Inspection on 12/12/07 for Quarry Mount Residential Care Home

This inspection was carried out on 12th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Quarry Mount Residential Care... 02/12/08

Quarry Mount Residential Care... 10/10/08

Quarry Mount Residential Care... 25/10/06

Quarry Mount Residential Care... 24/11/05

Quarry Mount Residential Care... 14/06/05

Quarry Mount Residential Care... 18/01/05

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Quarry Mount Residential Care Home 83 Bath Road Swindon Wiltshire SN1 4AX Lead Inspector Sally Walker Key Unannounced Inspection 09:30 12th December 2007 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Quarry Mount Residential Care Home Address 83 Bath Road Swindon Wiltshire SN1 4AX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01793 527715 01793 616130 Quarry Mount Care Ltd Mrs Karen Meadowcroft Care Home 32 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (32), of places Physical disability over 65 years of age (4) Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users who may be accommodated in the home at any one time is 32 No more than 25 service users aged 65 years and over with dementia may be accommodated at any one time No more than 4 service users aged 65 years and over with a physical disability may be accommodated at any one time 25th October 2006 Date of last inspection Brief Description of the Service: Quarry Mount is a large detached house in the Old Town area of Swindon offering accommodation and care to 32 older people, some of whom have dementia. The home is a short walk from local shops, post offices, bus stops and churches. The home is arranged on three floors. There is bedroom accommodation on all three floors. The communal space is arranged on the ground floor and consists of a large lounge, a dining room and a further lounge and dining room. There is also some seating accommodation in the hallway. There are two semi-detached bungalows in the rear garden accommodating four residents. There is a large garden at the rear. Seats and tables are provided in the summer so that residents can sit outside. A people carrier is provided for outings and for shopping. The staffing rota provides for a minimum of 7 care staff during the waking day. There are 3 waking night staff. Details about the weekly fees can be obtained directly from the home. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 12th December 2007 between 9.30am and 6.40pm. Mrs Karen Meadowcroft was present during the inspection. Mr Richard Harris of Quarry Mount Care Limited was present for some of the inspection. We spoke with 7 residents, 2 staff and one visitor. A tour of the building was made. We looked at the care plans, daily records, risk assessments, staff records, training records and menus. As part of the inspection process we sent survey forms to the home to distribute to the residents, relatives, GPs and healthcare professionals for their comments on the service. Comments are to be found in the relevant sections of this report. The home was asked to complete an Annual Quality Assurance Assessment as part of the inspect process. This was completed in full. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The home makes sure that it knows as much as possible about prospective residents and their social and medical history before confirmation that their needs can be met. Consideration is made as to whether residents in shared rooms will be compatible. The home regularly reviews its statement of purpose as the service changes. Although not always evidenced in the records, staff are fully aware of residents’ nutritional needs. If residents did not eat a full meal for any reason, staff were seen to give snacks later during the day. Any concerns over weight loss was immediately referred to GPs. Staff also made sure that residents had plenty of drinks throughout the day and night. Residents had good access to healthcare professionals. Medication data sheets are available for staff reference. Systems are in place for safe administration of medication. Staff engage with residents and good relationships have been established. The majority of staff are very respectful of residents dignity and privacy. Staff were aware of residents additional needs during the day, for example, getting a coverlet for one resident who said they were cold, making extra drinks and ensuring residents had footwear when they were walking about. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 6 An activities co-ordinator has been appointed for 30 hours a week. There is an improved programme of events both at the home and in the locality. Residents have more opportunities for accessing the locality. A range of different activities are specifically geared to the best outcome for individual residents. These include one to one sessions as well as group activities. Picture diaries had been produced with some residents so they could discuss what they had done in terms of activities with family. Families are encouraged to provide family photographs to inform the social care planning process. The home provides a varied choice menu for lunch. Meals and cakes are ‘cooked from scratch’. Although only sandwiches are provided for the evening meal, residents seemed satisfied with this. There is research-based evidence that some people with dementia will eat more of a meal if it is ‘finger food’. Staff are aware of, and have been trained in the local Safeguarding Adults procedure. Additional personal notices have been placed on fire exits near to some residents’ bedroom doors so that they do not mistakenly exit the premises. The home was cleaned to a good standard and no unpleasant odours were detected at any time. Staffing levels enable residents to receive the care and attention they need at different times of the day. A robust recruitment process is in place. No one starts work without checks on their suitability to work with vulnerable people. Staff are well trained and have good access to updated relevant training. More than half of the staff hold NVQ Level 2 or above. Mrs Meadowcroft and the providers are well known to the residents. They regularly consult with residents and families about the service. What has improved since the last inspection? All assessments are dated and sourced to enable comparison of progress over a period of time. The proprietors have considered ‘end of life’ initiatives and the impact of The Mental Capacity Act 2005 on residents’ decision making. [This is essentially to ensure people continue to make their own decisions. It also means that any decisions made by others will be in the person’s best interest]. Initial assessments have been carried out with regard to residents capacity and giving of daily care. Staff are to receive training on the implications of the Act and people’s decisions to make advanced directives on their healthcare. All staff, including those who had not resided in the UK for more than 3 years, are trained in medication administration. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 7 Documentation is available to record complaints and their outcomes; although none had been received. Significant efforts have been made to upgrade the quality and comfort of the environment for residents. All of the good practice recommendations and one requirement from the last inspection have been actioned. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families are given comprehensive information about the service in the statement of purpose. Detailed pre-admission assessments ensure that all needs are known before a placement is offered. EVIDENCE: The home sets out its aims and objectives in the statement of purpose. This is regularly reviewed and revised as the service changes. Information is now included on the home’s evacuation policy and procedure in the event of a fire as we recommended. We advised that consideration could be given to easy read guidance about different typefaces from the Royal National Institute of Blind People. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 10 There was evidence that the home gains as much information as possible from a range of sources when carrying out pre-admission assessments. Confirmation from healthcare professionals is sought about any clinical diagnoses. Mrs Meadowcroft said that when considering offering a shared room to a prospective resident, she ensures that both people will be compatible. Action had been taken to address the recommendation we made that assessments are dated and sourced to enable comparison of progress over a period of time. One of the residents said they had come for ‘an interview’ with the manager before they were admitted. They said they had been shown the bedroom and other facilities. In a survey form one of the residents wrote: “My daughter made all enquiries decided it was the best place for me as I was able to have a bungalow in the garden.” Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans show little evidence of how the care is directed. Daily reports however are very detailed in showing how care needs are met. Residents have good access to healthcare professionals. Systems are in place for safe administration and control of medication. The majority of staff uphold residents rights to dignity, privacy and respect. EVIDENCE: Each resident had an individual care plan stating their assessed needs. It was clear that the care plans were regularly reviewed. However the care plans we looked at had very little detail of how the assessed needs are to be met and monitored. There was little evidence of planning and monitoring in the care plans; only a statement of need in some cases. The daily reports were generally very detailed and showed a good picture of how the care was delivered. Some action had been taken to address the recommendation we Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 12 made that staff record how they reassure and support residents when they are distressed. However there were some entries which were open to interpretation, for example, ‘give reassurance’, ‘physically aggressive’ and ‘has started to become aggressive with staff’. Another care plan identified a bowel condition, stating food, which would aggravate the condition, should not be given. There was no record of what these foods were. We talked about the need to record what was witnessed or said. We also talked about the need to state clear guidance to staff in the care plan about how behaviours that challenge are managed. Mrs Meadowcroft was keen to address this with an urgent review and revision of all the care plans. Individuals risk of developing pressure damage were being assessed but the totals were not always recorded to show the next step in the process. We again advised that care plans must fully record each resident’s level of risk together with strategies used to minimise the risk. We were told that pressure risk assessments would be reviewed if a resident’s care needs changed. Information about the use of hoists was kept by the equipment. Individual care plans must also give details of any equipment or treatment to be used. We were told that details of the risk assessment for use of bed rails [often referred to as cot sides] would be found in the district nursing notes. We advised that the home must keep their own notes and not rely on nurses’ records. Residents were regularly weighed and any concerns over significant weight variation was referred to the resident’s GP. It was clear from observation that residents’ nutritional status was being supported but it was not evidenced in the care plans. We were told that if a resident does not eat their meal for any reason, staff offer a snack later on. This was evidenced during the afternoon when a member of staff gave a pudding to one resident. All of those residents visited had drinks within easy reach. Refreshments were given throughout the day. One resident said they had cups of tea in the night. We looked at whether staff had certificates of training from the district nurse to evidence that staff were competent to carry out blood glucose level monitoring. Some district nurses are unwilling to provide evidence that they have trained staff in this delegated responsibility. We advised a record is kept of all the named staff who have attended the training. This should include the date it occurred and who supplied the training. Daily reports recorded the regular results of blood glucose testing. However the care plans did not state the acceptable parameters of each resident’s wellbeing. There was no guidance on how each resident would have their condition managed or monitored. We advised that the home should consult with the diabetic nurse or other healthcare professional responsible for each resident’s care. The care plans must then record the strategies to be used. It must also be recorded what should happen if blood levels are outside the safe parameters. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 13 One of the residents told us that if they needed to see their GP they would ask staff who would arrange a visit. There was evidence in the daily reports that any concerns were promptly referred to the relevant healthcare professional. Residents had good support from the district nurses and GPs. At the last inspection we observed one of the GPs discussing a resident’s medical condition in a corridor. This highlighted the need for more office space. We were unable to conclude whether this practice was ongoing. We are however reassured by Mrs Meadowcroft’s positive attitude to ensuring confidentiality when we discussed the care of residents. Action has been taken to meet the recommendation that we made about consideration of the Department of Health ‘End of Life’ initiative. Mr Harris, in the Annual Quality Assurance Assessment stated that the home is working towards the Gold Standard Framework for palliative care with the assumption that it will eventually be applicable to care homes without nursing. The home also has a policy for caring for people who may need terminal care. Staff have received training in caring for people who may be dying. This links in with the home’s initial response to the Mental Capacity Act 2005 in assessing residents’ capacity to decide about daily care issues and providing staff training in advanced directives. We looked at the arrangements for the administration and control of medication. Residents can administer their own medication following a risk assessment. One of the residents told us they administered their own inhalers and medicine for gastric reflux. Action had been taken to address the recommendation that staff who had not resided in the UK for more than 3 years still have access to medication training. Mrs Meadowcroft assesses staff competence to administer medication. She said this would not happen for at least six months in to the role, following a period of training. Records are kept of staff medication training as we recommended. Medication is administered from a monitored dosage system put up by the supplying pharmacist. Records are kept of all medication as it is received into the home. Records also show administration of medication and any disposal of unused or unwanted medication. We advised that any handwritten entries into the medication administration record should be witnessed, signed and dated by 2 staff. We also advised that the home’s medication policy, particularly relating to action to be taken if an error occurs, should be placed with the medication administration record. The records showed details of what prompts an administration of medication that is prescribed to be taken only when necessary. However this was not always recorded in the care plans. There was written confirmation from the prescriber for one resident’s medication to be crushed. Mrs Meadowcroft said that alternative formulas had been sought for these tablets. The resident did have some of their medication in liquid form. We advised that the medication of people who use the respite service should be checked with their GP to Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 14 establish what they should be taking. As a matter of good practice, all the data sheets accompanying prescribed medication were on file for staff reference. At the last inspection we found that when we arrived at the home the majority of residents in the sitting rooms were either asleep or dozing. We recommended that the manager explored with the GPs whether there was any connection with sleeping patterns and medication. At this inspection we found no residents to be sleeping or dozing during the day. During the inspection we wanted to speak with a visitor in private. We asked one of the staff if there was somewhere to meet. We were taken to a resident’s bedroom. We said this was unacceptable. We were told that the district nurses would use this bedroom to treat residents. We talked to Mrs Meadowcroft about this disrespect for residents’ private space. She said it was unacceptable and would be addressed. She went on to say that indeed district nurses had been informed that they must treat individuals in their own bedrooms. The double bedrooms had screens for privacy. At no other time did we encounter any disrespect of residents’ privacy. Staff knocked on bedroom doors and waited to be invited in. Any prompts for support with use of the toilet were very discrete. We also saw evidence of staff engaging with residents, taking time to chat and respond to requests. One staff got a coverlet as a resident said they were cold. Another staff noticed that a resident was walking without their shoes so they went and got a pair. In a survey form a relative wrote: “From what I have observed, Quarry Mount Care home looks after my mother very well. When she first arrived at the home, she weighed under 7 stone. Within 15 – 18 months, my mother’s weight has increased to over 10 stone, she is happy, clean and well cared for.” Another relative wrote: “My husband, daughter and I visit regularly so this [keeping relatives informed] isn’t an issue. Usually am told [the resident] had a fall etc when one of the family visits. Very impressed with their understanding of dementia.” Another relative wrote: “I would like to know when [the resident’s] care is reviewed both formally or any in-house review. I only knew [the resident had] had one when the care manager phoned me.” Another relative wrote “In relation to medical care, staff have always been in touch with GP etc if I have raised any concerns. It would be helpful to hear about any progress e.g. when [the resident] was admitted [they] lost [their] hearing aid. I don’t know when [the resident is] likely to have an appointment or how often the referral has been chased. When I visit I have observed the staff giving individual attention to each resident. I never feel that people living at Quarry Mount are made to do things they don’t want to.” Another relative wrote: “Not always informed of incidents e.g. falls, changes to medications.” A further relative wrote: “Better control to ensure patients receive and are able to wear their own clothes. Improved personal care e.g. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 15 dentures fixative applied when provided. Chiropody service poor. Facilities where visitors/family can have more private 1 on 1 time to talk. We would like to see more thorough night-time checks on patients with dementia. E.g. [the resident] fell at [their] bed-side, incurring a head wound, which was not discovered until the morning – [the resident] could have bled or had a severe head injury – as [the resident] got [themselves] back into bed and the checks were not sufficient to see [the resident] was covered in blood.” A further relative wrote: “Yes we do have enough information and the staff are always friendly and willing to give us answers to our questions. [We] are very pleased with the care [our relative] is getting. The home gets in touch if there is any problem on behalf of [the resident].” Another relative wrote: “Creates a loving, homely, family atmosphere. It is hardly a question of improving – but rather maintaining their present high standard.” A further relative wrote: “Quarry Mount always send me a news update. Always made a point of saying to [the resident by name] ‘look who’s here its [your daughter by name]’. They not only care for my mother, they show her respect and love. When I visit her I can see the happiness in her eyes when they talk to her.” In a survey form one of the healthcare professionals wrote: “[regarding self medicating] “most residents are not suitable as they are suffering from dementia. Treats residents with respect dignity at all times. Residents always look well presented, very clean, no offensive smells ever. This is an excellent home. It is sometimes very difficult to get help as all staff seem to have their morning break at the same time and if you visit during this period it is awkward asking for help with residents. At other times staff are very helpful and caring conscientious.” Another healthcare professional wrote: “The team are dedicated to maintaining a caring, homely atmosphere. All clients I have assisted in moving there are happy in their choice of new home. Provides a safe and ‘homely’ environment”. Another wrote: “Excellent.” Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents significantly benefit from the extensive activity programme now on offer. Efforts are made to know about residents’ social histories so that activities are tailored to their needs. Residents benefit from more trips in the locality. Contact with families is encouraged. Those residents who are able to decide, have more control over their daily lives. Residents enjoyed the quality and choice meals. EVIDENCE: Those residents who can decide spend their day as they wish. Others rely on staff for direction. An activities co-ordinator had been appointed in May 2007 to provide different types of activities for 30 hours, Monday to Friday, each week. This has significantly improved the amount of activities for residents. This means the potential for nearly an hour one to one time with each person each week. The activity co-ordinator talked about the weekly programme. They were Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 17 arranging the coming year’s programme. They said they intended to develop crafts and provide dancing. The programme provides activities in the locality as well as at the home. Consideration is given to providing one to one time with those residents who do not respond to group activities. It was clear from talking with the co-ordinator that all events must have a positive process and outcome for each person, regardless of ability. On a Saturday care staff provide activities. The co-ordinator provided different group activities during the day in both of the sitting rooms. Some of these included reading a Christmas story and singing. The co-ordinator said they provided ball games and reminiscence stories. Female residents can have manicures once a week. The hairdresser visits every Tuesday. There is usually at least one outsourced entertainment each week. Residents also have occasional trips out in the home’s people carrier, staff cars or a Dial-A-Ride minibus. Residents had been to a local farm. Some of the residents had gone into Swindon to see the Christmas lights. There were trips planned to see a Nativity play and to the pantomime at the local theatre. The activity co-ordinator said at least one of the sessions each week would involve reading to the residents. Some of the residents showed us the decorations and crackers that they had made. One of the residents told us about the Halloween and bonfire night celebrations. They said they had made decorations for these events. They also said that 2 foreign students had come to help them make decorations for Christmas. They said they had been given the programme for the Christmas activities. This was also displayed on notice boards around the home. Residents had been invited to a Christmas meal at the local football club. There was also a Christmas party planned with a group of singers coming to the home. Staff said they held small fundraising events like a raffle to fund some of the activities. Residents said they could choose which activities they joined in with. One resident said they would be taken to the park for a walk and regularly went out for tea. They told us they liked to play bingo. One of the residents told us that a spiritual leader from one of the local churches came to give a service once a month. There was an extensive library of large print books in the hall. All of the events in the home were published in a quarterly newsletter. The home had developed diaries with photographs with some of the newer residents. The purpose was to record social events, trips out and family visits. The diaries could then be used as an aid memoir and discussion point with residents, families and staff about the residents daily lives. Families were encouraged to bring in photographs as part of the social history to inform the care planning process. As a matter of good practice all of the clocks in the communal areas and in residents bedrooms were showing the correct time. The clocks in communal areas were large so they could be easily seen. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 18 The daily menu was displayed on the dining room wall in large print for easy reading. The lunch menu was a choice of two dishes for each course. We were told that sandwiches were available for residents in the evenings rather than a cooked meal. We looked at the menus which confirmed this. Mrs Meadowcroft said that there was also soup and other snacks if residents preferred. She went on to say that there was a good range of filling for the sandwiches. There is research-based evidence that some people with dementia will eat more of a meal if it is ‘finger food’. All of the residents spoken with made positive comments about the meals. One told us about the choice of meals. They said there was a new chef and they were asked everyday for their choice of main course and pudding. We asked whether they liked to have sandwiches for their meal everyday. They told us that there was also home made soup and they could have something else if they wanted. The lunch was either cauliflower cheese or pork casserole. The meal was well presented and tasty. Those residents who needed support with eating were fed by staff at their own pace. They had their meal at the table with everyone else. There were sufficient staff available for this to happen. The cooks make all the home’s cakes. Milky drinks were given at suppertime. We talked with one of the visitors about their experiences during their regular contact with the home. They said that they could visit at any time and were made to feel welcome. They said that staff were friendly “on the whole”. They said they visited a number of care homes in the area and were “quite impressed” with Quarry Mount. They said staff “made [the residents] feel like people” with the extra care and attention provided. They said their only concern was that the television was on for too long with no one watching it as residents were asleep. They also said that there was nowhere to sit with residents in private. In a survey form one relative wrote: “Perhaps interacting with the clients more. Do they take [the resident] out at all? That may be pretty hard to achieve because [the resident] cannot walk all that well now, and [the resident] sleeps a lot.” Another relative wrote: “Since Richard and Sue have taken the home over, they are improving different things all the time, like the activities for the residents, and very recently a beautiful large conservatory across the back of the home. The residents can sit and look all over the garden. Last week while I was visiting [the resident], Sue was busy adding special touches around the lounge at the back. I said to her ‘you have that extra touch just making it look so homely Sue’ and her answer was ‘well it is their home isn’t it.’ I am very pleased with [the resident’s] care. I call in at all different times its always the same…they make me so welcome.” Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that residents and their representatives can complain about the service. Staff are aware of Safeguarding Adults reporting procedures and have been trained in recognising abuse. The providers are introducing training in the impact of the Mental Capacity Act 2005. EVIDENCE: The home has a complaints procedure which is given to residents or their representatives. Those residents with whom we could communicate were asked about making a complaint or raising issues they were not happy with. One resident said they would speak with the owners or a member of staff. Another resident described asking staff to change something the previous day. They said it was done immediately. Action has been taken to address the recommendation we made that a record is kept of any complaints or concerns together with action taken with timescales. The home keeps a log for complaints although none had been received. As a matter of good practice the home is to consider the implications of The Mental Capacity Act 2005. All staff are to complete training. Assessments had been carried out as to whether current residents had capacity to make decisions in activities of daily living and different aspects of their daily care. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 20 The assessments were clear that other decisions about their health and well being or finances would need to be in consultation with them or a significant other. The home was also considering those aspects of the Act which identify residents rights to freedom of movement and whether any aspects of care could be considered as restraint. We advise that risk assessments should be carried out for the use of any reclining chairs, which may restrict movement, provided by families for residents comfort. We were told that the district nurses carry out risk assessments for any use of bed rails [often referred to as ‘cot sides’]. Staff were trained in the local Safeguarding Adults procedure and had been given a copy of the Wiltshire and Swindon booklet. In a survey form one of the relatives wrote: “Items such as slippers and even more importantly, valuables have gone missing and have not been found, but we feel that the staff have so much work to do and [the resident] cannot remember where [they] have put items, but it is a worry for [us]. [the resident] has lost glasses and rings in the past. We always have a word with the staff and I know they do look when we complain.” These comments were copied to Mrs Meadowcroft. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the improvements made to the environment for their comfort. The home is cleaned to a good standard and no unpleasant odours were evident. Some communal use items should be discarded. EVIDENCE: Since the last inspection of 25th October 2006, significant efforts have been put into upgrading the quality of the environment for residents. Some of the bedrooms had been re-decorated. Some bedrooms had been fitted with suitable floor coverings. The home was cleaned to a good standard and no unpleasant odours were detected at any time during the inspection. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 22 We noticed that there was a listening device in one of the corridors. We were told that it was only used during the night to alert the night staff if any residents were up and about. We were told that there were no listening devices in any of the residents bedrooms. We advised that there needs to be a written policy on the use of the equipment, which gives clear guidance on its use. The policy must be clear about respecting residents rights to privacy. As a matter of good practice it was noted that large written signs were placed at eye level on the emergency exit doors to the fire escapes on the first and second floors. These were personally written with the names of certain residents who were likely to exit the doors by mistake. We noted that the Department of Health’s guidance on control of infection in care and nursing homes was not always being followed. This is in relation to suitable toilet brushes, the cleaning of the undersides of toilet surrounds, safe storage of items awaiting laundering and soaking of laundry prior to washing. We noticed that the ensuite facilities in residents bedrooms were not connected to the call alarm system. This means that residents would have to go back into their bedroom if they needed to summon staff. We advise that risk assessments are carried out with regard to each residents need for a call bell in their ensuite toilet. All of the residents who were able to talk about the environment made positive comments about cleanliness. They also told us it was comfortable. In a survey form one of the relatives wrote: [regarding what they thought the home does well] “Spends money on the upkeep of the property.” Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels enable residents to receive the care that they need. A robust recruitment process ensures protection for residents. Staff have good access to regular relevant training. EVIDENCE: The care staffing rota provided a minimum of 7 care staff during the mornings. This ensured care and support to those residents in the main home and those in the bungalow. We asked 2 of the residents who lived in the bungalow how their care and staff support was provided. They said that they had a member of staff to give them breakfast and help with any personal care. There was also a member of staff to provide cleaning. Mrs Meadowcroft and the assistant manager had covered caring duties that morning as two staff had gone on sick leave and cover could not be found. Mrs Meadowcroft said this was unusual but they would both cover in emergencies. Mrs Meadowcroft said that she was currently advertising for weekend house keeping staff. She went on to talk about difficulties in recruiting in this area of high employment. She said that care staff were covering the vacant hours and this was identified on the rota. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 24 Staff were attending training in risk assessments that afternoon. Records showed staff have good access to in house and external training. This included first aid, fire safety, moving and handling, dementia, visual impairment, managing behaviours, food hygiene, infection control, risk assessment, pressure care and wound care. More than half of the staff have NVQ Level 2 or above. Training needs are discussed at staff meetings. Facilities have been provided for staff to store their possessions when on duty. There was a robust recruitment process in place. No staff commences duties without a check on the Protection of Vulnerable Adults list to ensure they are suitable to work with vulnerable people. All the information and documents required by regulation were in place. All new staff have a period of induction as evidenced by records. New staff are also required to ‘shadow’ a more experienced member of staff during their induction. One recently appointed member of staff had already completed training in safeguarding adults, infection control, moving and handling, fire safety, behaviour that challenges, first aid and health and safety. In a survey form one of the residents wrote: “We have a happy day night staff.” In a survey form one of the relatives wrote: “The staff all seem very caring and patient – qualities essential to the well being of the residents. They do a very good job.” Another relative wrote: “Highly trained staff. Very sensitive to needs of individuals.” Another relative wrote: “Staff do not always appear to be adequately trained to care for people with dementia and its consequences of stages.” A further relative wrote: “Better training, particularly dementia and its complicated stages.” Another relative wrote: “Yes we do have enough information and the staff are always friendly and willing to give us answers to our questions.” A further relative wrote: “The staff are very good, friendly and experienced. Overall the care is very very good and we are pleased.” In a survey form one of the staff wrote: “I feel the residents are well looked after and staff are always being trained updated with new ways/procedures etc. the home is always looking for ways of improving itself. Residents are taken out regularly and entertained by singers, story tellers etc. [Could do better] Sometimes it feels that other staff are forced to rush certain jobs. On the odd occasion and can come across to the residents as being harsh. I therefore think that more staff should be employed. However this is only on odd occasions and I know they have been doing interviews.” Another member of staff wrote: “I am always given an update and am encouraged by others to read the report book before I start work in case there has been a change in a clients circumstances during the night. I was not given a start date until Quarry Mount had received confirmation of my P.O.V.A. and C.R.B. results. I have only been working at Quarry Mount for X months and have been asked Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 25 twice in that time if I am happy with all aspects of my job and if there is anything they can do to improve or help me. At the weekends there are not as many staff as weekdays, but I think this is perfectly acceptable. Quarry Mount looks after the elderly as if each service user were a member of their own family. This also applies to all members of staff. I feel like we are one big family. Although we have Senior Carers, nobody is treated any differently, we are all very important members of staff. [regarding what they could do better] I find this very difficult to answer as I am so happy with all aspects of my job. I have worked in several Nursing Homes and Residential Homes in my time and the standards of care for both service users and staff are by far the best that I have ever worked in.” A further staff member wrote: “I did have a CRB check done. They were very strict on who I could get a reference from.” Another staff wrote: [Does well] “Regular training with all staff including chef, cleaners etc. Encourages staff to pursue further development i.e. NVQ 2/3. Regular activities/outings for residents . Including someone solely employed as an activities co-ordinator. Choice for residents on things like when they want meals, what they want, when they get up/go to bed.” Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a competent and qualified manager. The home is run in the best interests of the residents. Staff either have group or individual supervision. Systems and policies are in place to ensure the health, safety and wellbeing of residents. EVIDENCE: Mrs Meadowcroft holds the Registered Managers Award and NVQ Level 4 in care and management. She has many years experience of working in caring for older people; more than 10 years as a manager. She has a clear view of how she expects to develop the services provided. Mrs Meadowcroft is well Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 27 known to residents and engaged with them in a very positive manner. The providers are regularly involved in the home and well known to residents, staff and the many visitors. An assistant manager is also employed. Staff either have group or individual supervision. Mrs Meadowcroft said that staff could ask for individual one to one time if there were problems. She said that staff had regular appraisals and a personal development plan. Mrs Meadowcroft had undertaken training in appraisal and was considering how this could be improved. Action had been taken to address the recommendation we made that all records are stored in accordance with data protection principles. Care records are stored in a locked facility. All other records were kept in a locked office. The registered providers carry out regular unannounced visits to report on the conduct of the home as required by regulation. It was clear from talking to residents that they were well known and accessible to residents, staff and relatives. The home carries out regular quality audits with questionnaires to relatives. The results inform the business plan. Smaller questionnaires on specific issues are sent out with the home’s newsletter. The home also usually meets at least twice a year with relatives to discuss any issues. Health and safety policies and procedures were in place. Contracts were in place for maintenance and repair of equipment and facilities. Risk assessments were carried out on the environment. In a survey form one of the relatives wrote: “Provided an excellent manager, Karen Meadowcroft.” Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement Timescale for action 01/02/08 2 OP18 13(4)(c)& (7) The person registered must ensure that care plans identify how assessed needs are to be met and monitored. This must include how behaviours are monitored, outcomes of pressure damage assessments, nutrition, use of any equipment and any interventions by district nurses. 12/12/07 The person registered must ensure that residents’ freedom of movement is not restricted by any safety or comfort equipment. Risk assessments must be carried out on any reclining chairs purchased by family to ensure residents safety. Care plans must identify the arrangements following risk assessments carried out by district nurses for the safe use of any bed rails. Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 Refer to Standard OP37 OP7 OP9 OP9 OP9 OP10 OP26 Good Practice Recommendations Consideration should be given to recording observations and conversations rather than using statements that could be open to interpretation. The home should keep their own records and not rely on those kept by the district nurses. Hand written entries in the medication administration record should be witnessed, signed and dated. The medication policy and procedure, particularly that relating to what to do if an error occurs, should accompany the medication administration records. Checks should be made with the GPs of those people who use the respite service to ensure that it is currently prescribed. A written policy should be in place for the use of the listening device in one of the corridors. Consideration should be given to ensuring infection control standards in relation to suitable toilet brushes, cleaning the undersides of toilet surrounds, safe storage of items awaiting laundering and soaking of soiled laundry. Consideration should be given to ensuring residents’ privacy and dignity is upheld. Healthcare professionals should not discuss residents in communal areas or use bedrooms inappropriately. 8 OP10 Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Quarry Mount Residential Care Home DS0000062385.V349626.R02.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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