven staff surveys returned to us told us that there is usually enough staff and one told us sometimes there is enough. We received the following comments in the staff surveys; I enjoy working at Moreton Hill because not only are the clients needs looked after but the individual staff problems are also supported, we could offer more one to one time with residents, we all work together as a team and in times of crisis we all come into our own and work great together, we do monthly clinical supervision as trained staff, we involve families in the care we give, it would be nice to have more staff to spend quality time with people The manager told us that the use of agency staff has reduced and in the three weeks prior to the inspection no agency staff were used. The AQAA told us that a drop in staffing levels on the dementia units last year was managed by using trained nurses from the main house, this led to increased supervision of current dementia staff and had a beneficial effect on their levels of Care Homes for Older People Page 25 of 31 Evidence: competence and satisfaction of relatives. We looked at three recruitment records in detail and there was good information and appropriate checks to safeguard people living in the home. References are sought and interview notes were made. The application form identified any gaps in employment. Risk assessments are completed for any information of concern on Criminal Records Bureau (CRB) checks. There is a formal induction and foundation training programme in line with Skills for Care standards, and the home keeps a record of all training. The AQAA informed us that a nominated home trainer provides internal mandatory training and external training is accessed where needs are identified. The National Vocational Qualification (NVQ) level 2 programme is ongoing and staff are encouraged to take part. New members of staff are supervised and have a named mentor; additional support is given dependant on individuals training needs requirements. We looked at the homes training information on the computer with the manager and comprehensive training is provided to include for example; manual handling, first aid and infection control. All seven the staff surveys told us that the staff were trained well and that staff have regular support form their manager. The Head of Dementia Care trains the care staff on the units. The registered manager is completing a Leadership Person Centred Dementia Care training course over five days, which will be cascaded to all staff, the head of dementia care has also completed the same course. The nurses have meetings every six weeks to update their knowledge and this includes tissue viability training. Four nurses have completed End of Life palliative care training this year. Care Homes for Older People Page 26 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is dedicated to providing people with a safe service that they can rely on to meet their needs, and that living in the care home is a positive experience. The quality assurance methods used ensure that people views are sought and that the home takes them seriously by continually improving the service. Evidence: The homes new registered manager has completed the Registered Managers Award and a leadership development programme through Barchester. The manager is a first level nurse and has worked at Moreton Hill for twelve years, first as a nurse then as the homes trainer for five years. The AQAA told us that the home has regular residents meetings to discuss their thoughts and views, these are then acted upon. Annual quality surveys are taken and Care Homes for Older People Page 27 of 31 Evidence: more specific surveys to find out what people want and then to make improvements. An example was a survey to improve the homes menu selection. People are also consulted when colours for soft furnishing and bedding are being decided. We looked at the January 2009 results of the last annual quality assurance survey carried out in October 2008. Questionnaires had been sent to people living in the home. Next-of-Kin and visiting professionals were also invited to complete the survey on the telephone or by email. The results from the surveys were sent to all people living in the home and the relatives and professionals in February 2009. The surveys identified several actions to be taken, which addressed the following issues for example; better communication for people and their relatives, improved range of activities, to improve the gardens and people experienencing problems and not communicating them to the staff. The actions were excellent and most had already been completed. The surveys indicated that peoples satisfaction with the home was outstanding and that staff should be congratulated at their next meeting. The AQAA told us that last year a very high score was achieved in the a Barchester maintenance audit. All accidents and incidents are recorded. Fire risk assessments are in place. The home is compliant with disposal of clinical waste, disposal of medicines, Control of Substances Hazardous to Health, electrical safety tests and the maintenance of equipment and there is a home incident plan in place. Risk assessments are generated as required to reduce risk to the minimum. The home provides secure facilities for peoples money and valuables. We looked at the accident records, which the manager has sight of and is maintained on the computer for auditing. There were details of follow-up preventative measures, for example a lower bed was ordered for someone at risk of falling out of bed. The maintenance person is responsible for achieving fire safety, and we looked at the records. All staff are trained in fire safety and fire marshalls have been trained on both day and night duty. Fire risk assessments have been completed and weekly fire alarm checks are recorded. The home is well managed by a competent and experienced registered manager. Quality assurance surveys help to ensure that the home is run in the interests of people. There are safe working practices to help ensure everyone in the home is protected. Care Homes for Older People Page 28 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 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 7 9 We recommend that mental capacity assessments are kept under review. We recommend that a tablet count is completed during medication auditing, as we revealed an inconsistency when we complete a spot check count. We recommend that the units have a copy of the Royal Pharmaceutical Society The Handling of Medicines in a Social Care. We recommend that any as required medication protocol should record what action to take and when should the medictaion be used regularly. This should be added to the homes medication procedure. It is recommended that the amount of staff required to meet the assessed needs of people in the dementia units at mealtimes should be reveiwed, and identified shortfalls remedied. 3 9 4 9 5 15 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) 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. 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