Care Home: Maesknoll

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What the care home does well The atmosphere and quality of life for people living at Maesknoll goes on improving. People spoke highly of the service they get. Comments included: `The home is good generally`, `They do everything well and I`m happy, so what more could I ask`, `I think we all get cared for really well`, `The home is generally good all round` and: `I`m happy here so I think they do everything well`. Staff commented: `All residents are well cared for and come first at all times`, `the care towards residents is second to none. All staff really care about the residents they deal with daily` and: `Care to the residents is excellent`. People benefit from a manager who is determined to put their needs first and give them a good quality of life in all areas. The environment of the home is well maintained and comfortable for everyone living there. Efforts are made to make the home as accessible as possible for disabled older people. Administration of records is good and makes sure peoples` lives run smoothly and their needs regularly checked. What has improved since the last inspection? One requirement and seven good practice recommendations made at the last inspection in December 2008 had all been met. They included: - A requirement to make sure the environment of the home is uncluttered and free from obstacles had been met. People are able to move around the home freely without risk. Recommendations adopted included: - The Statement of Purpose and service user guide were available to each person in larger print. Information about the home had also been put into picture format so that people with dementia and those with sight difficulties benefit from the same rights to information as others, - Work continues on making care plans more person-centred. Those seen now include more information about peoples` interests and records showed that they`re looked at formally with the person concerned and updated if needed, - Information about peoples` leisure interests is now being gained and included on care plans. The manager showed that peoples` wishes for activities and hobbies were now being met and: - All records we saw were kept properly and securely in good order so that peoples` information is kept confidential. From all the above we consider that the manager and staff show a real desire and commitment to improving the outcomes for people living at the home. What the care home could do better: No new requirements were made at this visit. One recommendation about showing evidence of staff training was made. All our findings showed that the home gives good quality care and positive outcomes for people living there. However, from surveys done with people living at the home and staff this question raised a few comments. People said: `Under the circumstances I don`t think they could do anything better` and: `Nothing. I think they do the best they can and look after us old people very well`. However, staff did feel some things could be done better i.e. `replace some old equipment`, `listen to the carers as we are their eyes and ears` and: `I love the job I do but don`t feel that the residents always get the attention they so much need`. Key inspection report Care homes for older people Name: Address: Maesknoll 101 Bamfield Whitchurch Bristol BS14 0SA     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: Sandra Garrett     Date: 0 5 1 1 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 Older People Page 2 of 33 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 33 Information about the care home Name of care home: Address: Maesknoll 101 Bamfield Whitchurch Bristol BS14 0SA 01173772690 01173772691 maesknoll@bristol-city.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Bristol City Council care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: May accommodate one named service user aged 58 years of age. Home will revert when named person leaves. Date of last inspection Brief description of the care home Maesknoll is registered with the Care Quality Commission (the Commission) to give accommodation and personal care to forty people aged 65 years and over. The home is owned and run by Bristol City Council and situated in the residential area of Whitchurch. Maesknoll is laid out over two floors and has a lift. There is a small patio and large areas of lawn surrounding the outside of the home. The fee for living at the home, in common with all other City Council care homes (excluding those for people with dementia) is 488.16 pounds per week. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority fees payable are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk http:/www.oft.gov.uk. A copy of the last inspection report was displayed in the Care Homes for Older People Page 4 of 33 Over 65 40 0 0 2 1 2 2 0 0 8 Brief description of the care home entrance foyer of the home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Before the visit, all information the Care Quality Commission (the Commission) has received about the service since the last inspection was looked at. We then drew up an inspection record in preparation for the visit. This record is used to focus on and plan all inspections so that we concentrate on checking the most important areas. We used information gained from the homes Annual Quality Assurance Assessment (AQAA) which is a self-assessment of progress and what they feel they need to improve on. We also looked at comments from our own Have Your Say survey that we did with seven people just before this visit. We received six completed surveys from staff. Comments from all surveys are included throughout this report. We spoke to five people living at the home, five staff (including the manager) and looked at a wide range of care, staff, health and safety and other records. Care Homes for Older People Page 6 of 33 What the care home does well: What has improved since the last inspection? What they could do better: No new requirements were made at this visit. One recommendation about showing evidence of staff training was made. All our findings showed that the home gives good quality care and positive outcomes Care Homes for Older People Page 7 of 33 for people living there. However, from surveys done with people living at the home and staff this question raised a few comments. People said: Under the circumstances I dont think they could do anything better and: Nothing. I think they do the best they can and look after us old people very well. However, staff did feel some things could be done better i.e. replace some old equipment, listen to the carers as we are their eyes and ears and: I love the job I do but dont feel that the residents always get the attention they so much need. 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 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from being given clear, accessible information about the home when they come into it, even if they have difficulties with seeing or because of dementia. Better use of information gained about peoples backgrounds, personal histories and preferences, helps people to get more person-centred care and be treated as unique individuals in their own right. Detailed pre-admission assessments make sure that the centre is the right place for people using the service and that staff are able to meet their needs. Suitably trained and experienced staff make sure peoples specialist needs are picked up and met where possible. Evidence: We followed up a good practice recommendation about making sure the Statement of Care Homes for Older People Page 10 of 33 Evidence: Purpose and service user guide are put into more accessible form for people with dementia or sight difficulties. We saw that everyone now has a copy of the statement and guide in large print. Copies are also on display in the entrance hall along with the last inspection report. The service users guide includes information on Maesknoll that is about the home, the local area, its fixtures and fittings, rooms and mealtimes. All the information includes pictures or photographs e.g. information about bus services shows a picture of a double decker bus. Pictures of the nearest local supermarket are also shown. From our Have your Say surveys filled in before the visit, we asked: Did you receive enough information to help you decide if this home was the right place for you, before you moved in? From the seven people that responded two said yes, two said no and three said they didnt know. People have their own file in their rooms that has the above information as well as a copy of their contract and latest care plan, among other things. Assessment information is kept in the office in a separate file. We randomly case-tracked four peoples care. Case-tracking means looking at all records associated with the person and tracking their care by talking with both them and staff caring for them. Although we chose people randomly, all four people have either dementia or cognitive impairment (this means an undiagnosed condition that could affect their memory and reasoning skills). This was surprising as the home caters for all older people and is not especially designed for people with dementia. However, we looked at assessments and care plans and the way people are cared for. Assessment information was carried through to care plans and every attempt made to give them a good quality of life. Staff at the home are currently able to meet the needs of the four people whose care we looked at and signed their care plans or reviews to confirm this. From the management team message book we saw that assessments are done by members of the team, particularly if hospital staff confirm they are medically fit to return home. Some people are admitted as an emergency, but every effort is made to get a copy of the assessment before the person comes to the home so that staff are able to decide if they can meet their needs. From the homes Annual Quality Assurance Assessment (AQAA) the manager had stated: All referrals and assessments are carried out by a social worker or a member of the mental health team. All paperwork is checked by the care homes management team or duty officer to ensure we can meet service users needs. The manager went on to state : We arrange a visit to Maesknoll prior to admission wherever possible for a day or overnight before people make a decision. Any Care Homes for Older People Page 11 of 33 Evidence: emergency admission will have a 72 hour review with a social worker. We spoke to one staff member who is keyworker to one of the people we casetracked. She told us how she tries to meet the persons needs. However, she was concerned that because of dementia the person might not be getting the quality of life s/he is entitled to. From looking at all records associated with this person and speaking with her/him it was clear that s/he is able to choose how to live and what to do. These choices are respected even though the person often wishes to isolate her/himself from others. The above example shows that staff are experienced and committed to meeting peoples specialist needs. The manager said that she has made links with agencies such as the Royal National Institute for the Blind so that staff can access support for people with sight difficulties. The mental health in-reach team from the local psychiatric hospital supports care homes and one of the members of the team called in to the home while we were there. The team gives advice on particular issues and also does short training sessions for staff. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvement in the way care plans are written makes sure people using the service are cared for in person-centred ways. Improvement in care reviews means that changing care needs and peoples views of the service will be picked up and met. People living at the home are looked after well in respect of their healthcare and medication needs. More thoughtful use of photographs makes sure people are treated with dignity and respect. Evidence: We asked people: Do you receive the care and support you need? Five people said always and two said usually. From the AQAA the manager had written that what the home does well is: more person-centred care plans, monthly reviews of them, listening to people, making necessary changes and making sure that every person has a GP and other health care Care Homes for Older People Page 13 of 33 Evidence: professionals are called out when requested. This matched with responses to our survey when six out of seven said they always get the medical care they need. One person said usually. We looked at care plans and followed up a good practice recommendation about them made at the last visit. All are now written in person centred ways. This means looking at a persons whole life, history and needs. It recognises and values them as an individual with rights and choices, rather than just focussing on meeting basic physical care tasks. The manager had changed the form to include a brief life history and make sure that peoples medical histories are included if relevant. The new plan also has information included about risk assessments, states whether the plan has been discussed and signed and shows confirmation that staff can meet peoples needs. Information seen in individual plans matched with what people and staff told us about their lives in the home. Every person has a moving and handling risk assessment. Other risk assessments are done for individual issues e.g. for risk of falls, leaving the building and pressure sores etc. We saw that care plans are well prepared before finally being typed and put in place. Theyre handwritten, checked by key members of the management team, changed if necessary then typed and given to the person. Care plans were signed by staff to show that they can meet peoples needs. Where behaviour that challenges may affect others, proper risk assessments were in place to make sure people are protected. Where people with dementia have difficulty finding their way around, photographs or items that show their former interests are put up outside their rooms. Formal care plan review sheets (so that people are able to say when their care needs change) were seen attached to care plans. These were signed by the person concerned, their relatives and staff. Peoples individual wishes and choices were recorded that helps staff know how to meet their needs. Daily records were better and gave more information about peoples experiences of life in the home rather than just about basic care. From a full staff meeting held in June the manager had told staff that: All recording is improving. However please write appropriate information. This is a working document that needs to be recorded on a regular basis. Records were factual and showed respect for peoples dignity. Healthcare records are kept to show when GPs are called in and outcomes of their visits, plus other healthcare professionals visits such as district nurses, chiropodists and community mental health nurses. We checked medication. All administration records (MAR) were regularly signed with Care Homes for Older People Page 14 of 33 Evidence: no gaps. Staff were using proper codes on the sheets to show why people hadnt taken medicines. We had previously suggested (after advice from our pharmacy inspector) that people having eyedrops, eardrops, creams or lotions applied should have their MAR sheets kept in their bedrooms, that are then signed when the relevant medication is applied. However, we found the sheets were back in the MAR file. The deputy manager said this was because sheets kept going missing from peoples rooms, making recording difficult. We checked supplies of medication kept for people that is controlled by law. A book is kept for the purpose of recording these. They were stored securely and two staff had signed for each time of giving for each person. Quantities kept were all correct. The medications fridge has an internal digital thermometer that shows the temperature its kept at. This was within normal range and we saw daily checks of the temperature were being done. Unopened medications such as eye drops were stored in the fridge to make sure theyre kept at the proper temperature for them. Photographs of each person living at the home were seen at the front of their MAR sheets. We followed up a good practice recommendation made at the last visit after we saw that one persons photograph was undignified. (it had been taken when the person had a severe facial injury). Photographs were much more respectful now and the manager had also put the date beside the photo to show when it was taken. We suggest that photos continue to be updated regularly so that all staff are kept aware of any changes. We spent time around the home and observed and heard staff interactions with people. These were respectful and people were treated with dignity. We didnt hear people being patronised or spoken with in any tone but friendly and caring. We saw from a full staff meeting held in January 09 that staff were reminded to be aware of what they say in front of the service users, ensure that everything is appropriate. The deputy manager showed us a new End of Life form for staff to record peoples wishes at the time of death and afterwards. The form isnt in use yet but had lots of questions so that people can have choice in how they want to be cared for and what their funeral wishes might be. The form attempts to match person-centred care plans by focussing on the person as a unique individual with rights and choices even at the end of their lives. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements in the range of activities shows that peoples needs for stimulating and enjoyable social and leisure pursuits are met where possible. Encouragement of contact with the community helps people stay in touch with what is happening outside the home. Whilst people feel meals at the home are well managed, provide daily variation and social contact, the managers wish to review dishes on the menu would give them a wider, healthier and more balanced choice. Evidence: We asked people whether they felt there are enough activities going on at the home. four said always and three said usually. One person commented: The entertainment could be a little better although a lot of the others are very reluctant to join in which sometimes ruins it a bit for the rest of us. One person we spoke to said that there was nothing going on and s/he spent all her/his time in the bedroom and got bored. We looked at activities records and her/his care plan. These showed that the person has had a long term interest in singing and Care Homes for Older People Page 16 of 33 Evidence: joins in with any activity or entertainment where singing takes place. The manager had also picked up on the persons love of singing and music and was trying to find concerts that s/he could be taken to on key time. This is good practice. We looked at copies of residents meetings held in March, June, July, September and October 09. These showed that activities,entertainment, festivals such as Christmas, Easter and Halloween among others are discussed regularly, together with meals and the standard of them. Activities records continue to be well written and gave good information about how people enjoy the particular event recorded. They also included peoples direct comments. Activities included among others: regular bingo and sherry evenings, outside entertainers with singing and dancing, exercise sessions with music, karaoke sessions, games of skittles, connect 4 and snakes and ladders. (These are all accessible for older or disabled people, being larger than average and with raised textures so that people can feel them easily). We saw on a notice board outside the dining room, posters in large print about: a crusty supper at the end of November, a Halloween party and trip to see the Christmas lights around Bristol. A Chinese takeaway evening had been held, subsidised from the homes amenities fund. Further, a Miss Millies takeway meal had also happened and the deputy manager said people really loved it. Quizzes with prizes had also been held and people were pleased when they won. Activities records also showed that people are asked what they want to do on any particular day. On one occasion in June, people didnt want to do anything but wanted some sweets. This sparked off a reminiscence discussion about sweets in their childhoods so by having the sweets the need for activity was met. The manager said plans are in place for future trips. From minutes of residents meetings that we saw, people had talked about what further activities they would like. One person had said that all the things the manager and staff were trying to arrange would be wonderful if residents take part so it works, not just turn up once then give up. Since the last inspection people had been asked about their previous leisure interests and what they would like to do, by means of a leisure interests checklist. We followed up a good practice recommendation made at the last visit about collating all the information gained from each person to help improve activities, so that they can more nearly match what people like to do. Further, we found from the activity records that a core of about 9 - 12 people regularly join in activities and entertainment but a larger Care Homes for Older People Page 17 of 33 Evidence: number dont. The manager said she had gone through the checklist but found it not particularly useful as it was more or less a yes/no format. She had therefore devised a new care plan form that includes peoples individual backgrounds and interests. From looking at the checklists however, staff had helped people start a knitting group, a weekly cookery session (where people are able to bake and eat their own cakes), getting an apprentice gardener to work with residents on developing the gardens and discussion had taken place about having a home pet.We saw notes of the meeting held about this pinned up on the notice board outside the dining room. Several people had wished for a dog or cat, but as the homes future isnt secure, this was not felt to be good for the animal concerned if it had to be rehomed. People had therefore settled on a hamster and fish. We met the hamster (called Horace), who currently lives in one of the lounges. The manager said that several people visit him and it had been helpful to people with dementia who might otherwise spend most of their time in their bedrooms. We also noted with amusement, in the managers meeting minutes of 26/10/09 that a fish is coming next week and a rabbit will be coming after Christmas! The manager had also made contact with an activity group called Age Link in Bedminster and Southville and some people had gone over there to join in different activities. One person is taken to a club held in one of the local pubs there and records showed his enjoyment of this. The manager clearly showed lots of ideas for people to be able to enjoy more leisure activities both in and out of the home. Using the new care plan format to record their personal histories and interests also makes sure staff know what they like. Outings remain popular although we noticed one outing to Clarks shopping village had been cancelled and not re-scheduled. The manager had suggested (after people had asked about outings), that smaller group trips might be better and people could go out with key workers in key time wherever they wanted. Key time (one to one time with a person and their key care worker) was recorded in peoples records and they are more able to go out to local shops or into the city to shop. All records of activities and key time were positive and showed good relationships between people and staff. We saw in the minutes of a management meeting held in September that key time was discussed and managers are to make sure this happens for people as some hadnt had their key time since June. All the above shows that people are consulted and offered choices wherever possible. Peoples choices are respected even if its to do nothing or not to engage with communal life in the home. Contact with the outside community is kept up by people being able to go out with their key workers locally or farther afield if they wish. The Care Homes for Older People Page 18 of 33 Evidence: manager had registered with the organisation Pets As Therapy and was waiting for a volunteer plus pet to come into the home. An activity group called Everyday Miracles comes in regularly to do music and movement with people. We discussed menus with the manager and deputy. They said they were unhappy with the current ones because they feel meals are very basic and not more varied in choices available. The manager had brought menus from one of the other homes to discuss with people to see if they would like greater choice of different tastes and dishes. We found however, that people themselves are satisfied with the ones they currently get. (This is very different from comments we got at previous Maesknoll inspections when people were not happy with the standard of meals at all). People now say theyre happy with menus and are able to have an input to meals available. They sometimes have takeaway meals brought in to give them variety, have two choices of meal at lunchtime, with a hot choice at tea time as well. They can have cooked breakfasts and drinks whenever they want. Jugs of water or squash/cranberry juice were seen in each lounge. People told us cakes and tea times had improved (this was a bone of contention at two or more previous inspections). We saw in minutes of the residents meeting held in September, that one person had challenged staff to try and improve on meals as (he) felt the food was already excellent and couldnt improve further. However, on the second day of our visit we sampled lunch with people, looked at menus and found we could understand better what the manager and deputys concerns are. We found that the meal choices available (either bacon, egg, mushrooms, tomatoes and mashed potato, or cheese and potato mash with baked beans), were more suited to either breakfast or tea time meals. Also, the meals didnt look very appetising and use of tinned mushrooms and tomatoes rather than fresh, spoiled the egg and bacon choice. We did however, find that people enjoyed the meal and the dish we chose was hot and tasty. Looking at the current menus we found that many of the lunchtime meals were basic and didnt need much preparation. Further, very few vegetarian options were available. The majority of meals across each days menu showed a high level of red meat or high fat dishes. Were aware that there are efforts being made to raise awareness of more healthy choices among all local authority homes. We can therefore understand the managers desire to improve the menus. We asked people in our survey what they thought of the meals at the home. One person summed it up by saying: The food is brilliant. People we spoke to at the visit Care Homes for Older People Page 19 of 33 Evidence: told us that the food continues to improve. One person said: Its better now than it used to be. I havent got any complaints at all. From all the above, whilst people are happy with the standard of food, the manager and deputy are to be commended for trying to improve standards further and give people a wider choice of all types of different foods. One issue about meals we raised with the manager was that the TV in the dining room was on throughout both lunchtime sittings. The management meeting minutes of September stated that the TV would be moved from the lounge to the dining room so that it can be used for activities. We saw however that people werent watching it and it could be a distraction for those people who have hearing, sight difficulties or dementia, as the programmes merged with the noise of the dining room and other conversations. One person told us the kitchen staff always put the TV on and the manager had also picked this up. She agreed that TV in the dining room should be for the benefit of people living at the home and not staff. We therefore advised the manager that if people want entertainment at lunchtime, age appropriate soft music would be better and less distracting. The manager said she would make sure this happened. It was clear from all we saw and heard that the manager, deputy and staff want to give people living at the home a greater say in how its run and what they would like to do. To this end setting up a residents committee had been suggested to help people give more constructive and regular feedback on what they want. This is good practice. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have the necessary information and feel confident about being able to raise concerns or complain about their care if they need to. Proper management of abuse issues keeps people protected from risk of harm or abuse happening to them. However, better and accurate recording of staff training in the issue will show that people continue to be kept safe. Evidence: In our survey we asked people if they knew what to do if they werent happy and whether they knew how to make a complaint. All seven people said they know who to speak to if theyre not happy and five said they know how to make a complaint. From the AQAA the manager had identified what could be done better: Complaints procedure in other formats for residents with sensory impairment and offer more ways for residents to complain if theyre not happy, without being judged. Copies of the complaints procedure were seen in individual peoples files kept in their rooms. This has been made into either large print or picture format for people with dementia to understand more easily. We looked at the complaints log. This showed that two complaints had been made this year. Both were about other peoples behaviour. Records showed proper investigation and action taken, together with whether the complaints were upheld or not. Care Homes for Older People Page 21 of 33 Evidence: Staff have done safeguarding adults from abuse training and some certificates for this were seen in individual training records. However, the checklist of training done for staff in all subjects showed that for safeguarding training, four night staff had done it in 2008, although one had done it in 2005. A 2009 date for this person was cancelled and due to be re-booked. Seven day care staff had also done it in 2008 and again others were booked for an update in March that was cancelled. However, other staff had done it on that date. All staff are trained in safeguarding adults including cooks and domestics and dates in December 09 were seen for some of them. Incidents of alleged abuse have been dealt with quickly and actions taken to make sure people are kept safe. Where abuse had taken place because of a persons challenging behaviour, mental health professionals had been called in and meetings held to discuss more suitable placements elsewhere. One meeting had been held in September but we were unaware of this and therefore had no opportunity to attend. We advised the manager to make sure that those arranging such meetings know inspectors are to be invited to them. This will help us make sure people are being protected. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a comfortable, clean, safe environment that is well decorated, looked after, physically accessible and meets their needs. Evidence: From the AQAA we noted that a number of rooms have been redecorated and recarpeted since our last visit. The manager had also written that people are encouraged to bring in their own possessions i.e. pictures, bedding and items of furniture. Plans for improvement over the next twelve months include: to continue to decorate areas of the home ensuring residents choose the colour scheme and furnishings to their liking, improve the garden, bedding plants and vegetable patch and: continue to ensure all areas of the home are accessible to residents with sensory needs. We followed up a requirement from our last visit about making sure all areas of the home used by people living there are kept free of extra equipment and furniture. An empty bedroom has been made into an equipment room so that none is stored around the home. It was good to see that lounges and communal areas were therefore free from equipment or excess furniture. From staff meeting minutes we saw that staff are constantly reminded about keeping all areas free of wheelchairs and where to store them properly. Cleaning issues are also regularly discussed as well as health and safety matters to make sure people living at the home are kept safe. Care Homes for Older People Page 23 of 33 Evidence: People were seen watching TV in their rooms or in the lounges. The smoking room was empty and didnt smell of smoke as it had at the last visit. All communal areas were clean and tidy although it was disappointing that more people werent using the comfortable lounges. However the manager said that the lounges are used especially now that one of them is home to Horace the hamster. All other areas of the home were fresh and clean at this visit and staff were seen cleaning rooms. No unpleasant odours were noticed at all. All seven people that filled in our survey said that the home is always kept fresh and clean. We saw from staff meeting minutes that staff are reminded about the environment: If you see a mess around Maesknoll please help keep the environment tidy and comfortable to live in. Staff were also reminded about putting cleaning signs away and cleaning bathrooms every day. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from a well trained, qualified and supported staff group that is available in suitable numbers to meet their needs. Continuing progress with Vocational training in care makes sure people are looked after well. Recording of staff training doesnt always show clear evidence that the training has been done. Further if night staff dont do the same training as those on days, people might not get a consistent service thats in their best interests. Evidence: We asked people if staff listen to them and act on what they say. Five people said always and two said usually. We also asked if staff are available when you need them? Responses were mixed with three saying always, three saying usually and one saying sometimes. Staff who filled in surveys for us also commented on staffing: more time could be spent with residents if there were more staff available, staff levels could be higher so there would be more time to actually feel relaxed when talking to people. Pressure on the floor is great and you dont have time to think during a shift. We all know the residents come first and we would all like to spend more time talking with them and making them feel important. One person simply said: more staff. Care Homes for Older People Page 25 of 33 Evidence: We looked at staff rotas. Its inevitable that agency staff are used to fill in gaps because of vacancies, annual leave or staff sickness. Wherever possible regular agency staff are used that get to know the home and people living there. Another local authority home nearby is closing shortly and vacancies are held for staff to be redeployed to Maesknoll if they wish. The manager was about to interview two cooks from there to replace one of the cooks who was retiring. The AQAA showed that the manager agreed that what could be done better was to fill vacant posts and reduce agency staff use. However, she went on to state that improvements over the last twelve months had included: duty officers more supportive, more accessible, one vacancy filled and: staff given more opportunity to voice their views. From rotas seen, suitable numbers of staff are on duty each day to meet peoples needs. Staff we spoke to didnt complain about shortages and said they felt the team works well together. Theyre asked at staff meetings if they have any concerns and are able to make suggestions about making life better for people living there. Minutes of staff meetings also showed that staff are commended for good work e.g. the deputy manager had fed back to them that breakfast time is always lovely, leisurely and relaxing for people. Very positive - so well done on this. Staff are reminded that if they have any concerns or feel morale is low the office door is always open to discuss any concerns they may have. One staff member who filled in our survey also commented: At Maesknoll we work as a team, always putting service users first. We encourage them with daily life. Progress with NVQ training (the national vocational training as recommended in the National Minimum Standards) continues. Of thirty care staff sixteen have NVQ Level 2 and three are working towards it. Staff also get essential training in a range of subjects including moving and handling, medication, food hygiene and fire and health and safety (including first aid). New staff get a formal programme of induction that includes basic training and shadowing experienced staff. All Adult Community Care staff have yearly reviews of their work that assesses progress and future development and training needs. We looked at a file that the management team had put together after the last inspection. This shows training dates for each staff member in all subjects. However, the dates arent enough in themselves as evidence to show that the training actually did happen. Those seen didnt match with certificates in files so we werent able to track that training had been done and properly recorded. The manager said she could confirm training had taken place on the dates recorded but she would make sure that staff brought in all their certificates to show this. We looked in particular at night staff training as there are fewer of them working at Care Homes for Older People Page 26 of 33 Evidence: night and they need to be able to deal with similar issues as those who work days. Some of the training sheets we looked at didnt have training dates at all for some subjects. We saw that night staff had done training in dealing with behaviours that challenge in 2007 and 2008. However, no dates were seen for mental health awareness. Further, only two night staff showed dates for training in dementia care. Certificates for dementia training for all staff were outdated and for a one day inhouse course rather than the two day course done in other local authority homes. All staff, including those on nights should have training in person-centred care of people with dementia or mental health issues. Care Homes for Older People Page 27 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Both people living at the home and the staff team benefit from an experienced manager who encourages an open style of management. Various ways of making sure people can comment about life in the home helps them to be sure their views and opinions will be taken note of. Peoples cash is well managed that makes sure they are protected from financial abuse. Better ways of keeping records about people living at the home makes sure theyre confidential and in good order. Good management of health and safety in the home makes sure people are kept safe. Evidence: The previous manager had received promotion to another job so an experienced Care Homes for Older People Page 28 of 33 Evidence: deputy manager from another home, Mrs Sharon Baker, has now taken over at Maesknoll. Mrs Baker is very experienced, having temporarily managed at least two other care homes. She has NVQ at Level 4 and we have had the opportunity to observe her management at other care home inspections. Mrs Baker has followed on with the good work started by the previous manager and also brought ideas of her own to Maesknoll. She works from a very person-centred approach and is keen to make sure people living at the home get a good quality of life and enjoyment. She has an open-door policy for both people, their relatives and staff. She was welcoming and open to the inspection process and supplied us with information that showed how requirements and recommendations made at the last visit had been met. All local authority care homes have quality assurance surveys done by an independent organisation. This survey happens yearly and was done at Maesknoll in late October. Copies of each years report are sent to the Commission. We looked at the results of the survey that showed that scores (out of a 100) ranged from 69 - 80 . Whilst a number of positive comments were made, an equal number of more negative ones were made particularly from relatives and other people visiting the home. Some of these comments are not borne out by this inspection. However, an action points list is added to the report and we recommend the manager acts promptly on comments received so that people continue to get consistent, good quality care. Checking of quality is also done by the team manager for the home who visits monthly and is aware of all issues affecting people and staff. Further checking is done at residents meetings where concerns can be raised and people are asked about what they want and the quality of the service offered. As above, staff are also asked for their comments and suggestions at regular staff meetings. All of these ways make sure the manager is aware of what needs to be worked on, how quality can be improved and how the service can be developed further. We did a sample check of peoples cash to make sure its being kept for them safely. All was in good order with receipts, balances and records of cash taken to buy things for people all correctly recorded and attached. People can choose to keep their own cash and have lockable space in their rooms for this but the majority prefer it to be kept securely by the management team. We followed up a good practice requirement about making sure care records are kept in an orderly way and confidential to each person. All recording has improved since the last inspection. Each persons records were well kept and easy to follow. No records were mixed up and all are kept confidential. Care Homes for Older People Page 29 of 33 Evidence: Fire and health and safety records were looked at. The risk assessment thats required under the new Regulatory Reform Order relating to fire safety was due to have been looked at in August but no record was seen of it. The deputy manager said she would follow this up. Two fire drills have been done this year, one in April and the other in June. Thirteen staff attended each drill. Discussions had been held following the drills on the outcomes and procedures used and issues picked up. All were written up to show the learning for staff from each one. Records of night staff fire walk-through drills were also seen. Records of regular fire safety training were seen, together with checks on fire safety equipment and health and safety matters. Some of the checks looked as if they hadnt been done since September but the deputy manager said she thought this was a recording error rather than them not having been done. Care Homes for Older People Page 30 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 30 All staff should show evidence of training attended. Night staff should do the same training as day staff particularly in person-centred care of people with dementia and mental health issues. This will make sure people are kept safe and protected by staff that understand and can meet their needs day or night. 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