Inspection on 15/04/09 for Mount Vale Care Home

This inspection was carried out on 15th April 2009.

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

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

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Mount Vale Care Home 16/04/08

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

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mount Vale Care Home Yafforth Road Northallerton North Yorkshire DL7 8UE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Martin     Date: 1 5 0 4 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 32 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 32 Information about the care home Name of care home: Address: Mount Vale Care Home Yafforth Road Northallerton North Yorkshire DL7 8UE 01609775444 01609768589 mountvale@barchester.com www.barchester.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Barchester Healthcare Homes Limited Name of registered manager (if applicable) Mrs Sarah Louise Broadbent Type of registration: Number of places registered: care home 65 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: 65 The registered person may provide the following category of service only: Care home with nursing: Code N, to service users of the following gender: Either, whose primary care need on admission to the home are within the following categories, Dementia: Code DE, Old age, not falling within any other category: Code OP. Date of last inspection 65 0 Over 65 0 65 Care Homes for Older People Page 4 of 32 Brief description of the care home Mount Vale is registered as a nursing home and can accommodate up to 65 people. The home provides care for people whose care needs fall within the categories of old age or dementia. Mount Vale is owned by Barchester Health Care Homes Ltd and is a new, purpose built care home. The building is made up of a former Georgian maternity hospital, which has recently been enlarged with modern extensions and converted into a care home. The home is located on Yafforth Road, Northallerton and stands in its own grounds, with a private car park. All of Mount Vales bedrooms are singles and have en-suite toilet facilities. Modern communal bath, shower and toilet facilities are conveniently located around the home and include equipment to help people use them. A number of communal lounge and dining rooms are also available for people to use if they want to. Enclosed gardens provide safe access to fresh air and the homes wider grounds offer more outside space. At the time of this inspection the homes fees ranged from £680 to £850 per week. These prices are dependant on what room is chosen and what nursing needs people may have. This does not includes extras such as chiropody, dental requirements, optical requirements, physiotherapy, hairdressing, newspapers, personal dry cleaning, staff escorts to hospitals and taxis. Up to date information about the homes fees and terms and conditions should always be sought from the homes manager. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of Mount Vale. The site visit was completed on 15th April and was completed by two inspectors. One of the inspectors is a pharmacist, who spent five hours at Mount Vale. The other inspector spent nine hours at the home. We looked at a selection of records, observed care practice and meal times, looked around the building and talked to people who live at the home, the staff and management. During the visit we also examined the homes medication policy & procedures, fourteen current medication administration record (MAR) charts, and the medication storage & handling arrangements in both units. We were also told about the investigation of recent medication incidents already reported to us. Before our inspection visit we asked the home to complete a self-assessment. This was completed well and returned to us on time. It provided the information we had asked for and told us what the home did well and what could be improved. We also sent Care Homes for Older People Page 6 of 32 surveys to a selection of people who live at Mount Vale, a selection of staff and some of the health care professionals (such as doctors and district nurses) who work with the home. Eight people who live at the home, two staff members and three health care professionals completed and returned surveys to us. The results from these surveys have been included in this report where appropriate. What the care home does well: All eight people who returned surveys told us that they had received enough information to help them make informed decisions before moving into Mount Vale. They also told us that they had received a contract. People can visit the home, are provided with written information and have their needs assessed before moving in. This helps people decide if Mount Vale can meet their needs and is somewhere they want to live. The home has in place good systems for care planning and recording peoples care needs. Staff are kind and helpful and peoples care needs were generally met. People who returned surveys were asked if they received the care and support they needed. Four people said always and four people said usually. All eight people told us that staff listened and acted on what they said. Comments made to us in surveys and during our visit included they are very kind and caring, they spend time with me if Im upset, all very kind and helpful really and mostly patient and kind and they will do anything you ask of them. Three health care professionals returned surveys and told us that the service always met peoples health care needs. Their comments included the advice & recommendations that I have given regarding foot ulcers and general care has always been documented and followed to the letter and (provides a) high level of personal care. We observed excellent administration practice and communication techniques when the nurse in charge gave medicines to people at lunch time. There are regular activities and events that people can take part in and opportunities for peoples friends and families to visit the home. Comments from people who live at Mount Vale included we have an excellent activities coordinator who has made a huge difference to the social activities I take part in and we have lots of fun. A varied menu is provided, with a choice of each meal made available. The home has in place procedures for reporting and investigating concerns and we found that complaints had been investigated and responded to. All eight people who returned surveys told us that they knew how to complain if they needed to and a health care professional who works with the home commented all concerns Ive raised have been discussed and solutions found and acted upon. Mount Vale provides a purpose built care home, that is comfortably furnished and decorated to a high standard. It provides people with a pleasant place to live. Comments made to us by people living in the home included the surroundings, they could hardly be any nicer, its nice to be surrounded by pleasant things and on the whole yes, its kept clean and tidy, and the laundrys well run. Staff are recruited safely and provided with regular training to help them do their jobs. People spoke well of the homes permanent staff, with comments including the carers particularly are wonderful, lovely and mostly patient and will do anything you ask of them. An appropriate management structure is in place. Regular checks and systems are also in place to monitor the service provided at the home and to maintain health and Care Homes for Older People Page 8 of 32 safety. 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 Care Homes for Older People Page 9 of 32 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 32 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 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can visit the home, are provided with written information and have their needs assessed before moving in. This helps people decide if Mount Vale can meet their needs and is somewhere they want to live. Evidence: The homes self-assessment told us that people are invited to visit Mount Vale and are given written information about the home before they decide to move in. The selfassessment also told us that all service users are fully assessed prior to admission. All eight people who returned surveys told us that they had received enough information to help them make informed decisions before moving into Mount Vale. They also told us that they had received a contract. We looked at a selection of care records during our visit. These records included written assessments that had been completed by the homes staff before people Care Homes for Older People Page 12 of 32 Evidence: moved into the home. They also contained information from other professionals who had been involved in planning and organising peoples move into Mount Vale. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has in place good systems for care planning and recording peoples care needs. Staff are kind and helpful and peoples care needs were generally met. However, the continuity and quality of peoples care sometimes appears to be effected by the use of temporary agency staff. Evidence: People who returned surveys were asked if they received the care and support they needed. Four people said always and four people said usually. All eight people told us that staff listened and acted on what they said. Comments made to us in surveys and during our visit included they are very kind and caring, they spend time with me if Im upset, all very kind and helpful really, mostly patient and kind and they will do anything you ask of them, one or two come with the attitude theyll not do what isnt their job, but its only one or two of them and some staff are better at this (listening) than others. Three health care professionals returned surveys about the home. They told us that the service always met the health care needs of the people living there. Their Care Homes for Older People Page 14 of 32 Evidence: comments included the advice & recommendations that I have given regarding foot ulcers and general care has always been documented and followed to the letter and (provides a) high level of personal care. However, some felt that a high turn over of staff recently and the use of agency staff sometimes effected peoples care. Comments included due to fluctuant staff levels, there is not the continuity of care which would be ideal and there have been a number of concerns raised with the home recently about the standard of care provided. These issues are covered in more detail in the staffing and complaints sections of this report. We looked at a selection of care records that are kept by the home. These records showed that each person had in place an assessment of their needs, care plans setting out the care they needed and how it should be provided, records of the care given and any involvement from other professionals. However, we found that peoples records were not always being reviewed and up dated as often as they should be. Peoples care plans and records should be reviewed and updated every month or more often if their needs are changing more frequently. We looked at how the home cares for people who are at risk of pressure damage. We found that risk assessments are carried out to identify who is at risk of pressure damage. We looked at the records of two people who had a wound or pressure sore. We found that information about the wounds were clearly documented on a body map and a wound assessment chart had been completed. Photographs were used to monitor the wounds accurately. Records showed regular monitoring by nursing staff, including dressing changes and visits from other health professionals when this was considered necessary. Records also showed us that some people who had been admitted to the home with pressure sores had recovered from them while living there. A pharmacist inspector spent time looking at the way medication is stored, administered and managed at Mount Vale. There are recently revised procedures in place for ordering, receiving, administering and disposing of medicines. The Nursing & Midwifery Council, Royal Pharmaceutical Society of Great Britain and CSCI professional advice documents on handling medicines in social care are also available in the home. The manager has carried out appropriate investigations into recent drug errors and has implemented ongoing management checks. However, we found supporting evidence that some staff working in the home may still not fully understand what is expected of them when handling and giving medication. We found that there are very few administration gaps on the MAR charts, meaning Care Homes for Older People Page 15 of 32 Evidence: that people living in the home can expect to receive their prescribed medicines correctly. However, handwritten entries of six medicines seen on five MAR charts were not sufficiently clear and detailed enough to be sure that other staff would always follow the prescribers instructions consistently. We saw that the quantity of medication brought forward from one monthly cycle to another is usually being recorded on the new MAR chart. This means it is possible to produce a complete record of medication within the home and to check if medication is being given correctly. Medicines, including controlled drugs, are stored securely in cupboards or refrigerators in locked store rooms which are maintained at suitable temperatures. This suggests that medicines are being stored securely at temperatures and conditions recommended by the manufacturer, so that staff know they are safe to use when needed. During our visit we noticed that nurses had been signing MAR charts for some creams and an antiseptic mouthwash which had actually been administered earlier by care staff. We spoke to staff and the manager about this during the visit. Professional best practice guidance recommends that whenever medication administration tasks are delegated by a nurse to a carer, then the whole of the task should delegated, including making a record on the MAR chart. Individual medication care plans should be developed to reflect the personal preferences and lifestyle choices of people living in the home. For example, daily medication giving times should be adjusted for anyone who prefers not to get up and have breakfast until later in the morning. The MAR chart dividers already have a section to record a summary of such care plan information. Care Homes for Older People Page 16 of 32 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. There are regular activities and events that people can take part in and opportunities for peoples friends and families to visit the home. A varied menu is provided, with a choice of each meal made available. However, peoples satisfaction with the meals varied. Evidence: The home employees an activities coordinator, who organises activities and social events for people to take part in. She was on holiday during our visit, but people who live in the home showed us the activities timetable that they had been given for the next week or so. This showed a variety of entertainment, religious services and activities taking place and we saw that Easter decorations were displayed around the home. Comments from people who live at Mount Vale included we have an excellent activities coordinator who has made a huge difference to the social activities I take part in and we have lots of fun. Comments from health care professionals who work with the home included there are a lot of activities available for the residents to participate in if they wish. Plus there are quiet areas and communal areas. I especially think the time and effort put into memory lane (upstairs) is amazing, the residents seem to especially like it. We observed staff offering people the daily newspaper and magazines to read and asking what people wanted to do with their mail. For example, Care Homes for Older People Page 17 of 32 Evidence: did they want it now or would they like it putting in their room for later. The home does not restrict people visiting Mount Vale. We saw visitors coming and going throughout our visit and people we spoke to confirmed they could visit when it was convenient for them. In their self assessment the home told us how they hold events that peoples family or friends can participate in. For example, a recent Valentines meal and a red nose day lunch that was planned. People were able to choose where they wanted to spend their time during the day, what they wanted to do and what they wanted for their meals. We received mixed comments from people about the food provided at Mount Vale. When we asked health care professionals what the home did well their comments included provision of specialised dietary care. Peoples care records included nutritional risk assessments and showed that dietary advice and supplements were obtained if people were considered to be at risk of malnutrition. Food charts were in place where peoples dietary intake needed monitoring, although these were not always being completed properly by staff. For example, sometimes not recording snacks between meals or the amount someone had eaten. When we asked people in surveys if they liked the food at the home two people said always, five said usually and one said sometimes. Comments included I have put on weight, the chef is lovely, he comes up to talk to me and asks me if I have enjoyed my food, I think its all been done on a shoe string and not very tasty, its so so, the presentation of it and the dining room is excellent, I think most people think its very good and it depends on who is on duty at the time, when there are agency chefs on duty its usually poor. One person told us that food served in peoples rooms was sometimes cold and they had to ask staff to re-heat it. We discussed peoples comments with the manager. The manager confirmed that a new chef is now employed at the home and another permanent member of kitchen staff was being employed on the day we visited. The manager hopes that this more stable staff team will help to improve peoples dining experiences. We spent time observing the meal times at Mount Vale. The dining rooms were pleasant places to eat, with the tables set nicely. Menus were available and showed that lunch was a three course meal, with a choice available for each course. We saw staff offering people a choice of food. For example, showing people the different options to help them choose. The staff we saw were encouraging and helpful when they assisted people with feeding, saying things like do you want the lemon squeezing on your salad and lets give this a try and see what you think. One person changed their mind about what they wanted to eat and staff brought her something else to eat Care Homes for Older People Page 18 of 32 Evidence: without any fuss. We saw that the food was served nicely and looked appealing. Care Homes for Older People Page 19 of 32 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. The home has in place good procedures for reporting and investigating concerns. However, although each concern is investigated and responded to, the number and similarity of concerns raised recently about peoples care suggests that people dont always get the quality of care that they expect from the home. Evidence: The home has in place a complaints procedure and information about how to make a complaint is made available to people. For example, information about raising concerns and complaints is displayed in the homes reception areas. Comments from health care professionals who works with the home included all concerns Ive raised have been discussed and solutions found and acted upon. All eight people who returned surveys told us that they knew how to complain if they needed to. We looked at the homes complaints record, which showed that concerns and complaints had been investigated by the homes manager and responded to appropriately. A recent safeguarding issue had been reported to the local authority appropriately and staff induction records showed that staff had received training on safeguarding adults. Nine people have raised concerns with the home since the last inspection. Although these concerns had each been investigated and responded to appropriately, the number and similarity of these concerns suggests that people are not always receiving Care Homes for Older People Page 20 of 32 Evidence: the level of care that they expect from the home. We discussed this with the homes manager who feels that there have been problems due staff turn over and having to use a lot of agency staff recently. However, she told us that new permanent staff are being recruited, including a new unit head who will help to improve the quality and continuity of care. Care Homes for Older People Page 21 of 32 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. Mount Vale provides a purpose built care home, that is comfortably furnished and decorated to a high standard. It provides people with a pleasant place to live. Evidence: We spent time looking around the home during our visit. Mount Vale has recently been converted and built for use as a modern care home and the building met the requirements of building control and the fire authority before opening. The environmental health officer visited in march and gave the home an excellent rating. There have been no recent visits by the fire authority. The decoration, furnishings and equipment at Mount vale are all new, good quality and in good condition. The home is pleasantly and comfortably decorated and furnished. The upstairs dementia care unit has been decorated and designed with the needs of people with dementia in mind. For example, coloured doors and picture to make toilets easier to find and lots of interesting items around the unit to create a more stimulating environment. Peoples rooms had been personalised with their own possessions and each bedroom has its own central heating thermostat, so that people can change their room temperature to suit their preferences. The furniture and decoration in Mount Vales communal areas provides very pleasant and comfortable places for people to spend their time. In their self assessment the home told us about their plans to improve the homes gardens and outside spaces. The manager Care Homes for Older People Page 22 of 32 Evidence: confirmed this during our visit, describing plans for an outside walkway, with sensory objects and plants for people to enjoy. People who returned surveys were asked if the home was kept fresh and clean. Seven people said always and one said usually. Comments made to us by people living in the home included the surroundings, they could hardly be any nicer, its nice to be surrounded by pleasant things and on the whole yes, its kept clean and tidy, and the laundrys well run. On the day of our visit the home appeared clean and tidy and we did not notice any unpleasant smells. Care Homes for Older People Page 23 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited safely and provided with regular training to help them do their jobs. However, a high staff turnover and use of agency staff has effected continuity of care and people dont always feel that staff have enough time to care for them, despite appropriate numbers of staff appearing to be on duty. Evidence: During our visit we observed care staff talking to people and helping with their care. We saw that staff were very polite, helpful and interacted well with people. Care and support was provided in a caring and supportive way. People who returned surveys and who we spoke to during out visit spoke well of the homes care staff. For example, the carers particularly are wonderful, lovely and mostly patient and will do anything you ask of them. We looked at a selection of recruitment records. These showed us that new staff are recruited safely and that the required checks and references are obtained before people start work. Where staff start to work after a PoVA First check (a check that allows staff to work while awaiting their full criminal records bureau disclosure) appropriate supervision and shadowing arrangements are put in place. We received mixed feedback from people about staffing levels at Mount Vale. In the surveys we asked people if staff were available when they needed them. Three people Care Homes for Older People Page 24 of 32 Evidence: said always, four said usually and one said sometimes. Comments made to us about staffing levels included included they cant answer the bell immediately for everybody, but its very tense for an old person if someone says theyll come back in ten minutes, but they dont, because you cant really double buzz if you know what I mean, I used to wear make up and nice jewelery, perfume etc and I dont think they (the staff) spend the time with me I expected, there are times when there are not enough staff on and this can mean that, for example, morning coffee arrives just before lunch, or washing is late to be returned and the thing is they havent got the time. We talked to the manager about staffing levels and looked at the homes rotas. This showed us that there is usually a trained nurse on each floor, with four carers on each floor during the morning and three carers in the afternoon and evening. At night there is one trained nurse and one carer on each floor. Although staffing levels on paper appear appropriate, the staffing levels and deployment at the home should be reviewed and serriously considered, given peoples comments and experiences. People kept telling us that Mount Vale had a high turn over of staff and that agency staff were being used a lot to cover shifts. The information provided in the homes self-assessment confirmed that this was the case. Comments included staff have regular training in home ventilation (use of specialist equipment to help people breathe), but high turn over of staff means repeated visits, I like the carers very, very much and the resident nurses, but were getting a lot of agency and due to fluctuant staff levels, there is not the continuity of care which would be ideal. When we asked people what the home could improve their comments included hire more staff and try to keep them, staff retention and stable staff. We discussed this with the manager. She explained that the home is continuously recruiting staff in order to maintain staffing numbers. Agency staff are used when necessary to maintain staffing levels in the home, but that where possible the home tries to use the same agency staff to increase continuity. New staff have been recruited and once the required employment checks have been completed the manager says that the home will be fully staffed and agency staffing will be greatly reduced. Both staff who returned surveys told us that they were given training that kept them up to date, helped them meet peoples needs and was relevant to their role. We looked at the homes training records. These showed that a variety of training was provided and that new staff received a proper induction training programme. The homes deputy manager now uses half of her time to coordinate training at the home and is a qualified manual handling trainer. However, in their self-assessment the home told us that only three care staff had achieved an National Vocational Qualification (NVQ) in care, although seven more staff were working towards this qualification. Care Homes for Older People Page 25 of 32 Evidence: We spoke with one person who has very specialist needs. The home provides training for staff and regular support from a specialist health professional to help meet this persons needs. However, people told us that despite this training and support staff do not always feel confident about using the specialist equipment. The person concerned was aware of this and told us that it made them feel vulnerable and anxious. Because of this the manager needs to look at what additional training and support staff need. Care Homes for Older People Page 26 of 32 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. An appropriate management structure is in place, with regular checks and systems being in place to monitor the service provided at the home and to maintain health and safety. Evidence: The home has an appropriate management structure in place. The homes manager is a registered nurse, who has experience of nursing and managing staff. She has successfully registered with us as the homes manager. She is supported by an experienced deputy and two unit managers. The home is also supported by Barchester Health Cares wider management systems and processes. The home uses the Barchester Health Care quality assurance system. This is a system of weekly, monthly, six-monthly and annual audits that are completed by the homes staff. We looked at the records of some of these audits and found that they were thorough and had been completed well. A residents survey has also recently been undertaken and in their self-assessment the home told us that the results of this had Care Homes for Older People Page 27 of 32 Evidence: been positive. At the time of this inspection the home encouraged family or other appropriate people to help people manage their finances and personal monies. They do not handle or hold money for people living at the home. We randomly checked a selection of maintenance and safety records. The maintenance manager undertakes regular safety checks of equipment to make sure it is working properly. We saw records of these checks, which included included the fire alarms, emergency lighting, the water temperature at hot water outlets and electric beds. Appropriate maintenance contracts are in place for the fire alarm, nurse call system and equipment that is used to lift and move people. Health and safety advice is readily available from Barchester Health Cares health and safety department and regular meetings to discuss health and safety at the home have been set up. Staff training is provided in health and safety related areas, such as manual handling and first aid. Care Homes for Older People Page 28 of 32 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 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Peoples care plans and records should be reviewed and updated every month or more often if their needs are changing more frequently. Care workers involved in the handling and administration of medicines should accept personal responsibility for the whole of the task, including making a record of administration, delegated to them by a nurse. The homes procedures and training programmes should be amended to ensure current professional best practice guidance is being followed. Handwritten entries on MAR charts should should be accurately recorded and detailed. They should also be signed, dated and checked by a witness. This makes sure that the correct information is recorded so that all staff understand and follow the changes correctly. Individual medication care plans should be developed and agreed which reflect the personal preferences and expressed lifestyle choices of people living in the home. These care plans should be regularly reviewed in line with changes in peoples medication, health & wellbeing. 2 9 3 9 4 9 Care Homes for Older People Page 30 of 32 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 5 15 Staff should complete dietary/fluid intake charts thoroughly and in enough detail to provide a full picture of the persons dietary/fluid intake. Such charts are of no practical use unless they are completed accurately and in sufficient detail. A review of peoples dining experience and the food provided should be carried out, in response to peoples comments about the food provided at Mount Vale. An analysis of concerns and complaints should be carried out, to ensure that similarities and patterns in concerns are picked up and acted upon appropriately. Staffing levels and deployment should be reviewed, to ensure that they meet the needs of the homes residents. A permanent and consistent staff team should be developed, to improve the continuity of care that people receive. 50 of the homes permanent care staff should achieve a National Vocational Qualification (NVQ) in care. The specialist training and support being provided to staff who use specialist equipment should be reviewed and developed, to ensure that it meets their needs and results in them feeling confident and competent when carrying out these specialist tasks. 6 15 7 16 8 9 27 27 10 11 28 30 Care Homes for Older People Page 31 of 32 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. 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