Care Home: Eastbury Nursing Home

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What the care home does well Prospective residents are fully assessed and given the opportunity to visit the home prior to admission, to ensure the home is able to meet their needs. There is a settling in period, plus reviews are carried out to ensure the home is right for them. The service user plan documentation is clear, providing a good picture of the resident and their needs, to include mental health care needs, and how these are to be met. Risk assessments are in place for all identified risks, to show how these are best managed for each individual. Residents are encouraged to make individual choices about what they do and do not wish to do and to maintain their independence to the best level they can. There are activities programmes in place to meet residents interests and needs. The home has an open visiting policy and visiting is encouraged. Staff care for residents in a friendly, dignified and professional manner, promoting good relationships between residents and staff. The food provision at the home is good and varied, with the preferences of residents being ascertained and met. The importance of individual choice in all aspects of the residents care is a priority at the home, and individual preferences to include, amongst others, care, culture and religion are recorded and respected. Staff have an excellent knowledge of the residents and their needs, providing effective continuity of care. The heathcare needs of each resident are identified and monitored on an ongoing basis. The home has very good access to healthcare professionals, ensuring that the health of each resident is being maintained at an optimum level, with prompt action taken to address any issues identified. Comment received indicated that the home is well organised and proactive in meeting residents healthcare needs. Medications are being well managed at the home, with accurate records being maintained and good auditing processes in place. Clear procedures are in place for the management of complaints and safeguarding adults issues, and these are adhered to, thus protecting the residents. There is a redecoration and refurbishment plan for the home, and there is evidence that this is followed. Infection control procedures are in place and are being adhered to. The home is being appropriately staffed to meet the needs of the residents. All staff receive the training and supervision they need to provide them with the knowledge and skills to care for residents effectively. The home has a manager and a deputy manager both of whom have been in post for several years, and the management of the home is excellent, providing residents and staff with support, guidance and mentorship, and empowering staff to become involved in aspects of resident care management. Robust systems are in place for quality assurance and these are ongoing, ensuring that all areas are being monitored and action taken without delay to address any issues and thus enhance the care provision at the home. Health and safety is being well managed at the home. The surveys received from residents indicated that they are very happy with the care provision at the home and that they are being looked after well. Surveys received from staff indicated that they receive good training so that they can meet the different needs of the residents. Staff commented that the management of the home are supportive and manage the home well. What has improved since the last inspection? Prospective staff complete a health declaration form as part of the employment process. There is written evidence of the induction programme being undertaken by new staff. The training matrix evidences the mandatory training undertaken by staff and also the training sessions that have been booked in order that staff training in health and safety is up to date. What the care home could do better: The staff employment application form needs to be reviewed to ensure it asks prospective employees for all the information required under Schedule 2 of the Care Homes Regulations 2001, and the form needs to be fully checked to ensure all sections are completed in full. Two recommendations have been made, one in relation to double signing any hand written entries on the medication administration record charts and one in relation to updating the redecoration and refurbishment plan to include all works carried out and those planned. Key inspection report Care homes for adults (18-65 years) Name: Address: Eastbury Nursing Home 12 Eastbury Road Northwood Middlesex HA6 3AL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Clare Henderson-Roe     Date: 0 8 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Eastbury Nursing Home 12 Eastbury Road Northwood Middlesex HA6 3AL 01923823816 01923841623 info@mdhomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: MD Homes care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia physical disability Additional conditions: The maximum number of service users who can be accommodated is: 20 The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Learning disability - Code LD Physical disability - Code PD Date of last inspection Brief description of the care home Eastbury Nursing Home is a converted detached house situated in a residential area. It offers support and care twenty-four hours a day to a varied group of residents. The needs cared for are those who have Physical Disabilities, Learning Disabilities, Dementia or Mental Health Needs. The home has a large well maintained private garden to the rear and car parking facilities at the front. Local transport facilities are Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 0 20 20 20 Brief description of the care home available in the form of buses and Northwood underground station, which is within walking distance of the home. The accommodation consists of ten single and five double bedrooms. The first floor of the home has four single and two double bedrooms. There is a Parker bath, with shower attachment and two toilets on this floor. Two walkin shower rooms are available, one on the ground floor and one on the first floor. There is a stair lift for those service users unable to manage stairs. The home has a spacious conservatory, which is light and bright. The garden is the designated smoking area. The Registered Providers are MD Homes. There is a Registered Manager and a Group Operations Manager, who deals with the financial and personnel management of the five homes within MD Homes. The fees range from £1,125 to £1,702 per resident, per week, depending on the needs of the individual. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection carried out as part of the regulatory process. A total of 6 hours was spent on the inspection process, which included a tour of the home and viewing records to include medication management, service user plan documentation, training records, quality assurance documentation, staff employment records and maintenance and servicing records. The Annual Quality Assurance Assessment (AQAA) completed by the manager prior to the inspection was also viewed as part of the inspection process. We spoke with 7 residents, 6 staff and 3 visitors. Completed surveys by 3 staff, 9 residents and a healthcare professional have also been used to inform this report. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? Prospective staff complete a health declaration form as part of the employment process. There is written evidence of the induction programme being undertaken by new staff. The training matrix evidences the mandatory training undertaken by staff Care Homes for Adults (18-65 years) Page 7 of 29 and also the training sessions that have been booked in order that staff training in health and safety is up to date. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A comprehensive pre-admission assessment process is followed and prospective residents and their families provided with information about the home to enable them to make an informed decision regarding moving into the home. Permanent placements are not agreed until the resident is happy for this to happen, ensuring their right to choice is maintained. Evidence: MD Homes have a comprehensive pre-admission assessment document and the assessments are carried out by the Manager or another senior member of staff. In addition, for residents with mental health care needs, a supplementary assessment for this is carried out, which clearly identifies the effects of their mental health on areas of their care needs. The home also obtains copies of assessments carried out by Social Services and/or the Primary Care Trust. This ensures that the home has a clear picture of the prospective resident and can make a fully informed decision in respect of whether the home is suitable and able to meet the assessed needs. When the resident is admitted to the home, copies of any discharge information from the hospital healthcare team are also obtained. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: The AQAA for the home states that prospective residents are encouraged to visit the home before they are admitted in order to see if they would like to live there. Also that copies of the Service User Guide and Statement of Purpose are provided, and MD Homes also have a website that can be accessed to find out more information about the home. Following admission, a review will take place after 6 weeks to see how the resident is settling in and agree if the placement is to be made permanent. If at this stage this is not known, then a further assessment can be carried out at a later date, until all parties are happy for the placement to be made permanent. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. Service user plans are in place for each resident and give a good picture of their needs and how these are to be met. Residents are supported to make decisions about their lives and their opinions are listened to, thus respecting their wishes. The risk assessment processes for each resident are comprehensive, identifying all associated risks and stating the action to minimise the risks to each resident. Evidence: We viewed 3 service user plans. These were well completed and gave a clear picture of the residents and their needs. The deputy manager explained that for residents who had been more recently admitted to the home, the service user plans will continue to be added to as the staff knowledge of the resident increases, in order to ensure that the information is very personalised to the individual. Residents are encouraged to be involved in the formulation and review of the service user plans, and there was evidence of input from residents and their representatives in some of the documentation viewed. Where a resident does not wish to be involved, then this is identified and recorded. The service user plans are reviewed monthly for residents Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: over the age of 65 years and 3 monthly for those under 65 years, and also whenever there is a significant change in a residents condition. All the care and nursing staff are involved in the completion of the daily records, and those viewed were clear, providing a good individual picture of the daily routine experienced by each resident. It was clear from the documentation viewed and also from listening to discussions between staff and residents that residents are encouraged to express their wishes and these are listened to and acted upon. The home has information about advocacy services, to include Age Concern, and the residents also have care managers and care co-ordinators who ensure that there are regular reviews of each residents care and needs, and the resident plays an active part wherever possible in these reviews, expressing their views. The deputy manager explained that the frequency of these reviews depends on the needs of the individual, and can be every 6 weeks, plus at 3, 6 or 12 month intervals. There are also regular residents meetings and residents are encouraged to express their views, which can then be considered when making any changes within the home. Risk assessments were in place for all areas of identified risk. These include nutrition, moving and handling, pressure sore risk, mental health and the risk of falls. There is also a general risk assessment document, so that all risks are identified and the action to minimise each one is recorded. In addition, the home has a document entitled risk to others, which clearly identifies how a problem may affect an individuals behaviour towards others. Where any of the risk assessment documents identify a risk, then a care plan is formulated so that there is clear guidance to staff in how to address each area of risk in relation to the individuals needs. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are activities arranged and where able residents are encouraged to lead active lives, both educationally and socially, to promote learning and social contact. The home has an open visiting policy thus encouraging contact with family and friends. Staff care for residents in a gentle and professional manner, thus respecting their privacy and dignity. The meal provision at the home is good, reflecting the likes of the residents and meeting their dietary needs and preferences. Evidence: We were informed that 4 residents attend local day centres for between 2 and 5 days per week each. The AQAA states that residents are supported to find out about opportunities for further education, developing employment skills and finding employment should the resident so wish. This is a nursing home and many of the residents have high nursing care needs, however all are encouraged where possible to maintain a level of independence where they are able. Four residents went on holiday Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: this year, and this is discussed so that the wishes of the residents are known and respected when planning their holidays with them. MD Homes have an activities coordinator who plans activities and outings. Residents are encouraged to participate in the planning of individual activities programmes, and we saw evidence of where a resident had recorded their own programme, and are supported to fulfil the programme. Residents are encouraged to participate in the local community and MD Homes have their own minibus to use to transport residents to and from community events. MD Homes also encourage residents to visit other 4 homes within the group, and friendships have developed between residents and social events are planned in each home to which residents from the other homes are invited. On the day of inspection staff were available to take residents out for a walk and to do some shopping, and it was clear that this is a regular part of the daily routine for some residents, and not only does this encourage residents out into the community, it also provides them with excercise and fresh air, to improve their overall wellbeing. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome at the home and that the residents they visit are being well cared for. Residents can receive visitors in one of the communal areas or in their own rooms, as they so wish. We observed staff caring for residents in a gentle, calm and professional manner, respecting their privacy and dignity. It was clear that the staff have a good knowledge of the residents and there was good interaction between residents and staff. Staff knock on residents doors before entering the room and use each persons preferred term of address. We viewed some items of personal clothing and these were identified to the individual resident. Staff have a good knowledge of the residents in their care, and strive to ensure that they are always treated as individuals. There was a very good and homely atmosphere in the home, and it was clear that the care and wellbeing of the residents is top priority for all the staff. We also observed staff using techniques to effectively diffuse any interactions between residents that had the potential to become heated. The religious needs of the residents are identified, and arrangements made for representatives from religious groups to visit the home and provide input. It states in the AQAA that MD Homes have also developed a world religions book that details all the major religions of the world and describes their beliefs and how they worship. This provides valuable information for staff, who can then show an understanding of an individuals religious beliefs, and support them to follow their religion. Information is also recorded in the service user plan, to reflect each residents religious plus cultural needs. We viewed the kitchen and this was clean and tidy. At the last Environmental Health Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Officers visit the home attained a 5 star rating in the scores on doors hygiene standard scoring system, which is the highest rating available. There is a 4 week menu and this has been developed from discussion with the residents to identify individual likes and dislikes, and also taking into consideration any religious and cultural needs. The home uses halal meat at all times. We discussed any dietary needs to meet cultural and medical needs, and it was clear that these are identified and catered for. Alternatives are always available to residents, should they not want the menu choices on offer for any particular mealtime. We briefly observed the lunchtime meal, and staff were available to assist residents and were ensuring their choices were being provided. For residents on specific diets to include special feeding regimes, these are recorded and there was evidence of input from the dietician. The food provision at the home is good and reflects the preferences of the residents, thus meeting their needs. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff offer support and assistance to residents for their personal care needs in a gentle and respectful manner, thus maintaining their privacy and dignity and also maintaining residents individuality. The healthcare needs of each resident are identified and there is a good level of healthcare input to meet these needs without delay, thus maintaining optimum health for each resident. Medications are being well managed in the home, thus maintaining residents health and safeguarding them. Evidence: From sampling the service user plans, it is clear that the needs of each resident are identified and then a care plan put in place to meet each need, to include any mental health issues. All staff read the service user plans, plus many of them have worked at the home for several years, thus providing continuity of care from staff who have the experience and knowledge to care for residents individual needs effectively. Residents are encouraged to express their preference in relation to the gender of the carer to provide them with personal care, and this choice is respected. Residents have a choice of when they get up and go to bed, and also for taking part in other activities such as aspects of personal care. Staff are available to support and assist them with personal care as needed, and it was evident that residents are very much individuals and there Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: is a good relationship between staff and residents. The home also works to ensure that staff are available to meet any cultural needs, and as previously stated the compiling of a book on world religions also provides staff with valuable information in order to ensure they care for residents in a way that also meets religious and cultural needs. Equipment is available throughout the home to meet moving and handling needs, to include mobility hoists, grab rails and also a call bell system so that residents can summon assistance. We also noted that for residents with mobility problems they have personalised wheelchairs to meet their needs. The home also has access to a physiotherapist, should specialist input be required to address any specific moving and handling care needs. Residents were dressed to reflect individuality and this is also reflected in their hair styles and overall appearance. Several of the residents are on the Care Programme Approach and have reviews with the psychiatrist and care co-ordinator. The frequency of these reviews depends on the needs of each resident, and for some of the residents this is a yearly review as their conditions are stable. However, a review can be arranged at any time if it is identified that a residents mental health needs have changed or become unstable. The service user plans evidenced that the healthcare needs of each resident are identified and a plan of care implemented to ensure these needs are being met. The home provides nursing care and several of the residents have complex medical care needs that need to be monitored and reviewed. The home has a GP who visits weekly and at other times if necessary, and residents health is kept under regular review. We looked at nutritional screening and care as part of the inspection, and it was clear from the records viewed that attention is given to ensure that nutritional needs are identified promptly and acted upon. Examples of this were the identification of a resident at high risk of malnutrition, and action was taken to include maintaining food and fluid charts plus close monitoring and the provision of a good quality nutritious diet. This resulted in steady weight gain and a good improvement in the residents condition. Another example was the need for weight loss, and this had again been effectively managed in order to improve the overall well-being and health of the individual, to include improved mobility. The registered nurses monitor the condition of each resident, and the care staff are also involved in this by reporting any observations they make in relation to the health and well being of each resident, so that prompt action can be taken when a concern is identified, in order to address it swiftly and prevent further deterioration. There is evidence of input from healthcare professionals to include GP, psychiatrist, community psychiatric nurse, physiotherapist, tissue viability nurse, dentist, optician and chiropodist. We were pleased to see that residents receive routine healthcare checks following admission to the home so that any healthcare needs are promptly identified and can be addressed. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: In addition, the home has a massage therapist who provides relaxation therapy for residents who wish and for whom such treatment is suitable. We sampled the medication records and management for the home. There was a photograph of each resident, and where any allergies have been identified then these are recorded on the medication administration record (MAR). We viewed several of the MARs and receipts and carried forward amounts of each medication had been recorded plus all administration had been signed for. A separate record is kept for any medications to be disposed of, and the home uses the required method of medication disposal for a nursing home, with clear records being maintained. The majority of the MARs had printed entries and they are provided by the dispensing chemist. Where handwritten entries were seen on the MAR we recommended that 2 registered nurses check and sign each entry. The deputy manager explained that the GP signs all handwritten entries at the next visit. The majority of liquid medications and creams had been signed when opened, and in the 2 instances where they had not, the supply date was recent and the deputy manager explained that the stock would only last for that period of 28 days, so there was no risk of medications being left open for extended periods of time without being used. She also said that she would remind all nurses to include the date of opening on such medications. The home uses a 28 day monitored dosage system (MDS) and the majority of medications are provided in a blister pack. When a resident has been in hospital, the home ensures that any stock of medication still prescribed that has accumulated during their hospital stay is used when the resident returns to the home, in order to reduce wastage. For medications supplied in a box, the nurses maintain a stock balance at the end of each day. It was clear that the medication monitoring and auditing is effective and ensures residents receive their medications accurately. Should a resident be non-compliant with taking medications, this is discussed with the doctor and the residents representative, and agreement reached and signed in respect of administering medications covertly. Approved use lancets were in use for the monitoring of blood glucose levels for diabetic residents. Where a dose of a medication changes, the registered nurses obtain a fax from the healthcare professional involved and this is kept with the MAR, on which the dose change is also recorded, in order to clearly evidence the current dose for the resident. The minimum, maximum and actual temperatures for the medication fridge are recorded daily and were within safe range. There were no residents on controlled drugs at the time of inspection. Medications are being well managed in the home. Care Homes for Adults (18-65 years) Page 19 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. The home has clear procedures in place for complaints and safeguarding adults, and these are followed, thus protecting residents. Evidence: The home has not received any complaints over the last 12 months. There is a clear complaints procedure in place and this is displayed at the entrance of the home. From the information received on the surveys, residents and their representatives know how to make a complaint. From observations made during the inspection, staff are aware of the importance of communication and of ensuring any issues are identified promptly and addressed. The home has procedures in place for safeguarding adults, and also follows the Hillingdon Safeguarding adults protocols. Staff spoken with were clear to report any concerns and understood whistle blowing. Staff do receive training in safeguarding adults. Care Homes for Adults (18-65 years) Page 20 of 29 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is being well maintained and provides a homely, safe and pleasant place for residents to live in. Infection control procedures are in place and are being followed, thus protecting residents, staff and visitors. Evidence: We carried out a tour of the home and viewed various areas of the home. The communal sitting room and conservatory provide good space for residents and there is also a well maintained enclosed garden with a ramp for access, to ensure that all residents can access the garden if they so wish. Bedrooms are personalised and residents are encouraged to bring in personal posessions in line with fire safety. Overall the home is being well maintained and there is a redecoration and refurbishment plan. We suggested that this be expanded to clearly identify all the work that has been carried out and is planned for the next 12 months. Information provided on the AQAA identified that over the past 12 months new electric beds, pressure relieving mattresses, sofas and curtains have been purchased, and work has been done to improve the garden. It is noted that the kitchen has still not been refurbished, and the AQAA states that this has been identified as an area in need of improvement. We viewed the laundry and the area was clean and tidy. Policies and procedures for Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: infection control are in place and staff are aware of the importance of following these procedures to minimise the risk of cross infection. Protective clothing to include gloves and aprons are available in the home. The home contracts out the laundering of all linen and towels, so it is only personal items and other small items that are laundered in the home. The home was clean and fresh throughout and looked very homely. Care Homes for Adults (18-65 years) Page 22 of 29 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff receive induction training and ongoing training and updates to provide them with the skills and knowledge to care for the residents effectively. The home has robust recruitment processes, however shortfalls need to be addressed to fully protect residents. The home is appropriately staffed to meet the needs of the residents and the home, and this is kept under review to ensure appropriate staffing at all times. Evidence: MD Homes endeavour to enroll staff on NVQ in care training on completion of the induction training programme. The AQAA records that the majority of care staff are qualified to NVQ level 2 in care or above, and the training records evidence that staff have undertaken training in topics relevant to the care of the residents, to include several areas of mental health training, to include more recently training in the Mental Capacity Act and Deprivation of Liberties. The deputy manager explained that if she identifies that staff have gaps in their knowledge over a particular topic, then she will carry out refresher and update training with the staff or identify it as a topic on which to book future training for staff. Staff were observed to be interacting well with residents and to be able to manage their needs well, plus nursing and care staff get involved in resident reviews as they have the skills and knowledge about the resident to do so effectively. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: At the time of inspection the home had 18 residents. The minimum staffing levels are 1 registered nurse and 4 care staff on duty during the day and 1 registered nurse and 1 carer on duty at night. There were days on the rota viewed where more staff were rostered to be on duty, and the operations manager explained that this was to ensure that there were enough staff on duty for any outings, hospital visits etc. We were informed that the staff rota is kept under review to ensure that the changing needs of the residents can be met at all times. The home also has domestic, catering and maintenance staff on duty to meet the overall needs of the home. Administration duties are undertaken at head office, which is situated in another MD Home nearby. We viewed 3 sets of staff employment records. On one application form viewed, the section for recording previous employment details did ask the applicant to record the reason for leaving each job. This was not seen on the other 2 application forms viewed. We saw 2 references, evidence of enhanced Criminal Records Bureau checks, health checks and photographs on the files viewed. We noted that in some instances there appeared to be gaps in employment, and there was no explanation recorded. The operations manager said that this had been discussed, and that she would record this in future. Also, that she would ensure that in future application forms once again requested the reason for leaving each job. Copies of signed contracts were available, and for staff who are working on a student visa, letters of confirmation of what hours they could work had been obtained from the colleges they are studying at. All new staff undergo an induction process. A general induction into the home is completed, and then the Skills for Care induction programme, to include the common induction standards, is followed. We saw evidence of completed induction documentation in the employment files viewed. Staff responses to the surveys indicate that they do receive an induction and also undertake periodic training in topics relevant to the diagnoses and care of the residents. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager and her deputy have the skills, experience and leadership qualities to effectively manage the home, lead by example and maintain a consistent high standard throughout. The quality assurance systems are robust and are followed, thus ensuring that the home is being effectively monitored at all times and swift action taken to address issues identified. Health and safety are being well managed at the home, thus providing a safe environment for residents, staff and visitors. Evidence: The manager has been in post for several years and is a first level nurse who has completed the Registered Managers Award. She also keeps up to date with training in topics relevant to the diagnoses of the residents and to her role. Comments received from residents and staff indicate that the manager is supportive and approachable. At the time of inspection the manager was on leave and the deputy manager was in charge of the home. The deputy manager has also worked at the home for several years and is also very supportive to the staff and residents. We discussed staff training and the deputy manager said that if at any time a shortfall in staff knowledge becomes evident, training is carried out without delay in order to ensure all staff have Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: up to date skills and knowedge to care for the residents effectively, and this was evident at the time of inspection. The deputy manager showed excellent leadership and management skills on the day of inspection, dealing with several other events as well as the inspection process and allocating staff appropriately to ensure that each event was managed effectively and well. The home is to be commended on the high standard of management and care it provides. M D Homes use the Registered Nursing Homes Association quality assurance system. Regular audits are carried out to cover all aspects of care and action is taken immediately to address any issues identified. Regulation 26 unannounced inspections are carried out on behalf of the registered provider and reports of these are available to read in the home. Residents meetings and staff meetings take place and minutes are recorded. It was clear from the minutes that issues raised are addressed and feedback given. The home carries out annual satisfaction surveys for the residents so that they can monitor how well the home is doing and address any areas of concern identified. There was evidence that residents are reviewed at appropriate intervals, and the home strives at all times to ensure that each resident is maintained at their optimum level of health and wellbeing, with swift action being taken to address any issues that arise. The quality assurance system is seen as an ongoing process, which provides effective monitoring for the home and M D Homes as a group. We sampled the maintenance and servicing records and those viewed were up to date, plus information provided on the AQAA showed that maintenance and servicing is carried out at required intervals. The fire risk assessment was last reviewed in April 2009 and there were also risk assessments in place for equipment and safe working practices. There was evidence of regular fire drills taking place for day and night staff, with records being kept. Staff undertake health and safety training and the training matrix has been updated to reflect the training undertaken by staff and also the updates booked for staff to keep their training up to date. The home has safety notices on display in areas such as the laundry and kitchen, to provide information for residents, staff and visitors and minimise risks. Accidents and incidents are reported and recorded, and notifiable incidents are reported to CQC in line with CQC guidance. The home has policies and procedures in place for the management of health and safety and these had been updated within the last 12 months. Health and safety is being well managed at the home. Care Homes for Adults (18-65 years) Page 26 of 29 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 Adults (18-65 years) Page 27 of 29 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 34 19 Staff records must contain all the information required under Schedule 2 of the Care Homes Regulations 2001. To protect residents. 22/01/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 20 Where a hand written entry is made on the medication administration chart, this should be checked and signed by 2 registered nurses. That the redecoration and refurbishment plan be expanded to include all work that has been carried out, plus the planned work for the next 12 months, in order to maintain an up to date programme. 2 24 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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