Care Home: Mallard Court

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What the care home does well Mallard Court provides people with a clean, comfortable and well maintained home.Mallard CourtDS0000069344.V376026.R01.S.docVersion 5.2Staff assess people before they are admitted, so they are in a better position to assure them that their needs will be met by the home. People`s care plans talk about their individual needs and choices, and how their care should be provided to protect both these wishes and also to keep risk to them to a minimum. People say that care is good, and are satisfied with the way staff support them. They made comments like `I`m very happy here. We are very lucky. We couldn`t wish for any more`, `The carers allow me to be independent`, `Staff good, and very friendly. I am well looked after`, and `Nursing staff are excellent`. People are offered a range of activities to suit their individual needs. They get written information about forthcoming events, so they can decide what they want to go to in advance. They are offered a choice of food at each mealtime. They can choose to eat with others, or on their own if they would prefer. Staff get a range of training so they have up to date knowledge about how to care for people in a safe but individual way. The manager runs the home efficiently. Everyone knows her, and say she listens, and sorts out any problems. What has improved since the last inspection? The home has done what was asked of them at the last key inspection in that people`s medication charts were written more clearly, and medication with a limited shelf life was marked to remind staff when it needed to be disposed of, so it wasn`t used when it was out of date. The supplying chemist has also visited the home and is happy with the storage arrangements. Senior staff have shown since the last inspection that they report allegations about people`s welfare quickly, so the right person can investigate the incident. This helps to keeps people safe from abuse. Fire doors are no longer wedged open. This protects people better from the risk caused by the spread of fire. To reduce risk to people, cleaning staff did not leave their trolleys, containing hazardous chemicals, unattended. And sluice doors were kept locked. What the care home could do better: People and/or their families should be encouraged to be actively involved in the review of their care plan, so they have the chance to have written down how they would like their care to be provided.Mallard CourtDS0000069344.V376026.R01.S.docVersion 5.2Some improvements could be made to the way staff handle, store and record medication. Where people handle their own, staff could check and record more often that it remains safe and manageable for them to do so. The mealtime on the dementia unit could be less rushed for some people, so they have enough time and support to enjoy the meal they have been served. Staffing levels could be reviewed on the first floor. People and staff on this floor could be asked whether there are sufficient staff to give people the care and support they need, when deciding whether there needs to be more staff made available. All staff could be reminded about what to do, and who to go to, if they believed that someone living at the home has been abused. They could be reminded about the role of the local authority, who they can go to directly if they do not wish to raise their concerns with the company. Key inspection report CARE HOMES FOR OLDER PEOPLE Mallard Court Avocet Way Kingsmeade Bridlington East Yorkshire YO15 3NT Lead Inspector Anne Prankitt Key Unannounced Inspection 16th June 2009 09:00 DS0000069344.V376026.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. Mallard Court DS0000069344.V376026.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 Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mallard Court Address Avocet Way Kingsmeade Bridlington East Yorkshire YO15 3NT 01262 401543 01262 403344 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) www.barchester.com Barchester Healthcare Homes Ltd Mrs Sylvia Mary Burnett Care Home 70 Category(ies) of Dementia (70), Old age, not falling within any registration, with number other category (70), Physical disability (70) of places Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Dementia - Code DE and Physical disability - Code PD The maximum number of service users who can be accommodated is: 70 25th July 2008 2. Date of last inspection Brief Description of the Service: Mallard Court provides both nursing and personal care only for older people who may have dementia or a physical disability. The home is situated in the town of Bridlington and enables easy access to the local shops and public transport routes. Accommodation consists of seventy places within single and double rooms on two floors with lift and stair access. There are lounges and a dining area on each floor. The grounds of the home are designed to be accessible to those in wheelchairs and with mobility problems. Information about the home and its service can be found in the Statement of Purpose and service user guide. People get a copy of the guide as part of their ‘welcome pack’ once they have been admitted. However, they get a brochure to look at when they first make enquiries about the home. The latest inspection report for the home is available from the manager on request. The registered manager told us on 16 June 2009 that the weekly fees range from £392 to £700 per week. This does not consider the free nursing care contribution where applicable. People pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these is available from the manager. Mallard Court DS0000069344.V376026.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 2 star. This means the people who use the service experience good quality outcomes. The key inspection included a review of the following information to provide evidence for this report: • • Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Returned, completed comment cards from twelve people living at Mallard Court, two staff, and two visiting health professionals. A site visit to the home carried out by two inspectors which took place on 16 June 2009, and which lasted approximately eight hours. • • During the site visit, we spent time talking with several people who live at the home. It was difficult to find out through conversation what some people’s views were about the home, and whether they liked it. We therefore watched care practices where appropriate, and spent time observing the general activity, to get a better idea what it is like to live at Mallard Court. We looked at four people’s care plans in detail, and we looked at others where we wanted to see specific information. We also looked at some staff records, and some health and safety information. The visit to the home was unannounced. The registered manager was available, and we provided her with feedback at the end of the day. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only where it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: Mallard Court provides people with a clean, comfortable and well maintained home. Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 6 Staff assess people before they are admitted, so they are in a better position to assure them that their needs will be met by the home. People’s care plans talk about their individual needs and choices, and how their care should be provided to protect both these wishes and also to keep risk to them to a minimum. People say that care is good, and are satisfied with the way staff support them. They made comments like ‘I’m very happy here. We are very lucky. We couldn’t wish for any more’, ‘The carers allow me to be independent’, ‘Staff good, and very friendly. I am well looked after’, and ‘Nursing staff are excellent’. People are offered a range of activities to suit their individual needs. They get written information about forthcoming events, so they can decide what they want to go to in advance. They are offered a choice of food at each mealtime. They can choose to eat with others, or on their own if they would prefer. Staff get a range of training so they have up to date knowledge about how to care for people in a safe but individual way. The manager runs the home efficiently. Everyone knows her, and say she listens, and sorts out any problems. What has improved since the last inspection? What they could do better: People and/or their families should be encouraged to be actively involved in the review of their care plan, so they have the chance to have written down how they would like their care to be provided. Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 7 Some improvements could be made to the way staff handle, store and record medication. Where people handle their own, staff could check and record more often that it remains safe and manageable for them to do so. The mealtime on the dementia unit could be less rushed for some people, so they have enough time and support to enjoy the meal they have been served. Staffing levels could be reviewed on the first floor. People and staff on this floor could be asked whether there are sufficient staff to give people the care and support they need, when deciding whether there needs to be more staff made available. All staff could be reminded about what to do, and who to go to, if they believed that someone living at the home has been abused. They could be reminded about the role of the local authority, who they can go to directly if they do not wish to raise their concerns with the company. 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. Mallard Court DS0000069344.V376026.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 Mallard Court DS0000069344.V376026.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): 3 and 6 People using the service experience good quality outcomes in this area. People are assessed before they move in to check the home will be the right place for them to live. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Unless the circumstances are exceptional, for example an emergency admission, a senior member of staff always goes to assess people to see what their needs are before a place is offered to them. One person confirmed that they were visited in hospital by the registered manager, who talked to them about their care. Information is also collected from other professionals who have already been involved in their care. For instance, from the hospital, or the person’s care manager. All of this information is used to decide whether Mallard Court will be a suitable place for the person to receive their care, before a place is offered to them. Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 10 People are encouraged to come and have a look round the home before they decide whether it will be the right place for them. Eleven of the twelve people who returned their survey said they got enough information before they moved in. Everyone thinking of moving to Mallard Court is given information in a brochure which tells them about what the home provides. This helps people who are unable to visit, to see better for themselves what the home looks like, and what it offers. When they move in they are given a welcome pack which gives them more detailed information about how the home runs, and what they can do if they are not happy about something. They can keep this pack to refer to in the future. Staff on the unit where the person will live are told about the person’s needs, so they have the chance to understand these needs before they are admitted. This helps to make sure that the person gets the right care in a consistent way as soon as they arrive. The home does not provide intermediate care. Therefore standard six is not applicable. Mallard Court DS0000069344.V376026.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): 7,8,9 and 10 People using the service experience good quality outcomes in this area. People get good care from a staff team who understand their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There was some good information in people’s care plans, which explained their physical, social and psychological needs, and how staff should try to meet these needs. The information was written in an individual way which highlighted people’s personal choices and preferences, and showed that staff had recognised that one person was very different from the next. For instance, in one plan they had written comments like ‘enjoys cups of tea and ‘Ovaltine’ before bed’, and, ‘can get breathless when anxious or worrying about something’. Communication problems were also considered. One care plan explained staff should ‘face’ the person and ‘speak clearly’ to give them ‘the best chance of hearing and understanding what has been said’. Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 12 Staff review the care plans each month, or more regularly if the person’s needs change. Keeping the plans up to date like this makes it more likely that staff following them will work in a consistent way, and which reflects the person’s current needs. There was only limited evidence however that the plans were reviewed with the person to whom they belonged. One person, although unable to sign their care plan, but happy with their care, said they couldn’t remember staff ever discussing it with them. This should be encouraged so people, or their family if they are not able, can comment about how they get their care. There are assessments completed to check whether any areas of a person’s health exposes them to risk, which staff might be able to minimise. This includes assessments to check the risk from falls, from pressure damage to their skin, and from poor nutrition. Where risk had been identified, action had been taken to try to minimise this. For instance, special mattresses to protect people’s skin, and referral to the dietician for advice where people were at risk from malnutrition. We discussed an assessment where the person’s risk from choking had been assessed. Whilst staff were confident about caring for the person, the action about who to go to should the person choke could have been clearer. This would help any new staff member who may have to act quickly in an emergency. The head of unit agreed to make this clearer. The care plans showed that staff seek advice when they need help to maintain people’s health, and explained when, and for what reason, they had contacted health professionals, such as their doctor, the dietician or the district nurse, to get help. Comments about Mallard Court from visiting professionals included that the home gives ‘a high standard of care to the residents. Treat residents as individuals, and treat them with respect’, ‘Always helpful documentation, up to date and readily available’. People who returned their surveys said they ‘always’ or ‘usually’ get the care and support that they need. Seven out of twelve people said that staff always listen and act on what they say. Four said they usually do whilst one said this was sometimes the case. When asked about the care, people made comments like ‘I’m very happy here. We are very lucky. We couldn’t wish for any more’, ‘The carers allow me to be independent’, ‘Staff good, and very friendly. I am well looked after’, and ‘Nursing staff are excellent’. One person and their family said they were ‘highly satisfied with the care’ and that they would ‘go to Sylvia’ (the registered manager) if they had a complaint. They were confident that ‘she would sort it’. On the day of the visit people said that staff respect their privacy. Staff made a point of knocking on doors before they entered people’s bedrooms. This gives people the opportunity to tell staff to come back later if they do not want to be disturbed. However, staff had tried to protect one person’s privacy and safety by stopping other people from going into their room. The way they had Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 13 achieved this however was not acceptable or safe. By locking their room, the person was isolated from the rest of the community. This also posed extra risk to the person in the case of fire. The manager dealt with this situation on the day. The majority of people have their medication looked after by staff, because they are not able to manage their own. Some people however do keep their own. They have a locked cupboard in their room to keep their medication safe. Staff re order on their behalf when their supplies run low. Staff need to make sure that they keep an up to date risk assessment, which is regularly reviewed, so they can be assured that the person is still safe and confident to manage their medication, and to check that it is still being stored properly. One person’s assessment had not been reviewed for over a year. The medication was generally well handled. Appointed, staff count and check in the medication each month when it arrives. They also sign to show they have given people their medication when the doctor has prescribed it. Those who administer medication have been trained in how to do so safely. There has been one medication error at the home since the last site key inspection which the home told us about, and then fully investigated. Appropriate action had been taken to help stop further errors from occurring. The following matters were discussed: • Currently the temperature of the fridge used to store medication on the first floor is not checked and recorded. This should be done on a daily basis to be sure that medication that needs to be kept cool is being stored at the right temperature. The home has a homely remedies policy which states that the staff can give some agreed medication to people, for up to forty eight hours, without it being prescribed by the doctor first. One person had been given medication regularly for longer than this agreed timescale, but without the doctor being told. The staff member agreed to consult with them, so that a decision could be made as to whether this needed to be prescribed on a regular basis. Two people had been prescribed medication ‘when required’, but which had not been needed for some time. This should be reviewed with their doctor, so see whether it should be discontinued. Some eye drops which should have been stored at room temperature were being stored in the fridge. This was put right at the time. Staff who apply creams kept in people’s rooms do not necessarily sign the medication chart. Instead, they tell the person in charge, who signs it. It is better practice for the person who administers the cream to be the one who signs the chart. • • • • Mallard Court DS0000069344.V376026.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): 12,13,14 and 15 People using the service experience good quality outcomes in this area. People’s social needs are considered an important part of their care. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Nine out of the twelve people who returned their surveys said there are ‘always’ activities for them to join. Three said this is usually the case. There are two activities organiser, who provide a range of activities over seven days to suit different interests. The activities are advertised in the main entrance, and people are given their own copy so they can see forthcoming events that are due to take place. This gives them the chance to plan ahead, and to keep time free to attend the activities of their choice. For instance, one person chooses to join in with the planned bingo sessions, but instead of going to other activities, they choose to spend lots of time with their family. To meet people’s wishes, there are now more trips out in the mini bus. One person told us about a trip to Scarborough they had enjoyed the previous week. They said ‘It was very nice. We had a picnic tea with strawberries and bananas’. Individual activities are also provided. The hairdresser has a salon at Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 15 the home, so people can go and have their hair done and enjoy a change of scenery. One the day of our visit, some people were joining in a ‘music to movement’ session. Others were reading the newspaper. A reminiscence session was planned on the dementia unit for the afternoon. To help meet people’s spiritual needs, there is a monthly religious service held at the home. The priest visits people on an individual basis. People were pleased that they could make choices in their daily lives. One person commented ‘I can do what I want and am not told what to do’. A member of staff explained that every day on their unit is different, because, unless there is a good reason why, such as to take their medication, people can choose to rise and retire when they wish. Visitors can come and go as they please. The ground floor entrance area was a hive of social activity in the afternoon, when people and their families sat together and chatted. People can also have their family join them for lunch. Out of those who returned their surveys, four people said they ‘always’ like the meals, seven said they ‘usually’ do, and one said this was ‘sometimes’ the case. People are offered a choice of menu at each mealtime. The tables were nicely set on each floor, and the meals looked well presented. There is a choice displayed at each mealtime. The home is hoping that they will soon achieve the ‘Heartbeat Award’, which gives recognition to healthy menus. People on the day said they liked the food. One person said ‘The meals are good – I love the food. They do anything I want. I have to be helped at mealtimes and I am always assisted properly’. One isolated comment was made that the food could be hotter. The staff have changed the serving arrangements on the first floor to overcome this problem, so that meals are served straight from the hot cupboard. In between meals, people are offered drinks and light snacks, including home made cakes and fresh fruit. The cook was knowledgeable about people dietary needs, and understood ways in which they could prepare meals so they provided extra nourishment. Fresh meat, fruit and vegetables are delivered to the home regularly, and there was a good supply readily available. There is food available even when the cook is not there, so that staff can prepare snacks for people should they become hungry between meals. Time was spent discreetly observing the mealtime on the dementia unit. Some people who needed help had a good experience at the mealtime. Staff sat with them, chatted, and offered assistance with their meal at the person’s own pace. Some people however were rushed between courses, and one person’s lunch was exchanged with their dessert when they were still eating it. It is good however that people on this unit are not offered their medication at the same time as their meals, unless it is necessary for them to have it with food. This allows everyone to concentrate on their meal without too many distractions. Mallard Court DS0000069344.V376026.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): 16 and 18 People using the service experience good quality outcomes in this area. People’s complaints are listened to and they can be more assured that action will be taken swiftly should staff have concerns about their welfare. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a clear complaints procedure which is displayed in the public areas of the home. People also get their own copy of the procedure when they move there. Staff knew that they must pass on any complaints to the right person so they could be dealt with quickly. Everyone who returned their surveys knew who they could speak to if they had any concerns. The majority knew how to complain. One person said that when they raised with the manager dissatisfaction about the serving temperature of the food, this was dealt with quickly. Another said ‘I have no concerns about any of the staff here’. A visiting professional commented ‘Families are able to raise concerns directly with the manager or a member of staff. Any concerns are dealt with immediately’. The complaint book acknowledged on one particular day that a number of people had not liked the tea that was offered. There was an apology offered. The menu is adjusted according to what people’s views are about it. There have been no further complaints. Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 17 The home has referred five separate incidents to the local authority to consider under their safeguarding procedures. These issues involved individual concerns about care practice, behaviour of people living at the home which challenged others, and theft. Each of these investigations has been completed, by either the local authority, or by the home at the local authority’s request. After more training, staff with the responsibility to do so, have become better at reporting to the right organisation quickly when incidents arise. This helps to make sure they can be investigated without delay, and the right action taken to put things right. This includes more management training, and information about safeguarding people’s liberty. Staff get training in abuse awareness. When spoken with most, but not all, were clear who to go to and when, should they witness or suspect that someone at the home had been abused. All staff should be reminded that they must report all incidents they witness straight away, in all situations, without delay, and should be reminded of the role of the local authority who they can go to if they do not wish to report direct to management within the company. Mallard Court DS0000069344.V376026.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): 19 and 26 People using the service experience excellent quality outcomes in this area. People live in a clean and comfortable environment which meets their needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home is situated on the outskirts of Bridlington. It has plenty of parking spaces for visitors. It also has well tended and colourful gardens which people sit out and enjoy. When asked what the home does well, one person commented that the ‘décor, fixtures and cleanliness are excellent. Another commented that the ‘cleaning’ was good. A further person said that their room is ‘great’. The premises are clean, well maintained and pleasantly laid out. Care is provided on two floors. People who have nursing needs receive their care on the ground floor, which has a large sitting area, quiet room, large entrance hall Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 19 with seating for people, and a dining room with a further quiet area beyond. Many people who leave their rooms tend to gather in the large foyer, where they chat with others, and watch the general activity as visitors come and go. The first floor is divided into two separate areas. One area provides care for people with dementia. This area has a sitting room, dining area, and two corridors that are decorated and furnished to make them more interesting for the people who live on this unit. One corridor provides an ‘indoor garden’ area, with garden seats, ornaments and paintings. The other has ‘Memory Lane’ items, such as vintage clothes, models of old cars, and other memorabilia, which people can pick up and touch if they wish. The second first floor unit provides personal care only. The people living in this area have a small sitting/dining area, although no-one chose to use it on the day. Instead, people either stayed in their room, or went downstairs to join in with the social activities and mealtimes. There are assisted baths and showers on each floor so people can choose where and how they would prefer to bathe. For those who are unable to choose, staff decide which facility best meets the person’s needs. People’s rooms contain their own belongings, and were personal to them. Those spoken with said they liked their room, and many chose to spend the day there. The laundry facilities are suitable for the size of the home. There was equipment available there to reduce the risk from cross infection, and to protect staff, who do not have to handle soiled linen unnecessarily, because care staff deliver it in special bags which can be put straight into the washing machine. Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 20 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): 27,28,29 and 30 People using the service experience good quality outcomes in this area. People are cared for by a staff team who get regular training to help them do their job well. However, calculating staff availability should more consideration to delivering consistent outcomes for people. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People do not agree about whether there are sufficient staff available to meet their needs. Out of twelve people who returned their surveys, four of these said staff are ‘always’ available. Seven said they ‘usually’ are, whilst one said this was ‘sometimes’ the case. One person’s survey continued ‘The only problems that occur are when staff fail to turn up for work so their colleagues are over stretched’ Another, when asked what the home could do better, said ‘even more staff to resident ratio’. One the day, a person said ‘I ring my bell and they come’. Another said ‘Staff come quickly enough. I understand and accept that sometimes I have to wait’. It was noted that staff are very organised, but very busy. On the first floor, where some people are less able to tell us what they think, comments were made by staff about how the level of people’s dependency has increased, and how this has impacted on the work on the unit. One said that there were ‘not enough staff for the current dependency levels’, although appreciated that this was something that the registered manager was trying to address. This is of Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 21 particular relevance when considering the incidents that the home has referred to the local authority, which involved some behaviour of people which challenges others living there. Another said ‘we could always do with more staff, but we are alright’. They said that when the numbers are depleted due to sickness which cannot be covered, this ‘affects the work’. Another commented that providing care on the unit was ‘getting more demanding’. Staff are working very hard to maintain the level of support people are used to, and they would like more time meet people’s social needs, which they felt was an important part of their care. They were pleased therefore that the activities people are around every day to provide this support that the staff sometimes cannot give. The registered manager has listened to staff, and is in discussion with the company to try to provide extra hours so more staff are available. This, if and when provided, will assist in providing consistent support to individuals living at Mallard Court. She is hoping that the outcome from this discussion will be positive. Both trained nurses and care staff receive a range of training to help them in the work they do. This training includes a rolling programme towards National Vocational Qualifications in Care at level 2 and 3. Training includes dementia awareness, which tells staff how they should approach behaviour which people may present and which challenges others. Staff are also receiving training in palliative care, so they can continue to improve the support given to people who are in the final stages of their lives. This collective training will help staff to give people good, safe, consistent care. Trained staff have completed a range of training to keep their clinical skills up to date. This includes training about specialist feeding regimes, blood taking and wound care. A good recruitment process is followed, which ensures that all necessary evidence is collected for the home to make sure that the person has not been barred from providing care, and that they are suitable to work with vulnerable people. Staff get a full induction when they first start working at the home. One recent starter said that their induction had been thorough, and they had not been expected to carry out any tasks until they felt confident to do so. Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 22 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): 31,33,35 and 38 People using the service experience good quality outcomes in this area. The home is efficiently run by a registered manager who people living there trust. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager is a trained nurse, and has lots of experience in the care of older people. She has completed a management award, and is registered with the commission. People and staff all spoke highly of her input and management approach. They see her regularly, and know they can go to her with any issues they may have. This is good, because this working relationship will hep the home to run well. When asked what the home does well, their comments included ‘good job Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 23 overall’, ‘Cannot do any better’, A good home, as good as any. They cannot do any better. I am very happy here’, and The home and staff are wonderful. Very caring and helpful’. A staff member said ‘This is the best home I have worked in’. A professional said ‘I believe this is one of the best managed homes within my area. Management and staff act in a professional but respectful manner with other professionals and resident’s families’. The company’s support network is well established, and means that different departments either visit the home to carry out audits, or request information periodically, so that they can check how the home is running, and to make sure that the manager is helped to deal with any slippages at an early stage. The manager gets good support from the regional manager, who checks the standards at the home when they visit. This helps to make sure that the expected standards do not slip. People, their families and health professionals are asked their views about the way the home runs. Meetings are held for people and their relatives, but they and professionals are also sent out surveys each year so they have the chance to pass on their written comments about how the home is running. The results of these surveys are put together and published, so people can see what everyone thinks of the home, where it does well, and what is being done to make further improvements. For instance, in the last year, because people have said they want changes, there are now more bus trips away from the home. The results of the most recent survey showed that the majority of people remained satisfied with the service they get. The manager also listens to the views of her staff. As well as regular staff meetings, the management supervise staff regularly so they can appraise their work, and look where further training may be needed. The home is encouraging families to look after people’s monies where they are unable to handle their own. It is the case that the home will not be offering this service to newly admitted people. The systems in place to manage people’s monies were clear and correct, and these people have reasonable access to their cash when they ask for it. The health and safety records seen showed that the home is kept maintained. Staff get a range of training so that they know how to work in a safe and lawful way, and this training is kept updated as necessary. The Environmental Health Officer has visited since the key inspection last year. He was generally satisfied with the systems in place in the kitchen. A requirement made by him had been addressed. Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 24 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 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 3 Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 25 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. 1 Standard OP9 Regulation 13 Requirement People who self medicate must have a completed risk assessment, which must be reviewed on a regular basis. This check must be recorded, to confirm that the arrangements remains safe and manageable for the person concerned. Further serious thought must be given by the company to increasing staff numbers on the first floor, in line with the registered manager’s submitted request. When reviewing this request, the views of the people living there, and the staff who provide them with care, must be considered, rather than relying solely on the staffing formula used by the company. Timescale for action 23/06/09 2 OP27 18 31/07/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 26 No. 1 Refer to Standard OP7 Good Practice Recommendations People and/or their families should be encouraged to be actively involved in the review of their care plan, so they have the chance to have written down how they would like their care to be provided. The care plan for the individual discussed should have more specific information about who to go to should the person suffer a choking episode. This would help to avoid unnecessary delays in an emergency. The temperature of the medication fridge should be checked and recorded on a daily basis to be sure that medication that needs to be kept cool is being stored at the right temperature. Staff should always follow the agreement made with the doctor when giving people homely remedies, so that after people need this for longer than forth eight hours, their doctor is informed. It should be discussed with their doctor when people have not needed their ‘when required’ medication for some time, so he/she can decide whether this medication should be continued. Staff should make sure that medication is always stored at the correct temperature according to the manufacturer’s instructions. This will make sure that it works to its full potential. The staff member administering medication should be the person who signs the Medication Administration Record, so it is a true record of what has been applied, when, and by whom. People should experience a consistently good mealtime, which should be unrushed. The quality of this experience should not depend upon which staff member serves them. All staff should be reminded about what to do, who to go to, and when, if they believe that someone living at the home has been abused. This should include reminding them about the role of the local authority, who they can go to directly if they do not wish to raise their concerns with the company. 2 OP9 3 4 OP15 OP18 Mallard Court DS0000069344.V376026.R01.S.doc Version 5.2 Page 27 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@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. 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