Inspection on 02/12/08 for Quarry Mount Residential Care Home

This inspection was carried out on 2nd December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

Quarry Mount Residential Care... 12/12/07

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

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The Vicarage

Fairfields Country Rest Home

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Poldhu

Queensmount

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Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Quarry Mount Residential Care Home 83 Bath Road Swindon Wiltshire SN1 4AX     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: Sally Walker     Date: 0 2 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Quarry Mount Residential Care Home 83 Bath Road Swindon Wiltshire SN1 4AX 01793527715 01793616130 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Karen Meadowcroft Type of registration: Number of places registered: Quarry Mount Care Ltd care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 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 The maximum number of service users who may be accommodated in the home at any one time is 32 Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 33 Over 65 25 32 4 0 0 0 Brief description of the care home 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. A conservatory was added in 2007. There is also some seating accommodation in the hallway. There are two semidetached 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. The staffing rota provides for a minimum of 4 and a maximum of 8 care staff during the waking day. There are 3 waking night staff. Details about the weekly fees can be obtained directly from the home. The last Key inspection was on 12th December 2007. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out on 2nd December 2008 between 9.30am and 7.00pm. Mrs Karen Meadowcroft was present during the inspection. We spoke with people who use the service and staff. We made a tour of the building. We looked at care plans, menus, medication, risk assessments, activities and staffing records. As part of the inspection process we sent survey forms to the home for people who use the service, staff and healthcare professionals to tell us about the service. Comments can be found in the relevant section of this report. Care Homes for Older People Page 6 of 33 We asked the home to send us their Annual Quality Assurance Assessment (AQAA). It was returned on time and completed in full. The last Key inspection was completed on 12th December 2007. We also carried out a Random inspection on 10th October 2008, to consider the high number of falls the home had reported to us. 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 care home does well: What has improved since the last inspection? Care plans now have more detail about peoples needs and how they are to be met and monitored. Daily records are clear statements that are not open to interpretation. Guidance on the use of bed rails is recorded in peoples care plans. The home keeps its own records of district nursing treatments, no longer relying on those kept by the district nurses. Handwritten entries in the medication administration records are witnessed, signed and dated. Care Homes for Older People Page 8 of 33 Visiting healthcare professionals are no longer discussing their patients in the communal areas or using peoples bedrooms inappropriately. Protocols are in place for the use of any listening devices in some peoples bedrooms and the top floor corridor. Laundry procedures have improved so that there is no need to leave items soaking. Toilet surrounds are clean and toilet brushes are stored dry. The kitchen has been totally refurbished. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering using the service and their families are given up to date information about what is provided. Gathering of detailed information ensures that peoples needs are known before accommodation is offered. Evidence: We received copies of the homes revised statement of purpose and service users guide before this inspection. We advised that the documents must not contain extracts from our reports. The copyright allows our reports to be used in their entirety. We advised that the statements regarding staff who are nurses must be removed. This is because readers could be given the false impression that nursing care is provided. We also advised that the statements about staffs origins should be removed. We advised that the statement mental frailty could suggest that the home is registered for the category of mental disorder, which it is not. We received amended versions of the documents immediately following this inspection. Care Homes for Older People Page 11 of 33 Evidence: People who are considering using the service have their care needs assessed prior to admission. Where an assessment cannot be made due to the person living at a distance, the home will obtain assessments from healthcare professionals or care management assessments. The home also seeks information from relatives and carers. The home is using a new computerised care planning format, which includes preadmission assessment. The home takes into consideration whether people who share bedrooms will be compatible. In the AQAA the Providers told us We have continued to maintain our protocol of changing working practices as and when necessary to meet any equality & diversity needs of new residents that are identified during pre-admission assessment. Each prospective resident and their relative is offered the chance to visit and spend some time in the home before making a decision. During a visit, an experienced member of staff is allocated to give out information, to pay special attention, to help the prospective resident feel comfortable in the surroundings, and to answer any questions about life in the home. One of the people we spoke with told us that people who were considering using the service would be introduced to them and the other residents when they visited. In a survey form one of the people who use the service told us I received enough information about this home, also I received a nice presentation pack. Another person told us I am very happy here. I have been here for number years and put myself into Quarry Mount. Another person told us that they were invited for visits to look around and spend some time there. Very helpful and reassuring. In a survey form one of the relatives told us my wife and I downloaded information from your website about several homes in Swindon. From this we visited several and compiled a short list of suitable premises. Quarry Mount was first to have a vacancy. Another relative told us that they went and looked around the home and talked with staff before deciding. Another relative told us we had a choice of 3 homes which we viewed with [my relative] and Quarry Mount appeared to be the best. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning has improved with more detail about how needs must be met. People have good access to healthcare professionals. Systems are in place for safe administration and control of medication. Staff uphold peoples rights to privacy and dignity. Evidence: Action has been taken to address the requirement we made that the care plans must identify how assessed needs are to be met and monitored. We said that this must include how behaviours are monitored, outcomes of pressure damage assessments, nutrition, use of any equipment and any interventions by district nurses. The Providers have purchased a computerised care planning package, which was introduced at a staff meeting. Mrs Meadowcroft and staff have made considerable effort to ensure that information from the previous format is transferred to the new system. At least half of the care plans had already been set up using the new format. We saw that care planning had improved with more detailed guidance on how individual needs must be met and monitored. The new system enables tracking of reviews and organisation of Care Homes for Older People Page 13 of 33 Evidence: medical appointments. Staff ensured that food and fluids were regularly given to anyone whose nutrition was compromised for any reason. Monitoring charts were in place, when needed, to record what people had eaten and fluids they had taken. People were regularly weighed. One of the people we spoke with told us that they were given plenty of drinks. They said they could also make themselves a hot drink. Staff were also recording when people who needed bed rest were turned and made comfortable. Pressure risk assessments were in place, with staff intervention recorded in the care plan. Pressure relieving equipment was in place. In the AQAA the Providers told us that they intended to improve our written pressure sore risk assessment to indicate when a referral to a district nurse should take place. We had discussed this at the Random inspection. Agreements were in place for the use of bed rails. Moving and handling risk assessments were in place. The district nurse visited regularly to advise on treatments and pressure area care. People have good access to healthcare professionals. Action has been taken to address the good practice recommendation we made that healthcare professionals should not discuss people in communal areas or use bedrooms inappropriately. We said that peoples privacy and dignity should be considered at all times. Action has been taken to address the requirement we made that peoples freedom of movement is not restricted by any safety or comfort equipment. We said that risk assessments must be carried out on any reclining chairs purchased by family, to ensure peoples safety. We also said that care plans must identify the arrangements following risk assessments carried out by district nurses for the safe use of any bed rails. In the AQAA the Providers told us that a new training course on personalised care was adapted to include a discussion of the issues around restraint. Action has been taken to address the good practice recommendation we made that the home should keep their own records and not rely on those kept by the district nurses. Care plans showed little detail of how those people with diabetes were supported to maintain their good health. We advised that individual parameters of blood glucose levels should be obtained from either their GP or diabetic nurse. There must be written guidance to staff on what action to take if the levels are outside these parameters. We also advised that the term diet controlled should be expanded upon, to determine what this meant. The care plans showed good details of peoples preferred routines for giving of intimate personal care. There was also good detail about peoples social, as well as medical Care Homes for Older People Page 14 of 33 Evidence: history. Assessments were in place to determine peoples capacity with regard to personal care. In the AQAA the Providers told us the home adopts the opinion that each resident has the capacity to make all their decisions unless proved otherwise. Workers are also aware that residents capacity may change daily and assess this at each individual decision. At the Random inspection of 10th October 2008 we saw that those people who we had been notified about having fallen, had had their risk of falling reviewed and revised following the falls. We saw that the layout of their bedrooms had been taken into account during the review. The assessments had clear details about what must be in place to minimize the risk of falls, including proper footwear. We saw that listening devices had been installed in these peoples bedrooms. There was a clear protocol on the use of these devices to protect peoples privacy. There was a listening device in use on the top corridor but not in any of the other bedrooms. Night staff were vigilant in monitoring those people who had been assessed as having a risk of falling. Mrs Meadowcroft regularly monitored the accident records to determine causes and any patterns of people falling. She attends the Primary Care Trust falls steering group every four months. One person told us they could have a shower twice a week. We saw that staff had made efforts to ensure that people were well groomed and had clean glasses. Some of the women we spoke with had had their nails painted as part of an activity. During the morning we saw a file on the sideboard containing personal information about when people had been supported to go to the toilet. Later in the day it had been removed. We saw that staff respected peoples privacy and dignity when supporting them with personal care. If staff needed to remind people to use the toilet, this was done quietly so that if other people were present, they did not notice. We looked at the arrangements for administration and control of medication. Records are kept of all medication checked into the home. Medication administration records were being appropriately recorded. Medication was properly stored. We gave the home information about new storage arrangements. Care plans identified when people should be given, or offered medication prescribed to be taken only when required, including pain relief. Peoples medication is regularly reviewed with their GP. In the AQAA the Providers told us that the registered manager undertakes random checks on medications to ensure that all staff involved are following our policies and procedures. One of the people who use the service told us about the arrangements for storage and administration of their medication. They said that staff were trained to give out Care Homes for Older People Page 15 of 33 Evidence: medication. They said they always received their medication at the time that it was prescribed to be taken. Action has been taken to address the good practice recommendation we made that hand written entries in the medication administration record should be witnessed, signed and dated. No action had been taken to address the good practice recommendation we made that the medication policy and procedure, particularly regarding what to do if an error occurs, should accompany the medication administration record. However Mrs Meadowcroft said she would provide guidance to go with the medication administration record, by the next day. Action has been taken to address the good practice recommendation we made that checks should be made with the GPs of those people who use the respite service. This is to ensure that they are taking medication that is currently prescribed. When we visited there were no people using the respite service. In a survey form one of the relatives told us a nurse if often on duty. The doctor calls for a weekly surgery and is obviously on call. Residents are taken to hospital if required. Staff are trained to administer first aid and regular treatment such as applying cream to patients skin. Another relative told us the standard of care at Quarry Mount is excellent, based on my observations when I visit. As far as Im aware my father is content. Another relative told us the staff are always there for her and check on her regularly. The local doctor visits Quarry Mount on a regular basis and checks on her need and medication. In a survey form one of the healthcare professionals told us most of the patients I see there would not be able to manage their own medication. There is a pleasant homely atmosphere. Most of the carers I have met appear to be caring in their attitude to the residents and treat them with respect. Karen the manager is pleasant and seems efficient in acting on advice/requests. In a survey form one of the healthcare professionals told us if concerns are raised about an individual, Quarry Mount will request an assessment by the appropriate service to ensure all that persons needs are being met. In my opinion I believe Quarry Mount provides a safe and friendly environment for residents and strives to meet all personal needs. The staff are friendly and approachable and willing to answer Care Homes for Older People Page 16 of 33 Evidence: questions where able. There is room to improve in any establishment particularly in the area of mental health. Keeping staff educated about residents with mental health problems and knowing how to deal with certain diagnosis is always a benefit. Quarry Mount do this well but there is always room for improvement. Quarry Mount in my opinion is an excellent home which provides a good standard of care to its residents. In a survey form another healthcare professional told us staff have good observation skills. Manager very helpful. Excellent work under the circumstances. Well trained staff. Good team work. Understanding. Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a range of varied activities that they like to do. People have good access to local events. Families are encouraged to join in with activities. People are encouraged to make decisions. People are offered a varied healthy diet. Evidence: An activities person is employed for thirty hours a week. Activities take place at the weekends and some evenings as well as during the week days. All the activities are publicised on different notice boards around the home. The programme for Christmas events was also displayed. On the day of the inspection the activities person provided a quiz during the morning and individual time with some people during the afternoon. Some of the other activities included: crafts, bingo, singers, going to see a local pantomime, Christmas lunch in a local restaurant, different religious services, a steam railway festival, pub meals, butterfly world and cream teas. The activities person told us that she talked with people about the benefits of going out. In the AQAA the Providers told us we have company transport which can be used for group outings, and we liaise closely with outside transport agencies (e.g, Dial-aRide, local taxis) to give residents a choice of services available to them. Care Homes for Older People Page 18 of 33 Evidence: The activities person said she talked with people about what activities they liked to do. She said she tried to find out about peoples past interests, to include in the activity programme. The activities person said that different games and crafts were kept available to staff so they could be involved when she was not at the home. She told us that activities were geared to what people could achieve and were age appropriate. She showed us books in which families are encouraged to write, or insert photographs so that they could discuss different things with their relatives. The activities person told us that she kept in contact with some peoples families by email, sending photographs of their relatives participating in different events. The families often sent photographs of family events, for example, new grandchildren, so that she could share the events with people. Families often joined in with some of the outside trips. The activities person told us that she had recently undertaken a course on providing chair exercises. She said she also attended all the courses available to staff. Some people had been to see the Christmas lights being switched on in Swindon. Another group of people were going to see the lights switched on in Wootton Bassett later that week. One person told us they liked Thursdays when singers would come to entertain them. They said that they were kept pretty busy with things to do. They showed us different crafts and decorations that they had made. They went on to say that they liked to play bingo and dominoes. They told us that some of the people who lived at the home were going out to Christmas lunch at a local pub. One of the people who use the service told us about the photographs in the corridors, showing various activities and trips out that people had been involved in. Some people had been to the Swindon Mela, an Asian festival. One person told us they regularly went to a local church. Another person told us about the visiting library. The activities person showed us the records she kept of the different activities each person had been involved in. In a survey form one of the people who use the service told us we go out and listen to bands and have parties, which are very nice. Also we might go to the theatre. There are lots to do. The meals are all very nice. Another person told us the home and food is first class. Another person told us meals over cooked. Someone else told us breakfasts good. Dinners vary, not always choices. Teas poor, some sandwiches and a piece of cake and tea. Sandwiches from fridge are cold. Some snacks during day. Drinks not often offered. In a survey form one of the relatives told us various in house games and exercises. Outside trips to theatres pub lunch shopping etc. My mother says the food is good. It Care Homes for Older People Page 19 of 33 Evidence: certainly looks appetising when I visit. We looked at the menus, spoke with the chef and asked those people we met with for comments about the meals. The menus did not reflect the many choices that were actually on offer. There was a notice board on the wall in the dining room showing the choices available. We saw that as well as the beef casserole, there was a vegetarian pie. We saw that there were indeed sandwiches listed on the menu every evening. However the menu board for the evening meal included: soup, beans or spaghetti on toast, sausage rolls, picnic eggs, cheese and onion rolls, various cakes, fruit, yoghurt and chocolate mousse. The chef told us that people could also have a jacket potato or salad. They said they would cook whatever people wanted. They gave an example of someone wanting fish and chips earlier in the week. Vegetarian meals were provided as well as meals for people who following a diet for diabetes. The chef showed us the different meals they had prepared for those people who did not want the beef stew or vegetable pie. They had also baked different cakes that morning for those people on special diets. The chef keeps a record of all of the different meals provided each day. Meals were served to the two dining rooms. The meals looked well presented and tasty. We saw some people being supported by staff to eat their meal, either being fed or prompted. They were given spoonfuls of the meals at the persons own pace. We saw that staff also encouraged people who they fed to take the spoon and feed themselves if they wanted to. One person who was eating their meal in the hallway told us that they preferred to eat quietly by themselves. All of the people we spoke with told us they enjoyed the meals provided. One person told us they liked to have the assorted sandwiches each evening. They went on to describe their favourite fillings. We saw staff give one person a milky drink, saying that they had not eaten much of their lunch. In a survey form one of the relatives told us although mum can no longer join in the activities, the staff make sure she has her music to listen to and they also read to her. Another relative told us my mother enjoys listening to music and joining in various games when able. Another relative told us I think Quarry Mount is an excellent care home. The staff are caring and understanding and Karen the manager is doing a first class job. If my mother needs anything e.g. clothing etc. she always finds time to go out and buy whatever mum needs. The staff will always let me know if there are any problems with mum. In a survey form one of the healthcare professionals told us I havent seen much Care Homes for Older People Page 20 of 33 Evidence: evidence of therapeutic activity during my visits although I have seen notices advertising forthcoming social events. As with most homes I would like to see more activities on offer. The communal rooms seem quite crowded. Care Homes for Older People Page 21 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place for people who use the service and others to make complaints. Complaints are taken seriously. Staff know how to refer any allegations of abuse to the appropriate safeguarding process. Evidence: The home keeps a log of all complaints received. There is record of any investigations, outcomes and responses to complainants. In the AQAA the Providers told us we fully investigate any complaints or concerns, in order to learn how to improve our service and we take note of any comments or testimonials by residents. We have a suggestions box into which people can anonymously post ideas. A review of any complaints takes place as part of the homes quality assurance procedures and we learn from complaints to improve our service. We asked people about making complaints. One person told us Ive nothing to grumble about. I would talk to the staff if I wanted to complain. Another person told us that they thought any complaints would be taken seriously. In a survey form one of the people who use the service told us I would tell a member of staff, but if none available I would tell my [relative] who would then report it. Another person told us it is a waste of time because I had things taken from my Care Homes for Older People Page 22 of 33 Evidence: room. We were not able to follow this up because the person did not give us their name. We gave the comments to Mrs Meadowcroft for her information. Another person told us cannot fault in any way. In a survey form one of the relatives told us I often ask my mother if she has any problems with the home. They have been few and relatively minor and after discussion with the manager they are soon solved. Another relative told us they would complain to the manager. Another relative told us Ive never known her to be unhappy. If I sense that there is a problem Karen is always available for any questions I may have. In a survey form one of the staff told us in these cases I would probably take their name number and give it to the manager. No training has been given for dealing with situations like this. In the AQAA the Providers told us residents and their representatives are made aware of what abuse is and the safeguards in place for their protection should they need them. Access to external agencies or advocacy services is actively promoted and relevant information is available within the home. Managers of the home are clear about when a No Secrets incident needs to be referred; they are open and transparent when discussing incidents with external bodies. All staff are trained in the principles, procedures and regulations relating to the protection of vulnerable adults and know how to respond in the event of an alert. Procedures are in place to deal with suspicion or evidence of neglect and these have been used during the last year, including one POVA list referral. We established that staff are familiar with the local safeguarding procedure for reporting any allegations of abuse. Police from the local safeguarding unit had provided staff training in the local policy and procedure. Staff were confident in using the homes whistle blowing procedure. The Providers take all complaints and any allegations of abuse seriously and take appropriate action. Care Homes for Older People Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a well maintained, clean and comfortable environment. Evidence: Peoples bedrooms are arranged on three floors, accessed by a passenger lift and stairs. If people are sharing bedrooms, they are consulted about whether they want to share, if the other bed becomes vacant. Some of the bedroom doors were locked during the day to prevent some people who liked to make tours of the home from entering. There were keys to the bedrooms nearby, so that the rooms could be opened when needed. The Providers continue to keep the home in good decorative order. The kitchen had been totally refurbished and refitted since the last Key inspection. In the AQAA the Providers told us they plan to install a sensory garden during the coming year. They went on to say that a program of routine maintenance works is kept on the premises and carried out within the home. This includes a rolling programme of redecoration, replacement (as required) of floor coverings in bedrooms and communal areas, and replacement (as required) of seating in the lounges. We have rebuilt and enlarged the kitchen, laid a special non-slip flooring material, installed an extraction system, enlarged the serving hatch and fitted it with a shutter, installed several new appliances and upgraded the gas supply to the Home. We have added conservatory blinds to Care Homes for Older People Page 24 of 33 Evidence: allow the temperature to be regulated. The providers listed other installations including: wall corner protectors to protect from bruising, new garden furniture, new washing machines, replacement windows with restrictors, portable ramp for wheelchair access to the bungalows. There are also plans for an extension to include an office, hairdressing salon, wet room and to replace the roof and improve the garden. Action has been taken to address the good practice recommendation we made that a written policy should be in place for the use of the listening device in one of the corridors. Guidance was also in place for those listening devices put in some of the bedrooms following falls. Action has been taken to address the good practice recommendation we made that infection control standards are met in relation to suitable toilet brushes, cleaning the undersides of toilet surrounds, safe storage of items awaiting laundering and soaking of soiled laundry. All of the toilet brushes had been replaced with ones which do not allow the brush to be stored wet. All of the undersides of toilet surrounds were very clean when we looked at them during the morning, and again later in the day. The laundry area was clean and organised, with bins for storing items awaiting laundering. We saw no soiled items being soaked. Two new washing machines had been purchased with a sluicing facility. This eliminates any need for pre-soaking. A laundry person works between 8.00am and 12.30pm each day including weekends. Mrs Meadowcroft told us that all new staff had received training in carrying out laundry duties. In a survey form one of the relatives told us on the odd occasion the home has a strong smell of urine and/or faeces which can be quite unpleasant. Another relative told us always seems to be [clean] including my mothers room. Another relative told us very fresh and clean. Another relative told us Ive always been impressed with the high standard of cleanliness at Quarry Mount especially my mothers room. We found the home to be cleaned to a good standard with no unpleasant odours at any time during the inspection. Care Homes for Older People Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from well trained staff. A robust recruitment process ensures that only suitable staff are employed, for peoples protection. Evidence: The care staffing rota provided for seven staff working during the mornings and four staff working during the afternoons and evenings. There was also a split shift where a carer works from 8.00am to 11.00am and from 4.00pm to 7.00pm, to ensure sufficient staff were available at peak times. At night there were three waking night staff. There were individual records for staff training. Staff are regularly updated with relevant training. Recently training had included: continence and catheter care, person-centred care, moving and handling, challenging behaviour, health and safety, observations and vital signs, whistle blowing, infection control and pressure damage prevention. Staff fill out feedback forms on their comments about the relevance of any training they undertake. They are also asked to comment on how they will put their training into practice. One of the staff told us they had NVQ Level 2 and were undertaking Level 3. Six staff were undertaking NVQ Level 2 and two staff were undertaking NVQ Level 3. Care Homes for Older People Page 26 of 33 Evidence: We saw from the information and documents on file that the home has a robust recruitment process. No one commences work without checks of the Protection of Vulnerable Adults list, to ensure they are suitable to work with vulnerable people. All new staff have a period of induction with records kept. Staff are provided with a light breakfast and a meal during their shifts. One staff told us that they really appreciated that the owners provided this for staff. In a survey form one of the people who use the service told us the staff are always polite and very helpful and are always welcoming. Another person told us gold star standard one of the main reasons selected to stay. I enjoy living at Quarry Mount and the girls are really good and kind to me. In a survey form one of the relatives told us during my visits there seems to be adequate staff available. Another relative told us I have always been very pleased with the care my mother receives has been excellent. The staff have all been so kind and helpful to the family. In a survey form one of the staff told us our job changes daily and we adapt. QM very hot on training and maintaining a high level. Encourage service users to maintain independence and to socialise. We do our very best to ensure QM feels like their home not a home. Even though we cover all areas I still sometimes struggle with our paperwork and the need for more in depth personal files. Another staff told us sometimes we are short staffed due to sickness or when we have too many residents who need help with feeding. Good team work and all the residents are very well cared for. Family are normally very pleased with the care their families get. Better communication [needed] at times between staff and management. Another staff told us we are always kept up to date, very thorough. Another staff told us I dont feel like there are enough staff in the evenings 2pm 8pm. There are only enough staff to get general tasks such as toileting all the residents done. I sometimes think it is difficult to handle depressed residents but I always get full support and help from co-workers. The service cares for all the residents. Its good at monitoring any changes concerning any of the residents. It could hire more people so more time could be spent individually with the residents. Quarry Mount is a really nice place to work and the management and staff communicate well when it comes to the well being of the residents. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a competent and qualified manager. The home is run in the best interests of the people who live there. Staff are supervised through group supervision and staff meetings. Systems and policies are in place to ensure the health and safety and wellbeing of people who use the service. Evidence: Mrs Meadowcroft has many years experience in caring for older people and more than 13 years management experience in the home. She holds NVQ level 4 in management and care, and the Registered Managers Award. She keeps herself up to date with current good practice with regular training courses. Mrs Meadowcroft is well known to the people who use the service. The Providers are involved in the day to day running of the home. Supervision is not regularly provided to all staff. In the AQAA the providers told us that staff are offered supervision every two months but rarely benefit from the sessions. Care Homes for Older People Page 28 of 33 Evidence: Mrs Meadowcroft told us that she carries out appraisals and group supervision and issues are discussed at staff meetings. She went on to say that staff will bring issues to her to discuss at any time. Mrs Meadowcroft said she makes herself available to staff. Risk assessments were in place for the environment, as well as tasks that staff were involved in. They had been regularly reviewed. There was a Stairwalker, an electric chair, able to climb stairs. Risk assessments were in place for those individual people on the top floor who were likely to use the equipment. Mrs Meadowcroft told us that it was used on the rare occasion when the lift was out of action. Health and safety policies and procedures were in place. The home contracts for servicing and maintenance of equipment. The premises manager deals with day to day maintenance and repair. The home does not hold any cash on peoples behalf. Any purchases are made from petty cash, receipts retained and peoples families invoiced. Action has been taken to address the good practice recommendation we made that observations and conversations should be recorded rather than statements that could be open to interpretation. We saw much evidence that staff were using appropriate moving and handling equipment when supporting people. All staff received regular updated training in moving and handling, infection control, fire prevention, first aid and food hygiene. In the AQAA the Providers told us that the home has a residents forums (the Service Quality Committee) where ideas on improvements to the services provided are discussed and recommended to management. Residents can make suggestions about what they would like to see on the menus and activities programme. We conduct annual quality assurance surveys via questionnaires that are issued to residents and relatives covering two main themes: (1) the experience of moving into a care home, for those admitted during the preceding 12 months, and (2) the experience of living in a care home, for those who have been living in the home for more than 12 months. We carry out frequent quality assurance surveys via short questionnaires that are completed via face-to-face interviews with some residents and visiting relatives. In a survey form one of the relatives told us Quarry Mount seems to be well run. As long as my mother is happy there, Im happy. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 Care plans must record how peoples diabetes is managed and monitored. Where blood glucose is tested, parameters of safe levels must be recorded inlcuding details of what action must be taken if the levels fall outside those parameters. For the persons wellbeing. 30/01/2009 2 9 13 All controlled drugs must be stored in a cupboard that meets the current storage regulations (The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007). So that medication is safely stored. 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Older People Page 31 of 33 No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 32 of 33 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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