Care Home: Maidment Court

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What the care home does well People tell us they are treated with respect and their privacy maintained.Maidment CourtDS0000004051.V376797.R01.S.docVersion 5.2People are able to maintain contact with those who are important to them and be part of life in the community. People tell us they have control over their own lives. Meals are nutritious and people tell us they are listened to about their choice on the menu. There is a complaints procedure which takes concerns seriously and tries to resolve them. Staff receive the training they need to understand how to protect vulnerable people from harm. The home is clean. The quality assurance process is continuing to develop using a variety of methods to demonstrate the home is improving its standards. What has improved since the last inspection? At the end of the key inspection in January 2009 there were nine requirements and one recommendation. At the end of the pharmacy inspection in March 2009 one additional requirement was made with regard to accurate records of all medication so that people living in the home receive exactly as the GP prescribed and changes are updated in the care plan. No other requirements were reviewed at that inspection. At the random inspection in April 2009 four requirements were found to be met and one requirement was made in relation to the safe storage of potential hazardous chemicals. No one is admitted to the home unless they have had their needs assessed and the home confirms they are able to meet those needs. Improvements have been made to care plans and there is sufficient information detailing how an individual’s health, social and personal care needs will be met. We found that risk assessments for people living in the home are up to date and provide information on the action to be taken. People who are more vulnerable and are cared for in bed have more detailed and precise care plans which are monitored consistently to ensure their needs are fully met. Improvements to medication systems have ensured that records are accurate and audited systematically. The refurbishment programme is complete and risk assessments have been completed on areas such as the third floor balcony. Recruitment practice is improved and records clearly show the information which has been requested and the audit trail of the recruitment of each person working in the home. There is a training plan in place which demonstrates which staff have completed mandatory training, when refresher training is needed and the Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 progress of staff that are completing their induction. This ensures the manager has a clear picture of the training needs of all staff working in the home. We looked at two pre admission assessment and could see they are signed and dated at the time of completion which gives a clear audit trail of a person health from the time they were admitted to the home. What the care home could do better: At the end of this inspection there are no requirements and three recommendations. It is important that people’s experience of life in the home matches their expectations and the manager should develop a person centred approach to individual activities for people. To ensure that people’s needs are met throughout the day consideration should be given to how the home is staffed at peak times of activity. The manager should maintain her skills and knowledge by attending training courses relevant to current good practice in older persons care. Key inspection report CARE HOMES FOR OLDER PEOPLE Maidment Court 47 Parkstone Road Poole Dorset BH15 2NX Lead Inspector Tracey Cockburn Key Unannounced Inspection 29th July 2009 10:20 DS0000004051.V376797.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 2 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 Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maidment Court Address 47 Parkstone Road Poole Dorset BH15 2NX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 674423 01202 676410 home.poo@mha.org.uk www.mha.org.uk Methodist Homes for the Aged Mrs Janine Amanda May Care Home 46 Category(ies) of Old age, not falling within any other category registration, with number (46) of places Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The twin suite, bedrooms 45 (a) and (b), is only to be let to a couple who have clearly expressed a desire to occupy such a room. 26th January 2009 Date of last inspection Brief Description of the Service: Maidment Court is a care home registered with the Commission to accommodate a maximum of 46 older people. The home is purpose-built and has a passenger lift to access the four floors of the home. Bedrooms are for single occupancy and have en suite toilet facilities. The main communal rooms of two lounges and dining room are provided on the ground floor. There are five assisted bathrooms, one conventional bathroom and a walk-in shower room. The home offers one room for respite care. The home overlooks Poole Park and is in within a short walk from the town centre. Parking for staff and visitors is available at the back of the home. There are well-maintained gardens to the front and back of the home. The fee range is from £507 to £554 per person, per week. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This inspection was unannounced and began on 29th July 2009 and was completed on Friday 31st July 2009. In total we spent eleven hours inspecting the service and seeking the views of the people who live and work there. Survey forms were sent to people as part of the planning process, we received seven surveys back from people who live in the service, nine from staff who work in the service and one from a health care professional. This inspection was carried out by one inspector but throughout the report the term ‘we’ is used to show that the report is the view of the Care Quality Commission. For approximately three hours of the inspection process we were accompanied by an Expert by Experience from Help the Aged. Experts by Experience is a project that involves people who use services in the inspection of those services. Their role as part of the inspection team is to help us get a picture of the service from the viewpoint of people who use it. The Expert by Experience, spent time looking around the premises, observing life in the home and talking to people who use the service both in private and over lunch. Their findings from the visit have been incorporated into this report. In planning the visit we used information such as the services action plan from the previous key inspection in January 2009. We also used evidence gathered from the random inspections in March and April 2009 to determine particular standards to focus on during the site visit. We could not find any evidence that we had requested an annual quality assurance assessment from the service. During the visit we looked at recruitment records, training records, individual care plans, risk assessments and health and safety records. What the service does well: People tell us they are treated with respect and their privacy maintained. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 6 People are able to maintain contact with those who are important to them and be part of life in the community. People tell us they have control over their own lives. Meals are nutritious and people tell us they are listened to about their choice on the menu. There is a complaints procedure which takes concerns seriously and tries to resolve them. Staff receive the training they need to understand how to protect vulnerable people from harm. The home is clean. The quality assurance process is continuing to develop using a variety of methods to demonstrate the home is improving its standards. What has improved since the last inspection? At the end of the key inspection in January 2009 there were nine requirements and one recommendation. At the end of the pharmacy inspection in March 2009 one additional requirement was made with regard to accurate records of all medication so that people living in the home receive exactly as the GP prescribed and changes are updated in the care plan. No other requirements were reviewed at that inspection. At the random inspection in April 2009 four requirements were found to be met and one requirement was made in relation to the safe storage of potential hazardous chemicals. No one is admitted to the home unless they have had their needs assessed and the home confirms they are able to meet those needs. Improvements have been made to care plans and there is sufficient information detailing how an individual’s health, social and personal care needs will be met. We found that risk assessments for people living in the home are up to date and provide information on the action to be taken. People who are more vulnerable and are cared for in bed have more detailed and precise care plans which are monitored consistently to ensure their needs are fully met. Improvements to medication systems have ensured that records are accurate and audited systematically. The refurbishment programme is complete and risk assessments have been completed on areas such as the third floor balcony. Recruitment practice is improved and records clearly show the information which has been requested and the audit trail of the recruitment of each person working in the home. There is a training plan in place which demonstrates which staff have completed mandatory training, when refresher training is needed and the Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 7 progress of staff that are completing their induction. This ensures the manager has a clear picture of the training needs of all staff working in the home. We looked at two pre admission assessment and could see they are signed and dated at the time of completion which gives a clear audit trail of a person health from the time they were admitted to the home. 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. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 may use this service are given accurate information about the service in order to enable them to make an informed choice about where they want to live and be assured the home can meet their needs. EVIDENCE: At the last key inspection a recommendation was made that pre admission assessments should be signed and dated at the time they are completed. We looked at the pre admission assessment for two people and found that both were signed and dated. The pre admission assessments contain more detail about the needs of the person, their history both personal and medical. Each file we looked at had a care plan based on the information in the assessment. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 10 Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: At the last key inspection a requirement was made, which had been repeated, that assessments and care plans must contain sufficient information on how people must be supported to meet their health and personal care needs. We looked at four care plans which we found clearly identified the support that people needed and how it should be provided to them. We found the information person centred and focusing on tasks they could do themselves and how staff should support them to maintain their abilities. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 12 We found that all the care plans we looked at had been updated since the key inspection in January. At the last key inspection a requirement was also made that people who were confined to bed needed to have their health care needs clearly defined and the support had to be consistent. We looked at the care file for one person who was cared for in bed, their room had been changed around so the see the garden from the window. We found there was consistent information in the fluid chart in their room and the guidance given to staff was clear and precise about how often they should be turned. In all four files we looked at each page of the support plan had been signed by the individual or their representative. In one file there was a plan on how to support someone to maintain their pressure area with a body map and guidance on how to maintain their dignity and privacy while supporting them. We looked at a nutrition plan for one person with clear guidance of what to if weight loss occurred. In one file we looked at there was clear referencing of a medical visit by the GP both in the daily records and in the support plan, with up dated information on action to be taken. In all four files we looked at there was information on appointments with health care professionals and action being taken. At the random inspection in April 2009 we found that the recording of people’s health care needs was not consistent and instructions for staff were at times confusing. When we visited on this occasion we found the recording of information specifically relating to people who was being cared for in bed was much more consistent with clear instructions for staff which were being followed. We also found that care had been taken to in one case rearrange the bedroom so the person had a view of the garden from where they sat in bed. A health care professional who sent back a survey form answered ‘always’ to the question ‘Does the care service respect peoples’ privacy and dignity? We were shown the medication records by the manager and found the requirement from the random inspection in March 2009 had been addressed. The manager told us that anyone who manages their own medication has a re assessment every three months. There are currently five people who manage their own medication. At the time of the visit two reviews had taken place. The manager explained that when the medication arrives in the home for people who self medicate, the individual signs to say they are theirs and has a discussion which is recorded with the senior member of staff about their ability and wish to continue self medicating. The deputy manager is currently responsible for medication with the support and supervision of the manager. The manager told us that all senior carers have delegated responsibilities and that she plans to rotate these responsibilities every six months, so that all senior staff have these skills which means they can cover for each other. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 13 The manager completes audits every three months the last audit took place on 8th July 2009. We checked the controlled drugs record for one person and found that the entry in the book matched the number of tablets. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 are able to make choices about their life style and are supported to maintain their life skills. On the whole social, cultural and recreational activities meet individual expectations further developments will enhance individual experience. EVIDENCE: The expert said the following in her report about what she found: “The activity co-ordinator provides a programme of mostly three activities a day including some evenings. The programme is provided largely by herself but also with help from a resident playing the keyboard, volunteers running a mobile shop and two hours from an art and craft person being bought in. The co-ordinator is undertaking training for a qualification, and as part of her training she has developed an activity profile form to be completed with all residents to ascertain their preferences for music, T.V. relaxation, activities etc. She is also aware of the concept of developing life history books with residents although work on this has barely begun. It seems Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 15 that this would be a useful next stage so that residents who are becoming frailer could have a visible record of their life for such times that they cannot remember so well. Reminiscence boards were on display in one of the lounges with photographs of resident’s weddings etc. All of the residents I spoke with were aware of the activity programme, one making a point of looking at the list on the reverse of the menu. Religious services are held twice a week from a visiting Methodist minister. However the only space for individual time was through having a manicure and one resident did say that now she can no longer read for herself she would welcome someone reading a newspaper to her and discussing news topics. Almost all the residents I spoke with commented that they would welcome more opportunities to get out on trips etc. It does seem that the 32 hours of activities provided by the co-ordinator is barely enough for a potential 46 residents who are increasingly needing more personalised activities. It seems there is a residents committee which is in the process of being re-organised.” One person who lives in the home returned a survey form which said; “No pressure to join in things or stay out of them, as far as I am concerned I come and go as I wish enter into things I can enjoy” One person said there are “lots of activities” People told us they are able to see their family and friends in the privacy of their own rooms if they wish. The manager told us that they have contacted and advocacy service and we saw the information the service has sent to the home for them to display and discuss with the people living in the home. The expert said in her report: “A menu is displayed for the day on each of the tables, with a copy of the weeks activity programme on the reverse. Residents are asked the day before about their choices for the afternoon meal, although I did not see a choice for lunch displayed on the menu. However residents confirmed they were given an alternative if they did not like what was being served. All residents confirmed that the food was good, “I think it’s wonderful” and “there is nearly always something cooked at tea time”. On the day of the inspection the lunch of roast lamb with fresh vegetables served separately, with a choice of three puddings all smelt and looked appetising.” Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 are able to express their concerns and have access to an effective complaints procedure. Safeguarding training, policy and practice should ensure that people using the service are protected from harm. EVIDENCE: Since the last key inspection there have been no formal complaints recorded in the log book. We did see a number of letters from relatives of people who have stayed in the home and comments included; “I wish to thank you and your staff for the kindness and support” “Thanks to all the staff for looking after our mother…….you have wonderful staff” We looked at the policies and procedures manual at the home during the inspection. It was noted that the home has an adult protection policy to reflect the expectations of the local authority. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 17 We looked at the staff training records that demonstrated that staff had received training in the Protection of Vulnerable Adults (POVA). Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 to the home enable people who use the service to live in comfortable, safe and well maintained surroundings. EVIDENCE: The manager told us that they have ordered furniture for the communal areas of the home and we saw the order sent to the supplier. The manager told us that they had consulted with the people who live in the home about the type of chairs and the fabric. They have ordered a variety of chairs, tub, low back, high back, a two seat sofa as well as a nest of tables and footstools. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 19 The expert said in their report: “Maidment Court is a four storey building situated on a busy road adjacent to Poole harbour. It is in the process of undergoing a programme of extensive refurbishment of bathrooms, communal rooms and resident’s bedrooms. Most residents confirmed they had been given the choice of having their room redecorated, some of which had chosen not to. Those that had gone ahead were involved in choosing colours and carpets. However one resident did say that she had to move out of her room the following week, and had she been given a choice she would rather have not had her room redecorated. Of the residents I spoke with, all had bought in items of their own furniture and personalised their rooms. One resident’s daughter even planted up some containers which were placed on the outside window sills of her room. There were no unpleasant odours in any part of the Home.” At the last key inspection in January 2009 concern was expressed about the use of the balcony on the third floor. The report states: “The home has two small high-level (third storey) terraces, which are enjoyed by those who can access them. However there were no associated risk assessments relating to either the terrace or the individuals who used them. It was however noted that some parts of these areas had been risk assessed on the 28/08/07 relating to “edge protectors” and the need to fit them, this had not been achieved at the time of the inspection.” Since that key inspection detailed work has been undertaken on the safety of the balcony. We noticed there are signs up by the balcony advising that in wet, icy or windy weather it cannot be used. There is also evidence of consultation with building control regarding the height of the guard rail; the panels currently exceed building regulations guidance of 1000mm. The management have also put in place clear guidance for staff on when the doors to the balcony should be locked at night and opened again in the morning. The management team at the home have also sought advice from the provider’s safety advisor. There are monthly audits on the furniture and fittings on the balcony. One person who lives in the home returned a survey form which made two comments under ‘what could the home do better?’ “Stop doors banging” and “make tea and coffee trolley come on time” One member of staff thought that ; “Training some staff how to do laundry” was an area for improvement. When we toured the building we noticed that the floor covering in one communal bathroom was stained around the drain, we spoke to the manager about this and we were shown evidence that action had been taken to address the stained area. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 20 At the last key inspection the following was noted about the small kitchenettes “Within the home there are several small kitchenettes that allow a degree of choice and independence for some who reside at the home by way of keeping some drinks, sauces etc in the fridges. At the last inspection it was pointed out that these areas were not being sufficiently monitored to ensure that good food hygiene practices were being observed. At this inspection it was again noted that there was out of date food in the fridges and the crockery and other utensils were dirty. There was no useful or comprehensive record of the fridge temperatures being monitored.” At this inspection we noted that none of the fridges had any food items in them. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In order for people to feel safe at all times there needs to be sufficient staff in the homes at times of high activity such as mornings, meal times and evenings. Improvements to recruitment and training ensure that people using the service are safe. Improvements to training for staff ensure they have the skills they need to do their jobs well. EVIDENCE: We looked at the staffing rota showing which staff are on duty at any time during the day and night. Following comments from people who use the service we think that they should consider additional staff at peak times of activity during the day. The expert found: “One almost universal comment related to how busy the staff were, with one resident saying that she goes to her room in the evening because there were no staff around to talk with or to deal with any minor issues as all the staff were involved in helping people to bed. Another person said “they could do Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 22 with one or two more staff” and another that staff “seemed a bit scarce”. Some people said they had to sometimes wait a while when the pressed their buzzer, with one person saying she had got quite a stomach ache through having to hold on for a member of staff to help her to the toilet. However all comments about the staff were very favourable, in that they maintained dignity, were thoughtful and good at their job.” One person who lives in the home returned a survey form which said; “The staff are all very kind and helpful, often under pressure” One person who lives in the home told us; “I feel there is the need of a member of staff to be around in the lounge especially in the evening” One member of staff who sent in a survey form thought the service needed; “More care staff especially at weekends” In discussion with the manager she was aware of this concern by both staff and people living in the home and said she would be looking at flexible staffing in the home. There are separate rotas for senior staff, care staff, night staff and kitchen, housekeeper, activity and maintenance staff. This shows us that there are the following staff working each day; 1senior carer as well as the manager, five carers in the morning, four carers in the afternoon. There is four night staff each night. During the day there is a cook, a kitchen assistant, two housekeepers, two laundry staff, an activity coordinator, part time administrator, maintenance person and gardener. We looked at the recruitment files for two staff that started working in the home since the last key inspection. We also looked at two other recruitment files for consistency of approach. We found that staff are recruited following completion of an application form and interview, there is a record of the interview and if successful a letter offering employment at the home. We found the files to be clearly ordered and there was evidence of an audit process. We found that all the information required in schedule two of the regulations was in place. We found two written references in place and staff have signed contracts and terms and conditions of employment. At the last key inspection a requirement was made in relation to mandatory training for staff, we found this had improved at this inspection and the manager had completed an audit of all staff training, identified the gaps and arranged training for staff who were not meeting the required standard. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 23 Eighteen staff have National Vocational Qualifications (NVQ) at level two. One person has NVQ at level three and one person at level four. Seven staff are currently working towards NVQ at level two. One member of staff thought they home could improve by; “Communication amongst staff when new residents arrive” Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management in the home has improved and systems are in place to ensure that people are listened to, the aims and objectives of the home are being met and care practice is provided to a consistent standard. EVIDENCE: A new manager has been appointed since the last key inspection and started work in the home on 20th April 2009. The manager has had a three month induction with the support of the peripatetic manager who has been working in the home since January 2009 when the registered manager left. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 25 The manager has a number of years experience in working with older people and is a trained nurse. There are clear lines of accountability within the home and the manager is working with the deputy and senior carers in developing the management team. There are regular senior meetings to discuss care and delegated responsibilities. These meetings are minuted. Since the last key inspection there have been improvements in the way information is communicated to staff. One member of staff wrote; “Over the last 6 months lots of changes have taken place for the better. The home has improved greatly and the residents are much happier, great work by the new manager” Another member of staff wrote; “A great big thank you to the relief manager that has made big improvements all round at Maidment Court. The home is now run as a team.” Another member of staff wrote; “Things have greatly improved here over the last 6 months. I feel more supported in my role” There is a quality assurance process in place this includes the weekly, monthly audits of systems and the three monthly audits of the medication. There are staff meetings as well as resident meetings where issues of concern are discussed and action is taken to address concerns. Since the last inspection all the staff files have been audited and where gaps have been identified they have been addressed, the same has happened in relation to training. People who live in the home are asked their opinion of the service. An action plan was drawn up following the last key inspection and this also forms part of the homes quality assurance process. Corporate policies and procedures are now being followed. The management undertook a questionnaire with people in the home around food in July and are working with people to make changes. All senior staff with delegated responsibility for supervising staff have completed supervisory training. The home is not responsible for the finances of anyone who lives in the home. All staff have received training in safe working practices and the manager monitors the on line learning system which enables her to monitor the progress staff are making through the mandatory training. There is a flu pandemic plan in place and the manager is monitoring staff sickness. We looked at fire records and found them to be in order with a current fire risk assessment. All accidents and incidents in the home are reported to the commission and the manager undertakes a monthly audit of reporting. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP12 OP27 OP31 Good Practice Recommendations The registered provider should consider how to develop individual activities in the home which meet people’s expectations and interests. The registered provider should consider how the home is staffed to ensure that people’s needs are met at all time of the day and evening at peak times of activity. The registered provider should enable the manager to develop their knowledge in current care practice for older people particularly person centred care. Maidment Court DS0000004051.V376797.R01.S.doc Version 5.2 Page 28 Care Quality Commission Care Quality Commission South West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.southwest@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. 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