Care Home: Madelayne Court

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What the care home does well The information provided to prospective residents is very informative and will help them make a choice and ensure the home will be able to meet their care needs. There is a thorough admission process and all new residents are visited before they come into Madelayne Court to ensure their care needs can be met. Care plans are in place to advise staff of each individual resident`s needs and how they would like their care provided. Staff are well trained and have the skills and experience to provide residents with the care they require. Many of the staff have achieved their NVQ qualification. Paperwork and records in the home are well kept and there are systems in place, which enable information to be easily found. What has improved since the last inspection? There is a new Manager who has been in post for approximately 4 months. She has the experience and knowledge of managing a care home. Staff, residents and relatives all reported that the new Manager was very approachable and that they felt they would be able to bring any concerns to her attention for action. There were a number of requirements made at the last inspection and all of these had now been met. Documentation seen had been well completed and provided evidence to show that residents are well cared for and their wishes and preferences are now taken into account. Training had been organised for staff and Madelayne Court have a skilled and knowledgeable workforce. What the care home could do better: There have been no requirements made at this Key Inspection. Systems are in place to show that the home is being managed well. Some residents and staff raised concerns over the number of staff that are sometimes on duty. Staff stated they were not always given enough time to meet the assessed needs of the residents and residents reported that staff are not always available when needed. The staffing of the home should be revisited to ensure there are sufficient staff on duty to cover the present resident`s needs at all times. Key inspection report Care homes for older people Name: Address: Madelayne Court School Lane Broomfield Chelmsford Essex CM1 7DR     The quality rating for this care home is:   two star good 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: Sharon Lacey     Date: 2 7 0 1 2 0 1 0 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 Older People Page 2 of 31 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 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 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 Older People Page 3 of 31 Information about the care home Name of care home: Address: Madelayne Court School Lane Broomfield Chelmsford Essex CM1 7DR 01245443986 01245443835 manager.madelayne@runwoodhomes.co.uk www.runwoodhomecare.com Runwood Homes Plc Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Michelle Hopkins Type of registration: Number of places registered: care home 112 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 112. The registered person may provide the following category of service only: Care Home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP, Dementia - Code DE. Date of last inspection Brief description of the care home Madelayne Court is owned by Runwood Homes PLC and is registered with us The Commission to provide personal care and accommodation for up to 112 older people. The home is also registered to care for service users with dementia. The home is located in Broomfield, a village type locality on the perimeter of Chelmsford, Essex. It Care Homes for Older People Page 4 of 31 Over 65 0 112 112 0 Brief description of the care home is a three-storey building that was purpose built and first opened in 2006. There are 112 single en-suite bedrooms on three floors that are accessible by stairs and three lifts. There are 41 single en-suite rooms on the ground floor, divided into three units, 50 single en-suite rooms on the first floor divided into 3 units and 21 single en-suite rooms within one unit on the second floor. Each unit has a lounge and dining room. There are six bedrooms with adjoining doors to accommodate shared accommodation for three couples if required. The gardens surrounding the property are laid mainly to lawn with established trees and are fenced. Gardens to the rear of the property have paved areas and raised beds that are accessible to wheelchair users. The home is on the main bus route. The home is accessible by car and the nearest railway station is nearby. Parking is available for staff and visitors in the large car park located to the rear of the home. The fees range from £453.11 - £750.00 per week, depending on individually assessed dependency levels. Additional costs apply for chiropody, toiletries, hairdressing and newspapers. This was the information provided at the time of this key inspection. People considering using this service may wish to obtain more up to date information from the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The Last Key Inspection to Madelayne Court took place on the 26th January 2009. This Key inspection was in the form of an unannounced inspection and took place over eight hours. All the Key Standards were inspected, but evidence was also gained on some of the other National Minimum Standards. A tour of Madelayne Court was completed and an inspection of relevant records and documentation took place. Areas looked at included information given to residents before being admitted, information gained when residents first come into the home, how information is given to staff on the care residents may require, the facilities and the environment of the home, and any complaints or safeguarding issues that may have been received since the last inspection. Also staffing and management of the home were inspected. An Annual Quality Assurance Assessment (AQAA) was sent to us. The AQAA is a selfCare Homes for Older People Page 6 of 31 assessment which is required by law and identifies how the service feel outcomes are being met for the people using the service. The AQAA submitted provided information on how the service had improved over the last 12 months and what improvements they still hoped to make. During a tour of the home a number of residents were spoken with about their life experiences at Madelayne Court. Some of the residents approached were unable to express their thoughts or feelings, so they were observed during the day interacting with staff and visitors. Questionnaires were sent out to residents, relatives, and also healthcare professionals. Information from those returned have been included in this report. Most staff members on duty were spoken with informally during the visit to the home and any feedback has been included as part of the report. Staff questionnaires were also distributed and information from those returned have been included. At the end of the day the findings of the inspection on the home were discussed with the Manager and advice and guidance was given. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents will be provided with information about Madelayne Court and the services it provides. Residents who move into the home will have their care needs assessed to be sure that these can be met. Evidence: Copies of the Service User Guide and Statement of Purpose were available in the foyer of the home. These contained information about the home and advised prospective residents of the services provided, the fees and also the facilities available. On viewing both documents it was felt that these were very informative and contained all the information required. The Manager confirmed that these documents are given to prospective residents when they view the home or when an assessment is completed. Copies of the Service Users Guide could also be found in residents bedrooms. Both documents had been reviewed in September 2009, but it was noted that it stated in the Service Users Guide that the home is inspected by the Care Quality Commission twice a year, but this practice has since changed and the information needs to be Care Homes for Older People Page 10 of 31 Evidence: updated. Feedback from the questionnaires returned by the residents at Madelayne Court, confirmed that most had received sufficient information about the home before they moved in. A small information brochure with general information about Madelayne Court had also been produced. The foyer had other documentation about the home and services available, which would be useful to both visitors and residents. There is a thorough admission process and details of this could be found in the Service Users Guide. It was established that all new residents would be visited before they were admitted to the home, to ensure their care needs can be met. The Manager confirmed this would normally be done by herself, the Deputy Manager or the Unit Manager. Four residents files were viewed and these contained a completed assessment form, which identified each individuals needs. Files also contained profiles of the residents and details of their social history. A dementia dependency assessment tool had also been completed on some of the files. The Service User Guide advised that trial visits are offered to all new residents. This provides an opportunity for prospective residents and their families to have an opportunity to visit Madelayne Court and assess the quality/facilities and the suitability of the home before they move in. The Manager stated that not many new residents choose to have a trial visit, but added that most come to the Home for respite care and then decided to move into the home permanently. The AQAA reported that trial visits is something that the home wish to promote before admission. To ensure the staff can meet the needs of the residents living at Madelayne Court, all staff are provided with training. From the training documentation seen this showed that the staff are well-trained and able to meet their residents care needs. Specialist training had also been provided to ensure staff have the skills and knowledge of the client group they provide care for. The organisation also have their own dementia specialist who provides support and training to staff in this area of care. The Registration certificate was on the wall in the foyer, but this contained details of the previous Manager. The new Manager has applied to be registered and is presently going through the process. There was a copy of the last inspection report in the foyer. The home does not provide intermediate care. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their health, personal and social care needs will be met. Each will have an individual plan of care and they will receive the care they need. Evidence: The Service User Guide contained guidance on care plans, including what they were, how often they were reviewed and how individual resident would be involved in this process. Four residents files were viewed and all contained a plan of care, which identified their care needs and how this would be met by the staff. These had been reviewed monthly. Some files included an assessment of pressure care, continence assessments, a dementia dependency assessment tool, nutritional records, moving and handling assessments and a risk assessment for falls. Details of the residents social history was also on file, which would provide details for any activities care plan. Resident files also contained a night care plan, which provided staff with information on what time the person wanted to go to bed and what care was required during the night. Whilst talking with residents, two raised concerns that they did not like being left in the dark at night. From further discussion it was established that the fire doors Care Homes for Older People Page 12 of 31 Evidence: automatically shut on all bedrooms at 22.00 pm; leaving some of the residents in total darkness. One resident stated I dont like the dark, I would like a night light. This was brought to the Managers attention for action and so that it could be added to their night care plan. During the inspection there was evidence that health care professionals were visiting individuals to provide them with care. The resident files viewed contained documentation with regard to visits by GPs, visits by District Nurses and also other health care professionals. There were also letters on some files with regard hospital appointments etc. Documentation showed that an optician had regularly visited. Feedback from the returned questionnaires showed that residents either always or usually received the medical care they needed. Comments included the carers/management within the home appear to care about the residents well being, good contact with surgery and nurses and medical advice and treatment are excellent. A member of staff was observed providing lunchtime medication to residents on one of the units. The home uses a monitored dosage system, which helps to assist in the safe storage and administration of medication. Medication was kept in a locked cabinet, which was clearly labeled with the units name. MAR sheets were used to record when medication had been provided and there were pictures of the residents on file to help the staff with identification. On viewing the contents of the medication trolley it was noted that boxes had been dated when they had been opened and medication was clearly labeled with each residents name. There was a medication profile for each of the residents, which highlighted what medication had been prescribed, what it was for and how many times a day it was needed; this form also had space to record any allergies. The documentation used to record controlled drugs had been completed correctly. It was confirmed with the Manager that an audit is completed weekly to ensure that medication is correct and this was reiterated in the AQAA. The medication folder contained samples of signatures of staff who assist with medication; this assists with identification when audits are completed. Medication sheets viewed did not have any anomalies and codes had been used where medication had been missed or refused. The AQAA reported that staff who administer medication had received appropriate training and competency assessments are done regularly. The staff member spoken with confirmed that she had received medication training. On the day of the inspection it was found that whilst observing staff and residents together, the residents were treated with respect and their privacy was always upheld. Staff were observed talking with residents and involving them as part of the conversation. One staff member was observed touching a residents hand who had Care Homes for Older People Page 13 of 31 Evidence: been asleep, to ensure that they were warm enough. Doors were shut whilst providing personal care. The Manager stated that residents will be able to stay at Madelayne Court for as long as the staff are able to provide the care they require. There was a bereavement pack in the foyer, which contained guidance on registering the death, the stages of grieving and how to organise a funeral. There was also space on the care plan to record details of any wishes. The home had an illness, accident or death of a resident form, which recorded clear details of what contact the relatives may wish to have if this occurred. Feedback from one health care professional stated they manage the end of life for their residents well. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with a variety of activities. Food provided by the home is of a satisfactory quality. Residents visitors will be made welcomed. Evidence: The Service User Guide contained details of the homes visiting policy, which states it encourages and welcomes all visitors between 9.00 am and 9.00 pm. It adds that visitors can call outside these times but arrangements need to be made with staff. There was evidence of visitors coming and going during the day. There are small areas around the home for residents to sit with the visitors or they can use the lounges, dining areas or their bedrooms. The Service User Guide also advised that they welcome family and friends who wish to stay and have a meal, but there would be a small charge for this. Three Activity Co-ordinators are employed to support social activities within the home; they also have access to the companies Dementia Activity specialists. Information could be found in the Service User Guide on what activities are available in the home. An activities rota was on the wall and this had details of activities that were to take place each day. This included folding laundry, shoe shining, flower arranging, cake decorating, ballgames, dancing, Dominos, puzzles, the PAT dog, music and Care Homes for Older People Page 15 of 31 Evidence: movements, karaoke, facials, collages and computer work. A newsletter has recently been introduced to help advise residents of any activities that are being organised. A singer had been booked for February and March and other entertainment included a visit from a baptist church, a flute duo, a coffee afternoon and holy communion. The home has a snoozlem room on one unit, and two residents were observed sitting in the room and appeared very relaxed and enjoying the atmosphere. There were also touch and feel boards around the corridors for those residents with dementia and to help aid stimulation. One resident was observed independently going out to feed the birds. Whilst touring the home there was evidence of arts and crafts on the wall, which have been done by the residents. When residents were asked if activities were arranged by the home, four said always, three stated usually and two said sometimes. Comments included they are currently working on improving their activities programme and have engaged extra staff to pay more attention to individual needs. On the day of the inspection there was only one activities coordinator for the whole of the Home. They were observed making hearts on one the units for Valentines Day, but many of the residents had not had any activities during that day. It was established that a hairdresser calls every week and two residents spoken with confirmed they had recently visited the hairdresser and they both looked well presented. The white board in the dining room listed the meals available and this included breakfast (porridge, cereals and white and brown toast), lunch (roast lamb, roast potatoes, cauliflower, cabbage or a jacket potato and stewed rhubarb and custard for dessert) and tea consisting of assorted sandwiches with mushroom soup, scones and cream. One resident stated that the dinner was roast lamb and rhubarb and custard and added that she knew this as it was on the board in the dining room. Other residents spoken with confirmed that tea, coffee and biscuits are served during the day. It was noted while touring the home that the dining rooms were pleasantly decorated and had tablecloths, plastic beakers, salt and pepper and table mats; relaxing music was playing in the background. Residents were offered a choice on where they would like to eat their meals. One resident advised I can eat it where I want to, but today Im going to stay in my room and other residents also chose to eat in their bedrooms. Staff were observed generally offering choice where possible with regard to meals and drinks. Feedback from the questionnaires received back found that four residents always Care Homes for Older People Page 16 of 31 Evidence: liked the meals, three usually did, two sometimes did and one never did. Comments received from the residents on the day of the inspection included nice dinner today it is lamb - I hope they are going to have a mint sauce, you get a choice of two meals, but they sometimes change it and I like roast dinners, but I do not like meatballs or beefburgers. The tables were noted not to have any sauces and there was also no mint sauce served with the lamb. The home had completed a catering survey in October 2009, comments were generally positive and 92 stated they were offered a choice of meal, 99 stated they were offered drinks during the day and 93 stated they were not hungry or thirsty at any other time other that mealtimes. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and relatives can be confident that any concerns or complaints will be listened to and acted upon. They can also be confident that they will be kept safe. Evidence: There is clear written guidance in the Service User Guide and Statement of Purpose on how relatives and residents can make complaints. It was noted that the information had the contact details of the Commission for Social Care Inspection and not the Care Quality Commission; so this needs to be updated. On viewing the complaints folder, this had a set form to record any complaints received and space to record any investigation and outcome. There were good records of complaints. The home also had a compliment book, which had copies of letters and cards that had been received from relatives, friends and residents. Whilst looking at this file comments included high standard of care, thank you for such good care, you do a really excellent job of caring, caring attitude, staff very helpful and thank you for all the help and kindness shown. Of those residents who responded to questionnaires, eight knew who to raise any concerns with, whilst one did not. One added the home Manager has an open door policy and is easy to speak to about any problems. There are policies and procedures in place to assist with the safeguarding of vulnerable adults; and the Manager is aware of the local authority guidelines. There is a whistle blowing policy and guidance on safeguarding vulnerable adults in the staff Care Homes for Older People Page 18 of 31 Evidence: room. Documentation seen confirmed that safeguarding training had been provided to staff and three staff spoken with confirmed that they had completed this training. Further safeguarding training had been arranged for 26/01/10 and 01/02/10. Details regarding the deprivation of liberty could be found in the foyer, which consisted of the Department of Health guidance. The Manager confirmed that DOL assessments had been completed. There is also guidance on finances, making wills, power of attorney, and the Mental Capacity Act. There were details of the service users Charters of Rights in the foyer and also an advocacy service for any relatives or residents who may need this form of information. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in home that will meet their needs and is comfortable and well maintained. Evidence: Madelayne Court is a purpose-built home, which provides residents with a spacious and comfortable environment. It is a large detached property that has been built to meet the needs of older people with dementia. The environment and furnishings are set to a high specification and residents live in a safe, well maintained environment. The home employs a full time maintenance person. There are communal areas on each of the units, which consist of a dining and lounge area. Whilst touring the home it was noted the walls have been brightly painted and each of the units are a different colour, which would help aid orientation for those residents who have dementia. There were also pictures on the walls and in the corridors for residents to look at and help with orientation and stimulation. All bedrooms are single and have ensuite facilities. On viewing the bedrooms, these were all nicely decorated and the furniture and furnishings were in good condition. Residents are invited to bring in personal belongings to help personalise their rooms and guidance on this could be found in the Service Users Guide. Bedroom doors had residents names and a picture to help each resident identify their bedroom and also aid orientation for those with dementia. Care Homes for Older People Page 20 of 31 Evidence: Radiators had been covered to help keep residents safe and there were sensors on the bathroom lights and toilet lights, which helped reduce electricity usage. Two residents had brought up about lights going off at night and this had been brought to the Managers attention so that night lights could be fitted. Residents were noted to use wheelchairs, walking frames and walking sticks and there is a rail around the corridors of the home, which could be used to steady residents. It was noted that doorways were wide enough for wheelchair users and there were also ramps available where needed. Wheelchairs seen were clean and had foot plates attached to them. There was storage around the home for wheelchairs, hoists and other mobility equipment. There is a call bell system and this was seen working on the day of the inspection. The Service User Guide provided guidance to residents on what they could bring in with them, when they were first admitted. Each bedroom viewed contained personal belongings and appeared very homely with photographs and small ornaments etc. Residents bedroom doors had names and pictures to help residents with orientation. There are sufficient bathing and toileting facilities within the home and each bedroom also has ensuite facilities. The bathrooms and toilets are situated in convenient locations around the home and these are clearly identified. There were large bathrooms and toilets with plenty of room for wheelchairs and walking equipment. The bathrooms were bright and residents could choose from having a bath or shower and appropriate equipment was made available. All bathrooms and toilets inspected had the use of paper towels and soap to assist in infection control in the home and there was guidance to staff on the correct procedures for hand washing. During a tour of the home it was noted that sluices on each of the units had been kept locked, to ensure residents safety. There were pedal bins in the bathrooms for clinical waste and bathroom waste. The home had hand sanitiser in the foyer and requested that this was used before entering and leaving the Home. It was noted while touring the home that the home was generally odour free. Five of the nine residents who returned questionnaires stated the home was always fresh and clean, whilst four stated it usually was. On viewing the training matrix it showed that most staff had attended infection control training, but there were some staff is still needed to attend or required updates. Some comments received included they must make sure that they provide enough supplies of gloves, aprons, pads and wipes so that we can do our job properly, the home should always make sure that there is enough supplies of materials like gloves, pads, aprons, towels, washing up liquid etc and when visiting I often hear staff discussing lack of cleaning materials, hand towels, hand gel, soap and staff have to purchase alcohol gel themselves as the home do not provide this. One staff member spoken with also confirmed that they Care Homes for Older People Page 21 of 31 Evidence: sometimes run of of cleaning materials. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that they will be cared for by competent and experienced staff. Evidence: The Manager confirmed that there are presently 6 staff vacancies at Madelayne Court. Staffing rotas were viewed and these contained details of the staff members name, job title, day, dates and times worked. The home presently employs approximately 90 to 100 staff. There are seven units over three floors. On the ground floor there are three units with approximately 40 residents in total. Staffing consists of six staff 1 care team manager in the morning and five staff in one care team manager in the afternoon. On the first floor there are three units and approximately 50 people. Staffing consists of seven staff and one care team manager in the morning and six staff and one care team manager in the afternoon. On the second floor there is only one unit which has 21 highly dependent people with dementia. Staffing consists of two staff and one care team manager. The Manager is supernumerary to staffing numbers and there is also a Deputy Manager. Unit Managers are supernumerary two days a week. Night care consists of two care team managers and six care staff to cover all three floors. There are also a receptionist, administrator, laundry staff, domestic staff, Cook, Cooks assistant, three activity coordinators and a maintenance man. When residents were asked whether staff were available when needed, five stated always, three said usually and two said sometimes. When staff were asked if they were Care Homes for Older People Page 23 of 31 Evidence: given enough time to meet the assessed needs of the residents, one said always, two said usually, one said sometimes and another reported never. One staff member added make sure there are enough staff to give quality care for each service user. The home has a policy and procedure for the recruitment of new staff. The files of three recently recruited staff were viewed and these showed that correct recruitment practices had been followed. Files contained written references, proof of identity, full employment history, medical history, details of any criminal offences and Criminal Record checks. Files also had copies of terms and conditions, confirmation that staff had received a handbook, interview forms and photos. The Manager stated that she is in the process of recruiting more staff. Those staff who returned questionnaires confirmed that their employer carried out recruitment checks before they started work at Madelayne Court. The Manager confirmed that the induction provided to new staff was in line with Skills for Care guidance and that all new staff had completed this. When staff were asked if their induction covered everything they needed to know when they started as a carer, one said very well, five stated mostly and one said partly. The Service User Guide states that staff would attend regular training in moving and handling, fire procedures and evacuation, basic first aid, safeguarding and whistle blowing, dementia, risk assessments, health and safety and infection control training. The company have internal trainers who provide all training to staff and this is organised at different homes throughout the year. The Manager had produced a very clear training matrix, which showed the training staff had completed and when updates were required. On viewing this it showed that most staff had completed all relevant training. A training schedule was available and this listed training to be completed during January and February 2010 and included moving and handling, first aid, health and safety, safeguarding, and dementia training. Two staff files were viewed and both contained evidence of training certificates. Other training organised for staff included drug awareness, pressure care, Parkinsons, diabetes, stroke, hydration, customer care, falls, mental capacity act, deprivation of liberty act, and palliative care training. The training matrix produced showed that many of the staff were competent and had completed this training. All staff who returned questionnaires confirmed that they had been provided regular training, which was relevant to their role and helped them understand the needs of their residents. Thirty one care staff have now completed their NVQ level II and 18 care staff their NVQ level III. A number of domestics, activity coordinators, administrator, cooks, kitchen assistants and home receptionist have achieved NVQ qualification. This means Care Homes for Older People Page 24 of 31 Evidence: that the home have over 50 of its work force NVQ trained. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is run and managed efficiently and effectively. Residents live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Evidence: The Manager has been in post at Madelayne Court for approximately four months. She has the skills and knowledge required to manage a care home and is also a qualified registered general nurse; although the home does not provide nursing care. There were clear lines of accountability and the Manager confirmed that she also receives support from upper management within the company. On discussion with the Manager she was aware of her responsibilities under the Care Home Regulations and National Minimum Standards. There is a Deputy Manager in place who is an experienced manager from a previous home. Feedback from one resident questionnaire included there have been noticeable improvements in staff morale, and generally since the arrival of the new Manager. Care Homes for Older People Page 26 of 31 Evidence: The Manager has arranged an open office for any relatives who may wish to come and speak to her. Staff spoken with during the inspection found the new Manager approachable and they all stated that if they had any concerns they would be able to go to speak with her. When speaking with staff they were happy to openly discuss the running of the home and there was generally a pleasant atmosphere. Madelayne Court has systems in place to monitor the quality of the service it provides. Residents and relatives views are gained through sending out questionnaires and there is also a suggestion box in the foyer for comments. An internal quality report is also completed, which is quiet comprehensive and highlights any areas the home needs to improve on. Regulation 26 reports had been completed by senior management on a monthly basis and these highlighted areas of improvement. Resident meetings had occurred in October and December 2009 and these included areas discussed (food and activities). There was a copy of Essex County Councils Quality Report completed in 2008; this stated that the home had exceeded in training and management. There are a copy of the local business plan in the foyer for 2009 and 2009/10. This covered training, support, care, targets for the coming year and a financial plan. There was also guidance on finances in the Service User Guide. Six residents finances were checked and all were correct except one. The record stated that there was £40 available, but when viewing the wallet there was only £20. This was investigated whilst the Inspector was still on the premises and evidence showed that only £20 had been received, but it had been recorded twice. There was supervision matrix in place and this showed that staff had received appropriate supervision. Documentation showed that meetings, one to ones and appraisals had been routinely completed. There was also evidence of direct observation supervision had been completed on staff. Four staff files were viewed and over the past 12 months one staff member had received ten supervisions, the second had received five, the third six and the fourth had received eight. When staff were asked if they Manager gave enough support and met with them two said regularly and four stated often. Records were well organised and systems had been put in place to enable the Manager to provide the evidence to show that the National Minimum Standards and Regulations had been met. Documentation was provided to show that regular safety checks had been completed on the home. There was evidence of accidents forms being completed, valid insurance, Care Homes for Older People Page 27 of 31 Evidence: hoists checked, fire alarm system checked, PAT testing, fire extinguishers checked, gas certificate, water temperatures, fire alarm systems and security lighting. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 1 15 16 26 Ensure documentation is updated with regard to the frequency of inspections to the home from CQC. Ensure residents views are gained with regard to what condiments/sauces they would like with their meals. Ensure the contact details of the CQC are updated in the Service User Guide. Ensure there are sufficient supplies of cleaning materials and personal protective clothing to assist staff with infection control procedures within the home. Ensure that there are sufficient staff on duty at all times to meet the needs of the present residents. Feedback from staff was mixed on the induction they received when they first joined Madelayne Court. Look at the induction presently offered to new staff to ensure it covers all the information needed when they are first employed as a carer. Ensure correct reocrds are made of any resident monies received. 5 6 27 30 7 35 Care Homes for Older People Page 30 of 31 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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