Care Home: Mariner`s Court

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What the care home does well The staff team at Mariners Court work well together. Staff interacted with residents and appeared willing to engage in conversation with residents even though this ability may be limited due to their dementia. This means that staff get to know people living at the home well and the relationship observed between staff and residents appeared to be warm, friendly and caring. People`s individual wants and needs are well known to staff so that people living at the home can be supported in the way that they like. Routines are flexible so that as far as possible, people can enjoy a life style of their choice. One relative commented that, "All the service is excellent, the care and attention my mother, and all the residents get, is first class, next to none". Quality assurance is considered important. This includes regular questionnaires for residents, relatives and other stakeholders to enable people to have their say and influence change. What has improved since the last inspection? The refurbishment of the physical environment at the home has continued. Communal areas are bright and welcoming and the majority of bedroom accommodation has been upgraded to a good standard. The home provides a comfortable, safe and well maintained place for people to live. We were told in the Annual Quality Assurance Assessment (AQAA) that the home`s Service User Guide and Statement of Purpose have been reviewed and updated to make sure that the information remains current. These two important documents tell residents, prospective residents and other interested people about the home and the services and facilities provided. There is a more person centred approach to activities concentrating on what the individual prefers to do and is able to participate in. This has enabled residents to engage in a wider range of activities suited to their particular needs and requirements. What the care home could do better: Although there is a good system in place to make sure that the individual needs, wants, wishes and requirements of each prospective resident are known prior to admission, it was noted that for some recently admitted residents, a care plan was not in place until quite a number of days after admission. Given that a pre admission assessment had taken place before admission, there was no reason for a rudimentary care plan not to be in place on the day of admission that could be added too as more information became available. This would have enabled staff to have detailed written instruction about how a particular need was to be addressed so as to ensure consistency in meeting assessed needs. There is a requirement that a prospective resident is informed in writing of the outcome of the pre admission assessment. This would confirm to the prospective resident that their current needs could be met at the home or alternatively not met. To date this has not been happening. This issue also came to light during a site visit at another of the care home`s within the group. We have been assured that steps are now being taken to address this issue and prospective residents will be informed in writing of the outcome of the pre admission assessment. Although staff training is given some priority, it was noted from the staff training matrix seen during the course of the site visit, that a number of staff working at the home had not completed mandatory dementia awareness training and challenging behaviour training. Given that the vast majority of people living at the home have some degree of cognitive impairment, it is essential that all staff undertake this important training. This would help to ensure that staff have some understanding of the effects of dementia and how best to assist residents during their daily activity. It was also noted that not all staff have completed all elements of mandatory health and safety training. This should be provided as soon as possible to ensure that residents are kept safe. Key inspection report Care homes for older people Name: Address: Mariner`s Court 44/46 Laidleys Walk Fleetwood Lancashire FY7 7JL     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: Denise Upton     Date: 0 8 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Mariner`s Court 44/46 Laidleys Walk Fleetwood Lancashire FY7 7JL 01253872493 01253872493 marinerscourt@centuryhealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Century Healthcare Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: All future admissions to the home must be service users of the category Dementia Code DE The maximum number of people who can be accommodated is: 26 The registered person may provide the following category of service 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: Dementia Code DE maximum number of places 26; Old Age, not falling within any other category Code OP maximum number of places 4; Physical Disability Code PD maximum number of places 1 Date of last inspection 26 0 1 Over 65 0 4 0 Care Homes for Older People Page 4 of 33 Brief description of the care home Mariners Court is a home that is registered to provide care for 26 service users who have dementia. There are however three service users who currently live at the home who are assessed as not having dementia. The home is a detached property and overlooks the boating lake on Fleetwood promenade. This is a three storey property and has 24 single rooms. Ten of these rooms have en-suite facilities and there is a lift to all floors. There are four lounge areas on the ground floor, one of which is a smokers lounge. Outdoor facilities are good and there is now ramp access to the garden area. There are shops and services in the local area and bus services operate from a short distance away. Fleetwood sea front is a short walk away and the town centre is within half a mile. There are garden areas to the side of the home and a yard to the rear. Residents have access to these areas and can sit out in good weather. There is ample car parking space at the front of the home and on the promenade opposite the home. There is a Statement of Purpose and Service User Guide, which is available for persons making enquiries about the home. The written information explains the care service that is offered and what the resident can expect if they decide to live at the home. The owner of the home also has copies of previous inspection reports that can be made available to prospective residents and their families or representatives. The current fee for residential care at Mariners Court is £466.50 per week and covers all aspects of care, food and accommodation. Additional charges are made for chiropody, hairdressing, newspapers and personal items. Further details about the fee and what is included in the fee can be obtained from the manager at Mariners Court care home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on outcomes for people living at Mariners Court and involved gathering information about the service from a wide range of sources over a period of time. This unannounced key inspection site visit took place during the course of a mid week day and spanned a period of approximately eight and a half hours. Twenty two of the thirty eight standards identified in the National Minimum Standards Care Homes for Older People were assessed. We spoke with the managing director of the company, the personnel manager, the homes recently appointed manager, the deputy manager, and the chef. The majority of people living at Mariners Court have various degrees of cognitive impairment therefore some conversations were brief and limited. However we did speak individually and at length with two relatives and a resident who had lived at the home for a long time and did have mental capacity. Every year the manager is asked to provide us with written information about the quality of the service they provide. They are also asked to make an assessment of the Care Homes for Older People Page 6 of 33 quality of the service. This information, in part, has been used to focus our inspection activity and is included in this report. During the course of the site visit, a number of documents and records were examined and a tour of the building took place including communal areas of the home, toilets and bathrooms, some bedroom accommodation and the laundry and kitchen areas. There is a passenger lift in place to assist those residents who cannot manage the stairs. Care Quality Commission (CQC) surveys were also received from two relatives who completed the survey on behalf of two people living at the home and three members of staff. The comments received from these people were in the main very positive. This helped to form an opinion as to whether Mariners Court care home was meeting the needs and expectations of the people who live there. The last key inspection at Mariners Court took place in September 2007. Annual Service Review Inspections took place in 2008 and 2009. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: Although there is a good system in place to make sure that the individual needs, wants, wishes and requirements of each prospective resident are known prior to admission, it was noted that for some recently admitted residents, a care plan was not in place until quite a number of days after admission. Given that a pre admission assessment had taken place before admission, there was no reason for a rudimentary care plan not to be in place on the day of admission that could be added too as more information became available. This would have enabled staff to have detailed written instruction about how a particular need was to be addressed so as to ensure consistency in meeting assessed needs. There is a requirement that a prospective resident is informed in writing of the outcome of the pre admission assessment. This would confirm to the prospective resident that their current needs could be met at the home or alternatively not met. To date this has not been happening. This issue also came to light during a site visit at another of the care homes within the group. We have been assured that steps are now Care Homes for Older People Page 8 of 33 being taken to address this issue and prospective residents will be informed in writing of the outcome of the pre admission assessment. Although staff training is given some priority, it was noted from the staff training matrix seen during the course of the site visit, that a number of staff working at the home had not completed mandatory dementia awareness training and challenging behaviour training. Given that the vast majority of people living at the home have some degree of cognitive impairment, it is essential that all staff undertake this important training. This would help to ensure that staff have some understanding of the effects of dementia and how best to assist residents during their daily activity. It was also noted that not all staff have completed all elements of mandatory health and safety training. This should be provided as soon as possible to ensure that residents are kept safe. 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 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into Mariners Court are given information about the home and have their needs assessed so they will know if their needs can be met. Evidence: Recently the homes Statement of Purpose and Service User Guide have been reviewed and updated. We were told that these two important documents that tell residents, prospective residents and other interested people about the home and services and facilities provided, can now be provided in alternative formats such as large print, easy read and on tape for people who are visually impaired. This helps to enable as many people as possible assess to this important information. An initial pre admission assessment is carried out for each resident prior to agreeing a move into the home. The homes manager carries out the initial assessment visiting the individual in their place of residence, such as at their home or in hospital. Information is also gathered from other professionals, such as social workers, as Care Homes for Older People Page 11 of 33 Evidence: appropriate to each individual. Risk assessments are carried out regarding areas such as mobility and nutrition. Discussions with the manager confirmed that people are not admitted to the home unless there is confidence that all their needs can be met. Care is also taken to involve relatives and informal carers in this process so that important information such as the likes, dislikes and lifestyle of the individual is known, to enable care to be tailored around their individual needs. Where ever possible, a pen picture life history is completed by family members to enable staff to get to know the person and have some understanding of what is important to them. One relative spoken with confirmed that she had been very involved in her husbands admission to the home and that the process of her husbands admission had been, Absolutely excellent. The initial first weeks of residency are classed as a trial period for both the resident and the home. During this settling in period further information is gathered about the individual so as to ensure up to date detailed and informative care planning takes place. Whilst it is apparent that the needs and requirements of people living at the home were being met, there is a requirement that any person that has been assessed for possible admission to a care home must receive written information following the pre admission assessment. This should confirm the outcome of the pre admission assessment and that the prospective residents current needs and requirements could be met at the home or alternatively that they could not be met. This should be provided prior to admission. There was no evidence that this had occurred. This issue had also been noted during the recent site visit to another of the homes within the group. We were told that steps have been taken to address this issue and that prospective residents will now be informed in writing of the outcome of their pre admission assessment. Intermediate care is not provided at Mariners Court care home. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Mariners Court have their needs met and their care is provided in a manner that protects their privacy and dignity. Evidence: Care plans are in place and address a variety of known needs including, mental health, physical health, mobility, personal care and social activities. Each care plan shows the identified need, the desired outcome and what staff need to do to achieve this. There is a system of monthly reviews taking place, with care plans being amended if the residents needs have changed. There is also information regarding lifestyle choices, including preferred daily routines, such as times for getting up and going to bed and this feeds into the care planning process. Each person also has a night care plan, detailing any support required during the night. Risk assessments are in place and address potential risks such as falls, continence, emergency situations, getting in and out of bed, bathing, moving and handling and the use of equipment, including the use of bed rails. Care plans and risk assessments evidenced were detailed and informative and Care Homes for Older People Page 13 of 33 Evidence: personalised to the individual. Good instruction was given to staff. For example one night care plan informed staff that, **** can sometimes be unsettled at night and will wander if unable to settle in his bedroom. Staff to assist **** downstairs, offer a hot drink and a slice of toast and make comfortable in a recliner. Another care plan in regard to communication said, Staff should speak slowly and clearly using uncomplicated language. Staff need to take time to listen to *** and have patience with him. Ensure *** is given time to chat calmly as *** can sometimes become quite loud and this can be distressing to other residents. *** does not realise he is distressing the other residents and would find this upsetting. One person living at the home can display inappropriate sexual behaviour that is linked to their dementia. The care plan for this issue was detailed and gave very clear instruction and guidance to staff about what they should do if an instance occurred. There was also a risk assessment in place so that any risk to female staff was minimised. It was documented that the risk assessment had to be reviewed at least monthly to ensure that the risk remained current and there was clear recorded evidence that this instruction had been carried out. For some residents a Deprivation of Liberty screening tool is completed along with a Mental Capacity Act screening tool. This is good practice and helps to ensure that an individuals liberty and freedom is not unnecessarily restricted. Although the individual care plans evidenced provided staff with good and detailed instruction as to how an assessed need was to be meet, in respect of one recently admitted resident that was case tracked, no formal care plan had been put in place for the first twelve days of their admission to the home. Given that sufficient pre admission information had been obtained prior to this resident being admitted, there was no reason for a rudimentary care plan not to be in place from the day of admission. Initial needs and requirements were already known and staff should have been provided with written instruction as to how these requirements were to be met so as to ensure a consistent service was offered that met assessed needs. Whilst it is appreciated that verbal discussion does take place within the staff team, this is not the same as clear written instruction. Verbal information can get changed in the telling or important information not passed on. It is important that a rudimentary care plan is in place from the day of admission based on known information. As further information comes to light over the coming days and weeks, the initial care plan should be amended and or expanded as required. This would ensure that all staff had the same written detailed information so that care is delivered in a consistent way at all times. Discussion with a relative confirmed that she had been very involved regarding her Care Homes for Older People Page 14 of 33 Evidence: husbands recent admission to the home and had provided staff with a lot of information about her husband. This same relative praised the way her husbands admission to the home had been managed, confirmed that she was a frequent visitor and that the staff were, Excellent with residents. However this relative also said that she was disappointed in that at the first review meeting she attended, two or three weeks after her husband had been admitted to the home, there was, Not a lot written in the care plan. As previously stated, it is important that an initial care plan is in place from the day of admission that gives clear direction to staff as to how an assessed need is to be addressed. It is also important that the initial care plan is kept under constant review particularly during the early days following admission. Initial needs and requirements may change very quickly and staff need up to date guidance that may not wait until a formal review takes place. Daily records are kept by staff giving a clear account of how each person has been, during the night as well as during the day. Good records are maintained of any health care issues or visits from health care professionals such as GPs. This helps to ensure that any health problem and associated treatment is monitored and that clear information can be provided to health professionals such as district nurses. Records are kept of each persons weight with any significant changes being responded to. The relatives spoken with confirmed that they are kept informed of important events affecting their relative. Only senior care staff that have received appropriate, mandatory, medication training are responsible for assisting residents with their prescribed medication. This is important because it means that staff have the necessary skills and knowledge to handle medication safely. Medication is safely stored and written guidance is in place, which outlines good practice for handling and administering medication. Most medication is provided in blister packs by the dispensing pharmacist, who also provides advice. The medication records for three people living at the home were viewed and all had been completed appropriately. Separate storage and recording arrangements are in place for any controlled drugs. Discussion with the deputy manager highlighted that there had previously been an issue where medication had been delivered to the home, generally repeat prescription medication, that had not been ordered that month because none was required. Whilst this situation has got better of late, this could be avoided if the prescriptions issued by the General Practitioner, were seen prior to being dispensed by the pharmacist. This would enable staff to check that the individual prescription was for the medication that was actually ordered, rather than including medication that was not required that month. This would prevent none required medication being stored in the home and Care Homes for Older People Page 15 of 33 Evidence: help to prevent waste. We were however told that PRN care plans were in the process of being developed, but none were available on the day of the site visit. It was noted that although when required medication had been prescribed for some people living at the home there were no protocols in place to advise staff when it would be appropriate to give this medication. When required medication is medication that is not necessarily taken on a regular basis. Given that the majority of residents living at the home have some form cognitive impairment and may not always be able to verbalise when they are in pain or if they need their medication, it is recommended that individual protocols be developed to advise staff when to give this medication. This may be based on a persons specific behaviour if they are unable to verbally communicate their needs. This would ensure that a consistent approach is adopted by all staff when giving this medication. We were informed that medication is audited on a monthly basis and spot checked by the Director of Nursing. This enables any discrepancies to be addressed quickly in order to prevent similar mistakes happening again. It was observed that the privacy and dignity of residents was well respected and that staff were sensitive and mindful of residents feelings. One relative told us on a survey form that staff at the home, Build a rapport with residents and makes them feel secure, treats them with dignity and is aware of individual needs. All staff receive training in respect of maintaining privacy and dignity during their induction training and National Vocational Qualification (NVQ) training, a qualification that all staff working at the home are encouraged to achieved. A resident spoken with also said that he felt his privacy and dignity was always respected by staff and confirmed that he held his own key to his individual bedroom accommodation. This same person said, People here look after me, I have been happy here. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with activities and a variety of home cooked food, which they enjoy. Evidence: We were told in the Annual Quality Assurance Assessment (AQAA) that a range of activities specifically designed for individuals with Dementia is provided. This includes reminiscence discussions, quizzes and board games. Residents are encouraged to continue with past leisure interests where ever possible or encouraged to participate with different interests. One relative told us that although her husband did not really have any specific interests prior to living at the home, since he was admitted he will now join in with activities such as bingo, games and music games. At the time of the site visit one lady was seen to be absorbed in independently completing a jigsaw puzzle, and several other residents were engaged in a ball activity with a member of staff. A resident spoken with said that he frequently went out on his bike, an activity that he clearly enjoyed and where ever possible residents that are able, are encouraged to go out so as to help maintain their independence. Another family member said that arrangements had been made for his relative to be provided with talking books for the blind, but this activity has ceased as his aunt had become frailer and less interested in participating in social activity. Care Homes for Older People Page 17 of 33 Evidence: As observed at the time of the site visit, residents also enjoy outings with their family. An activities board is provided to let residents and relatives know what events are taking place. Residents also enjoy outings in the companys own mini bus. This enables residents to take trips to places such as the zoo and local garden centres. We were also told that residents are given opportunity of visiting events that take place in the companys other homes in the area. Birthdays and religious festivals are celebrated. Mariners Court sought the views of relatives that has enabled a more tailored programme of events to be organised to suit individual needs and expectations. Religious needs are given careful consideration. There are regular visits from clerics of different dominations and although currently no resident wishes to do so, we understand that if a resident did express a wish to attend a church service they would be enabled and assisted to do so. A communion service takes place each Friday at Mariners Court, conducted by a member of the local church for people that wish to attend. A hairdresser visits the home on a weekly basis and a chiropodist visits approximately every six weeks. It is important that any specific social or religious requirement of each person living at the home is included in their care plan. This would help staff to plan ahead so that important needs are not missed. Visitors are made welcome as was evident during the site visit and activities are arranged that relatives and friends are invited to. Very recently a barbecue was arranged that one relative said she had very much enjoyed and familys of people living at the home were invited to a significant birthday of one of the residents. We were told that relatives are always made welcome, one relative confirmed this stating that she, Feels part of a family. One relative told us that he was, Impressed with the care and that staff were Excellent with residents. There appeared to be a good, comfortable relationship between relatives and staff that clearly benefits people living at the home. Wherever possible, people living at Mariners Court are encouraged to exercise choice in their day to day lives. However, the majority of people living at Mariners Court have a diagnosed of dementia resulting in various degrees of cognitive impairment. Relatives or another advocates usually take on the responsibility for financial affairs. Advocacy information is available. People are able to bring personal possessions to the home to make their bedroom more homely, personalised and comfortable. The resident spoken with said he was happy with the meals provided. There is a free choice of foods at breakfast including a cooked breakfast if required, meals can be Care Homes for Older People Page 18 of 33 Evidence: taken in the individual residents bedroom, dining room or as seen, in any other communal area of the home. Although there is a choice of meals at lunchtime and teatime, an alternative of the residents choice is always made available if required. There is a four week rotating menu, showing that a wide range of foods is offered in order to provide good nutrition. The majority of staff have received training in malnutrition care and assistance with eating so as to ensure that a well balanced menu is encouraged. Supper is served in the evening and hot and cold drinks are provided at regular intervals throughout the day or on request. From discussion with the chef we were told that the four weekly rotating menu had very recently been reviewed and amended. Residents views were listened to and the changes to the menu have been influenced by this. Nutrition is considered very important and fresh foods, including fruit and vegetables are served daily and sourced locally. In order to aid understanding, for some residents that have cognitive impairment, the menu choice at each main meal is put on a plate and actually shown to each resident so they can make an positive choice about what they eat. The chef also told us that he was made aware of any specialist diets required at least on the day the person was admitted to the home. The chef also confirmed that he also had access to the pre admission assessment information that included dietary requirements. In order to ensure that individual dietary requirements were addressed, the Internet was used to gain information especially if a newly admitted resident required a specialist diet that was less well known. Any specialist dietary requirements would be determined through the pre admission assessment process. The kitchen is open at night to enable staff to prepare snack meals for residents if required. The chef confirmed that there is a sufficient food budget made available to ensure that a varied and nutritious diet is always provided. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are handled well and taken seriously ensuring people feel listened to. Evidence: Mariners Court care home has the corporate complaint policy and procedures in place, which includes details that any complaint would be responded to within a maximum of 28 days. From information contained in the Annual Quality Assurance Assessment (AQAA) completed prior to the site visit taking place, no complaints have been received by the home in the last twelve months. We were told that a record of any complaint is kept that includes details of any action and investigation undertaken. The complaint procedure is incorporated in the homes Statement of Purpose and Service User Guide a copy of which is given to each newly admitted resident. A resident and relative spoken with individually, both said that they were aware of the complaint procedure and knew who to speak with if they did have a concern or complaint. The resident spoken with said he, Had no complaints. Recently however there has been a safeguarding issue raised. This is currently under investigation. The company are fully cooperating in this matter. Mariners Court care home continues to have a variety of policies and procedures in place for the protection of residents. This includes the corporate adult protection policy and a whistle blowing policy to help protect people living at the home from abuse or discrimination. The majority of staff have received training regarding protection and Care Homes for Older People Page 20 of 33 Evidence: abuse, it is understood that arrangements are to be made to ensure that the remaining staff will receive this important training as soon as possible. From information gained from the current staff training matrix provided by the company, it appears that safeguarding adults training is only provided once. Consideration could be given to ensuring that staff are provided with regular safeguarding adults refresher training so as to reinforce this important training and to remind staff of the importance of protecting residents and the responsibility of the staff group in this matter. Care staff also receive guidance in respect of adult protection as part of their National Vocational Qualification (NVQ) training. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are provided with a clean, comfortable and pleasant internal and external environment. Evidence: Mariners Court is situated on the Promenade with extensive views across the Irish Sea from the front of the building. Communal accommodation, that is bright and airy, consists of three lounges, a dining room and a conservatory where residents are allowed to smoke. This gives people a choice of where they want to spend their time and allow for more privacy when entertaining visitors. A lift is installed to make access to the upper floors easier for staff and residents. Since the last key inspection, a refurbishment programme has been ongoing to update the internal and external environment, to provide a comfortable, safe and pleasant place for residents to live. There is a designated hairdressing salon on the ground floor that is well used. The company has recently installed reminiscence style art work to some walls around the home to encourage stimulation and interaction with residents. The majority of bedrooms have been refurbished to good effect. Residents and their familys were given opportunity to be involved in choosing their own colour scheme and from observation, it was clear that residents are encouraged to take into the home any important items such as pictures, photographs, ornaments or pieces of furniture. The resident spoken with was very pleased with the environment in which Care Homes for Older People Page 22 of 33 Evidence: they lived. A relative spoken with described her husbands bedroom as, Very comfortable and explained that although they were told that her husband could have taken important things into the home, he decided not to bother. A schedule is in place to ensure that the remaining bedroom accommodation is brought up to the same good standard as the refurbishment programme continues. A number of bedrooms are provided with an e-suite facility and a wet room has been provided to replace an existing bathroom. There are separate male and female toilets located on the ground floor of the building and sufficient bathroom and toilet facilities are provided on the upper floors. We were told that the existing ground floor male toilet facility is to be refurbished and replaced. There are a number of aids and equipment provided within the home to ensure the safety and comfort of residents. The garden areas are private and secure and well designed to suit the needs of residents accommodated. This outdoor space is provided with tables and seating so that residents can sit out in the summer months. A new kitchen has very recently been provided. Mariners Court care home was clean, hygienic and well maintained with a variety of policies and procedures to advise staff in the control of infection. Laundry facilities are in a designated area of the home and does not intrude on residents. The laundry is equipped for the needs of the home and a designated laundry assistant/domestic assistant has been appointed. We were told that as part of the on-going maintenance programme, the laundry area is to be refurbished later this year that will include the purchase of a new industrial washing machine. Information in the staff training matrix confirmed that the majority of staff have received infection control training. We were told that this important training is to be provided to all staff. This is essential to ensure that people working at the home are aware of good infection control measures in order to protect residents. Hand washing facilities and gels are available in the laundry area that are also sited throughout the home. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements, recruitment and training ensure that people are cared for and supported safely. Evidence: The resident spoken with and relatives that helped complete a Care Quality Commission (CQC) resident survey, all said that staff were either always available when they were needed or usually available when they were needed. At the time of the site visit there were five members of management and care staff on duty, the chef, a combined laundry and domestic assistant and there are normally two members of the domestic cleaning team on duty during the morning and early afternoon period. This means that care staff can focus on their support role. During the night time period there are three waking watch members of staff on duty. Although there have been some changes of late, we were informed that the staff group is generally stable with some of the care staff having worked at the home for a considerable period of time. This helps to provide a consistent service by a group of staff that know each residents individual wants, needs and requirements very well. Relatives and the resident spoken with all spoke very highly of the staff team. One relative wrote on a CQC survey that, All the team are so considerate and caring to all the residents, which gives us piece of mind. Another relative said, I cannot praise the girls enough, absolutely exceptional. A resident told us, Staff are very good, Care Homes for Older People Page 24 of 33 Evidence: exceptional, very helpful in every way. National Vocational Qualification (NVQ) training is encouraged with the majority of the care staff team having achieved Level 2 of this award. In addition, a small number of staff have completed the more advanced level 3 of this award. We were informed that a further number of staff are either waiting to commence or sign up for various levels of NVQ training. NVQ training is a nationally recognised qualification for care staff and shows that the majority of staff at the home have had their skills, knowledge and understanding assessed in order to provide a good standard of care. This means that residents can be confident that they are supported by a skilled staff team. The majority of staff have also undertaken a range of additional training including mandatory health and safety training however it was clear from the staff training matrix that some staff still required this training. We were also told that dementia awareness training and challenging behaviour training is also mandatory for staff supporting people with dementia. However it was clear that not all care staff had received this important training including the recently appointed the homes manager. A senior carer had also not received challenging behaviour training. Whilst it is understood that a training programme is in place, given that a high proportion of residents accommodated have cognitive impairment, it is essential that this training is provided soon as possible after commencement of employment. Newly appointed staff may not have worked extensively before with people that have a diagnoses of dementia and require the basic skills, knowledge and understanding in order to address these residents specific care needs. Since the last key inspection, a corporate staff training data base has been set up that identifies which staff have received what training. The data base will also prompt when each individual member of staff is due refresher training. This will help to ensure that all staff received all elements of mandatory training and regular updated refresher training so as to ensure that best practice is consistently maintained for the benefit of residents accommodated. Care should be taken to ensure that staff are provided with mandatory refresher training at the recommended intervals. From information provided in the Annual Quality Assurance Assessment (AQAA) that was completed by the Director of Nursing prior to the site visit taking place, it is understood that all newly appointed members of the care staff team and ancillary staff team are routinely provided with nationally recognised Skills for Care induction training. This makes sure that all newly appointed staff have the basic skills and understanding to ensure that they are competent in their basic role. Care Homes for Older People Page 25 of 33 Evidence: The recruitment records for three recently appointed member of care staff were viewed. Documentation includes an application form, health questionnaire, two references, a job interview assessment form and confirmation that a criminal records bureau disclosure had been obtained. This disclosure included a check against the nationally held list of people who have been deemed unsuitable to work with vulnerable people. These robust recruitment practises help to ensure that only suitable staff are employed at Mariners Court. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mariners Court is run in the best interests of the people who live there and their welfare is promoted and protected. Evidence: A new homes manager at Mariners Court has recently been appointed. It is understood that in due course, an application to register this person with the Care Quality Commission will be submitted. However in order for the manager to be registered with the Commission, this person will have to demonstrate that they have the qualifications, experience and personal qualities to run the care home in the best interest of the people that live there. A resident spoken with was very complementary about the new manager saying, **** is good, thoughtful and very nice, she asks us if we have enjoyed our food and had enough. There are clear lines of accountability within the home and external management. An external manager from the organisation visits the home on at least a monthly basis to audit records and to speak with residents and staff. This helps the external manager Care Homes for Older People Page 27 of 33 Evidence: to make a judgement as to whether the home is well managed and whether the care and support provided by staff at the home is meeting the needs of the people that live there. There are good corporate quality assurance and quality monitoring systems in place. Ways to gain information regarding quality assurance about the home and whether the support offered is meeting residents needs, is considered important. Various quality assurance systems are in place including, questionnaires for residents, their family and other stakeholders, planned resident and relative meetings that are held regularly, as are staff meetings. The customer satisfaction surveys are provided biannually. Outcomes are tabulated, the home informed of the outcome, and any action required has to be completed within a specified time scale. This information is also provided to residents and relatives by way of the notice board, resident and relative meetings and individual discussion. Relatives are also invited to various social functions at the home such as barbecues, afternoon tea, birthdays and other celebrations. This sort of activity also provides an informal platform for people to air their views as does, regular informal discussion with staff. A relative spoken to during the inspection visit stated that staff are approachable and will listen to any suggestions. Although very happy with care her husband receives, this person did say that staff had accepted and acted on some constructive criticism regarding one area of service provision, that she had made. The home has also successfully maintained the Investors in People award (an external quality assurance monitoring organisation) demonstrating that there is a commitment to have the quality of care provided, assessed both internally and externally. People living at Mariners Court are encouraged to remain financially independent. However in reality, because of cognitive impairment, most residents are assisted in this task by a relative or other advocate. For some people, their financial interests are protected within a legal framework. Advocacy information is available. However where the home do retain small amounts monies for some people, a robust system is in place to protect the interests of residents. This includes clear and accurate records of any financial transactions undertaken, secure facilities to hold monies and regular financial audits undertaken by company managers external to the home to ensure that agreed procedures are being followed. Training records show that most staff have completed essential health and safety training, including moving and handling, food hygiene, infection control, first aid and fire safety training. However all care staff should receive this important training as soon as possible after their appointment. This would help to protect residents, keep Care Homes for Older People Page 28 of 33 Evidence: them safe and ensure that staff have basic knowledge about these important issues. Records relating to health and safety were seen. Records showed that equipment such as manual handling equipment and fire equipment are regularly serviced and that electrical installation and electrical equipment are also checked. Detailed room, home and fire risk assessments are in place. There are also detailed policies and procedures in place to ensure that the health and safety of people living at the home are appropriately safeguarded. We were told in the AQAA that the home pro actively monitors its health and safety performance and consults with a contracted consultant who also independently audits the home on an annual basis and advises on any issues if they arise. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The planned introduction of informing prospective residents in writing of the outcome of their pre admission assessment, should commence as soon as possible. This would confirm to the prospective resident, that their current needs and requirements could be met at the home or alternatively not met. A rudimentary care plan should always be in place from the date of admission, that is based on the pre admission assessment information previously obtained. This initial care plan should then be updated and amended as required over the first few days and weeks as new information becomes available. This would ensure that all staff had the same written information to ensure that a consistent service was provided, based on assessed individual needs and requirements. It is recommended that individual protocols be developed for when required medication has been prescribed. This would help to ensure consistency of use. It is recommended that prescriptions are seen and agree with what was actually ordered prior to medication being dispensed. This would help to prevent waste. Page 31 of 33 2 7 3 9 4 9 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 5 6 7 12 18 30 Any specific religious or social care requirements of each resident should be included in their individual care plan. Consideration could be given to providing staff with regular safeguarding adults refresher training. All newly appointed management and care staff should be provided with dementia awareness training and challenging behaviour training as soon as possible after commencement of their employment. All management and care staff that have not done so should receive mandatory health and safety training that includes, manual handling, food hygiene, first aid, fire safety and infection control as soon as possible, so that residents are further protected. 8 38 Care Homes for Older People Page 32 of 33 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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