Care Home: Mardon House

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What the care home does well People received good care services that tried to address individual personal needs. Peoples health and social care needs were considered and people were supported to make choices about the care they received. There were a range of social and leisure activities, inside and outside of the home that people enjoyed and took part in. People were protected by good recruitment, training and support for staff, so that staff had the skills they needed to care for people safely and with staff suitable to work with potentially vulnerable people. There were good complaint and protection procedures in place so that people could raise concerns and those concerns would be addressed. There were a range of management and administration systems and procedures in place including good record keeping, good recruitment and quality assurance systems to ensure the smooth running of the home. The manager worked well with health and social care professionals and outside agencies to improve the overall environment in the home and the services provided. What has improved since the last inspection? This is the first inspection since the owner manager purchased the home. Since purchasing the home there had been large investments in introducing new systems, recruiting staff, and major improvements to the environment. Investment in equipment, furnishings and improvements in decor have been made since purchasing the home. What the care home could do better: There were a number of recommendations related to the continued development and improvement of the systems and procedures put in place since purchasing the home. Recommendations were, in extending the detail of some of the care plans and assessment records, fully recording complaints and concerns, continuing quality assurance systems and working with outside agencies to continue to improve the environment. Key inspection report Care homes for older people Name: Address: Mardon House 10 Higher Brimley Road Devon TQ148JS     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Andrea East     Date: 0 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Mardon House 10 Higher Brimley Road Devon TQ148JS Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Goddard Type of registration: Number of places registered: care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accomodated is 14 The registered person may provide the following category of service only: Care home only - Code PC - to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (code OP) Date of last inspection Brief description of the care home Mardon House is a care home providing care for up to 14 older people. The home has communal areas, one is used predominantly as a dining area, one as a lounge area and then a smaller lounge is used as a quiet area. There is a mix of single and double rooms some with ensuite facilities or toilets and bathrooms near to peoples individual rooms. There is a chairlift to the first floor and large pleasant gardens to the rear of the property. Care Homes for Older People Page 4 of 26 Over 65 14 14 0 0 Brief description of the care home The home is situated near to local facilities, bus routes and the nearby seafront and town centre. The service users guide and statement of purpose was displayed in the hall and is available on request. Fees for the home ranged from £330-£391. Additional charges were made for toiletries hairdressing and chiropody on an individual basis. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection site visit was unannounced and carried out over one-day. People have spoken with regarding the lifestyle in the home and the care services they receive. The manager who is also the owner of the home and staff were spoken with. People were spoken with in the homes Lounge and in private rooms. In addition a tour of the premises was made and records were inspected, including care medication and staff records. Care Homes for Older People Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 7 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were confident that their care needs had been assessed and that their needs could be met, right from the start of their stay in the home. The services provided did not include intermediate care Evidence: Two files, which included a range of information on peoples access needs were examined. There was a clear procedure for assessing peoples needs before they came into the home to stay on a temporary or permanent basis. This included a basic format of assessment which had details of peoples needs, preferences and how they wish to be cared for. One assessment document has not been fully completed with detailed information. The manager said that she had much more detailed information from the assessment which had not been recorded. This information was later transferred into ongoing care Care Homes for Older People Page 9 of 26 Evidence: plans and assessments. Assessment documentation should be as fully completed as possible at the time of assessment. So that all staff have access to detailed information about peoples needs, right from the start of people moving into the home. The manager said that people were assessed prior to coming into the home and this would include her visiting them in hospital or people visiting the home. People who had recently moved into the home, said that they felt their needs had been assessed and take into consideration before they moved into the home. Care Homes for Older People Page 10 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service had their health, personal and social care needs met and this was set out in individualised plan of care. Care records could be more detailed and more specific. People were involved in decisions about their lives and played a part in planning the care and support they received.People were treated with dignity and respect their privacy was upheld. People were supported and protected by the homes policies and procedures for dealing with medication. Evidence: Care plans and assessments for two people were examined. Care plans and assessments covered a range of topics, including moving and handling, potential risks and how they would be addressed, and peoples preferences and choices in how they were cared for. Care Homes for Older People Page 11 of 26 Evidence: The records examined also showed how people were involved in their care, and how relatives and outside professionals had been consulted with about how best to care for people. There were daily records on how people were supported in attending to their personal hygiene in their daily life in the home. The care plans and assessments did not include all aspects of peoples care. There are areas of care that staff were supporting people with which had not been captured in any detail. For example one persons mental health required reassurance and support from staff in dealing with some challenging behaviour, this was not always fully recorded or made clear in the care plan. More detail in the care plan and assessments would help staff have the information they need to care for people consistently. The manager and staff spoke with clearly had a detailed knowledge of peoples individual needs and preferences, which care planning and assessment did not always reflect. People said that their needs were fully met and that they had made decisions with staff and the manager on how best to meet their needs. The manager said that the feedback from health and social care professionals, had been very positive about peoples care. Surveys completed by people living in the home, said I am very well cared for and Im very happy, they look after me well and they provide the help I need. Surveys completed by staff said residents are very well looked after and can have whatever they want and need. Medication storage, administration and recording were good. So that people were protected from harm by the homes medication systems and procedures. Medication was stored safely, in a clean and tidy environment and administered safely with clear records to show when medication had been received. Medication administration was also part of staff training and there had been training and support from the pharmacy supplying medication to the home. Care Homes for Older People Page 12 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples lifestyles in the home met their expectations and satisfied their needs. People who use the services were able to make some choices about their lifestyle, and were supported to develop some skills. Social educational cultural and recreational activities met peoples expectations. People enjoyed a varied diet, of their choice and in pleasant surroundings, with support from staff. Evidence: People said that they were involved in making choices, supported by staff in enjoying a varied lifestyle in the home. This included people making choices about how rooms were decorated and furnished and how people spent their leisure time. On the date of the unannounced site visit most people had chosen to go to the local pub restaurant for their lunch. On their return, they were clearly delighted at having the opportunity to go out supported by staff and enjoy the local facilities and surroundings. Care Homes for Older People Page 13 of 26 Evidence: The manager and staff said that people were offered the opportunity to take part in a range of activities including spending time on a individual basis with staff. This was not always fully recorded in care plans and assessments. It is important to record the activities people participate in, so that the manager can ensure that everyone has the opportunity to take part in activities that suit them. People described keeping themselves active by completing jigsaws, visiting with friends and family and following hobbies such as painting, knitting and crochet. People enjoyed a range of food and drinks for a choice of menu. People people said they enjoyed the food and drinks that were available throughout the day and night. Meals were supplemented with prescribed nutritional drinks for those people needing addict vitamins and minerals. Special diets of peoples personal preferences were also catered for. Menu plans and daily records of peoples food choices were stored in the homes kitchen. Peoples dietary preferences were also detailed in care assessment records. People enjoyed their meals and snacks in their rooms or in a bright clean pleasant dining area or a quieter separate lounge dining area. Care Homes for Older People Page 14 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were confident that their complaints and concerns would be listened to and acted upon. People were protected from abuse. Evidence: There was a clear written procedure for dealing with complaints and concerns. A complaints procedure was displayed in the hall which the people living in the home and staff were aware off. People said that they felt able to raise any concerns or worries with the staff or the manager and that these concerns would be addressed. Staff also said that they felt sure that the manager would address any issues raised with her to ensure that people were happy with the service was provided. There was a complaints book in place. The manager said that she had not received any complaints. It is important to record complaints so that it is clear that concerns and complaints no matter how small had been considered and addressed. Recording concerns can also act as a measure of quality assurance. Staff were aware of the policy on dealing with possible abuse issues and how to report any potential issues to the manager or outside agencies. There were a range of policies and procedures available to staff on dealing with Care Homes for Older People Page 15 of 26 Evidence: possible abuse issues including policies on protecting people who report abuse, risk assessments and health and safety. Staff had also received or in the process of receiving training in safeguarding vulnerable people. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People lived in a clean, well maintained environment. The home presented as clean, pleasant and hygienic Evidence: Since purchasing the home manager is decorated throughout the building, replacing carpeting, curtains, furnishings and electrical equipment. She has also replaced fire and alarm call systems and was working with Devon and Cornwall Fire safety department recommendations and requirements made by them were fully addressed. Other purchases to improve the environment included new beds, bedding, cleaning materials, new office equipment, new laundry equipment including the dryer and wash machine and a new entrance to the home. A range of documents about health and safety environment were available for staff. This included risk assessment to the premises highlighting any areas that may pose a risk on how to minimise those risks. Walking around the premises the home appeared to be clean, bright and personalised people tastes and preferences. Surveys completed by people living at home said that the home was clean and tidy. Care Homes for Older People Page 17 of 26 Evidence: The manager had chosen to change the use of one-bedroom into a fully equipped office and divided one Lounge into a bedroom and a smaller separate lounge area. This meant a better working environment for staff when completing confidential documents and more choice of pleasant areas for the people living at home to enjoy. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The number of staff on duty, and their level of skill and experience, was sufficient to meet peoples needs. Recruitment procedures were in place to ensure that only those suitable to work with vulnerable people were employed at the home. Recruitment procedures could be improved. Evidence: The manager and husband live on the premises. They provide night-time support to waking night staff and take a fully active role as part of the staff team. Staff complete care, laundry and catering duties as part of a small team of staff who were described as just like a large extended family. The cleaner had recently left and staff were also cleaning on a temporary basis until this role could be filled. People said that staff were lovely, very helpful and kind. Staff said that they received the support and training needed to care for people safely. the manager described a range of training for staff, including enrolment to complete Care Homes for Older People Page 19 of 26 Evidence: National vocational qualifications at levels two and three in care. Staff training was ongoing and for some very recently started as they had only been employed at the home for a short time. The manager said induction for new staff was in place and an uncompleted file was available as an example of what staff completed. Staff supervision took place on an informal basis throughout the day as the manager and staff team work together. Formal supervision that was recorded had been started for some staff. There were good recruitment practices and procedures in place. To staff files were examined and they contained completed application forms, references and details of employment. Completed police checks were not kept on the premises. Confirmation of protection of vulnerable adults checks and the numbers related to police checks were available. the police check the form should be available for inspection purposes. Police checks with any offences had been explored and a decision made on peoples suitability to be employed working with vulnerable adults. This was not recorded in recruitment records. Interview notes that staff had been interviewed for employment had not been made. Good good recording of interview notes and exploring police checks would demonstrate how the manager ensures only those people suitable to work with vulnerable adults are employed in the home. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager, who is also the owner of the home, is qualified, competent and experienced. The day-to-day management of the home ensures the health and safety and welfare of the people living there. Evidence: The manager, who is also the owner of the home, has a range of experience and training in caring for older people in care settings. She is currently working towards a National vocational qualification at level IV in care management. The manager had introduced a number of systems to improve the environment, support staff and provide good standard of care for the people living at the home. For example planning and ikmplementing new decor and refurbishments, risk assessments tfor the premises and individuals and the start of a quality assurance system. The manager was also actively working with health and social care professionals and other outside agencies, such as Devon Fire and Rescue Service and Environmental Care Homes for Older People Page 21 of 26 Evidence: Health, in managing the home to improve the environment and services to the people living there. The manager and staff described the ethos of the home as being centred on providing good care and getting things right for the people who live there. Survey said that the home was well managed and that people felt safe and protected. The manager said peoples personal finances were dealt with through relatives and advocates. The manager said that there was no one currently needing financial support from the home as everyone had some kind of advocate working on their behalf. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 Continue to extend pre-assessment information to include as much detail as possible. So that all staff have detailed information on peoples needs before they move into the home. Care plans and assessments should be extended as planned, to contain more specific information about how peoples needs are met. As planned, record the day-to-day activities and social events for each person. As planned, fully record all complaints and concerns, with details of how those concerns were addressed. As planned, continue with the refurbishment and redecoration of the property, including plans to continue to upgrade fire safety precautions. Improve recruitment practices by fully recording the interviewing of staff and fully recording any discussion regarding past employment and criminal record. Continue as planned, to support staff in completing national vocational qualifications at level two and above. so that Page 24 of 26 2 7 3 4 5 12 16 19 6 29 7 29 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations staff have the skills to care for people safely. 8 33 The newly formulated quality assurance system, including questionnaires to ask peoples opinion of the home, should be fully implemented. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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