Care Home: Markfield Court Care Centre

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What the care home does well Markfield Court is well managed by an experienced and competent Registered Manager. We saw that there was a comprehensive assessment of peoples’ needs is carried out by either the Registered Manger or her deputy, who is a Registered Nurse. People who are considering moving into the home can be confident that their needs can be met. We found that everyone who lived in home had a care plan that detailed the care and support they needed, and the plans of care had been regularly reviewed. We found the home was clean and pleasant and in the process of being redecorated. It had a bright and friendly atmosphere and staff were observed to interact well with the people who lived there, and were helpful toward visitors. Staff were well trained to provide a good standard of care.Markfield Court Care CentreDS0000001917.V377391.R01.S.docVersion 5.2 What has improved since the last inspection? This was a positive inspection and there were significant improvements to care delivery to the credit of the Registered Manager and her staff. The Requirements & Recommendations following the last inspection had been addressed. Care plans provided good information regarding peoples’ health and personal care needs, and appropriate risk assessments were in place. The home was being redecorated and refurbished. The reception area had been redecorated and refurbished; all three corridors had been redecorated and had had new carpets. The carpets had been replaced on the ground and top floor lounges. The kitchen and staff area had been redecorated. A new fire system had been installed and additional profiling beds, airwave mattresses, wheel on weighing scales, a hoist and chair scales purchased. What the care home could do better: Diabetic care plans should contain information for care staff in the recognition to a diabetic hypo and hyper glycaemia attack so that these could be readily identified and responded to in an emergency. People’s social care needs should be recorded in more detail to ensure that a personalised plan of care will support their individual social, cultural, religious and recreational interests. Access to the rear garden through the patio door should be risk assessed and/or have permanent ramp to prevent it being a trip hazard for people accessing the garden. The garden at the rear, bordered by a field enclosed with a barbed wire fence could be a potential hazard for people walking close to it. This should be risk assessed and/or a have a safer fence installed to ensure that people who may trip or fall close to it are protected from the barbed wire. Key inspection report CARE HOMES FOR OLDER PEOPLE Markfield Court Care Centre Ratby Lane Markfield Leicestershire LE67 9RN Lead Inspector Mrs Carole Burgess & Mrs Gillian Adkin Key Unannounced Inspection 1st September 2009 09:20 DS0000001917.V377391.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Markfield Court Care Centre Address Ratby Lane Markfield Leicestershire LE67 9RN Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01530 242595 01530 244287 markfield.court@ashbourne.co.uk www.schealthcare.co.uk/home Ashbourne Life Ltd Sarah Stephens Care Home 85 Category(ies) of Old age, not falling within any other category registration, with number (85), Physical disability over 65 years of age of places (85) Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Markfield Court Care Centre is registered to provide personal care to male and female service users who fall within the following categories:Old age, not falling within any other category (OP) 85 Physical Disability - over the age of 65 years (PD(E)) 85 The maximum number of persons to be accommodated at Markfield Court is 85. 18th September 2008 2. Date of last inspection Brief Description of the Service: Ashbourne Life Ltd is the registered providers of Markfield Court and part of the Southern Cross Healthcare group, a large national care home provider. Markfield Court provides both residential and nursing care. It is a traditional building set in large, attractive woodland, and was formerly the nurses’ accommodation for the old Markfield hospital. It is located close to Junction 22 of the M1 on the outskirts of Ratby and Markfield, and is close to the town of Coalville. It is easily accessed by public transport from the City of Leicester. Accommodation is located on three floors, which can be accessed by two lifts. There are forty-five single bedrooms and twenty double bedrooms many are en-suite. There are lounges and dining rooms on each floor. Additional toilets and specialised bathing facilities are available throughout the three floors of the home. The Statement of Purpose and Service Users’ Guide (these provide information on how the home is organised and what services they provide) are provided for people who live in the home and for people who may be interested in moving into the home. At the time of the inspection the Registered Manager told us that the weekly fees ranged between £388.00 and £650.00 per week dependent upon individual care needs. There are some additional costs for individual expenditure such as hairdressing, newspapers etc. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. ‘We’ as it appears throughout the Inspection Report refers to the ‘Care Quality Commission’ (CQC). Any references to the ‘Commission for Social Care Inspection (CSCI) should be taken as CQC, who now hold the legal responsibilities previously held by the CSCI, as of the 1st April 2009. The inspection process consisted of pre-planning the inspection, which included reviewing the Annual Quality Assurance Assessment (AQAA); which is selfassessment tool completed by a representative of the service, reviewing the previous Inspection Report, and any information we have received since that time. The unannounced site visit commenced on the 1st September 2009 and took place between 09:20 and 17:00. The focus of the inspection was based upon the outcomes for people who receive either residential or nursing care. The method of inspection was ‘case tracking’. Discussions were held with the people who live at the home, as well as people who were visiting on the day of the site visit. We also spoke with some or the staff, the Registered Manager and Operations Manager. Pre-Inspection Surveys: We received four responses from people who live in the home to our preinspection surveys. They said that what the home does well: ‘The home is friendly and welcoming. The Registered Nurses are excellent. All staff are very approachable and do their best to solve any problems’. ‘Gives one the feeling of being at home. I am only happy when I enter its doors. We are content with life at Markfield Court’. ‘The food is very good. I get extra if requested when hungry. The social activities are good’. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 6 They said that what the home could do better: ‘The staff could do with more understanding of individual capabilities’. ‘I would like a bath or showers more frequently’. ‘Helpful and friendly staff, most of the time’. ‘More outings for people able to travel’. ‘Speed up the refurb’. What the service does well: Markfield Court is well managed by an experienced and competent Registered Manager. We saw that there was a comprehensive assessment of peoples’ needs is carried out by either the Registered Manger or her deputy, who is a Registered Nurse. People who are considering moving into the home can be confident that their needs can be met. We found that everyone who lived in home had a care plan that detailed the care and support they needed, and the plans of care had been regularly reviewed. We found the home was clean and pleasant and in the process of being redecorated. It had a bright and friendly atmosphere and staff were observed to interact well with the people who lived there, and were helpful toward visitors. Staff were well trained to provide a good standard of care. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 7 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. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Markfield Court enables people who require care to make an informed decision as to whether the home is appropriate to their needs by providing information about its services and through its assessment process. EVIDENCE: We wanted to look at the information provided to people who lived at Markfield Court to find out whether it was detailed and answered all of their questions. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 10 The home had produced two documents which provide the relevant information - the Statement of Purpose and Service Users’ Guide - both documents provide information about the services provided, staffing arrangements, the home’s philosophy of care, and how it supports people who lived in there. We found that a copy of the Service Users’ Guide was provided in peoples bedrooms. There was also a generic, company Statement of Purpose on audio cassette if this was required. We sent pre-inspection surveys to some of the people who lived at the home. The surveys told us that people had received enough information about the home before moving there. We wanted to find out how the Registered Manager of the home can be confident that the service it provides can meet the needs of people, especially those with nursing care needs, before they move into the home. The Registered Manager said that everyone has their needs assessed by her and/or the deputy manager who was a Registered Nurse. People whose care was funded through health or social services had an additional assessment carried out by the authority funding that persons care. We looked at the records of six people living at the home, which included people who were receiving both residential and nursing care. We found that assessments were comprehensive, and provided a good level of information to determine whether the needs of the person could be met, these assessments were used to develop a provisional care plan, which was in place when the person moved into the home. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are clear and detailed and insure that the health and personal care that people receive is based on their individual needs, and is regularly reviewed. EVIDENCE: We wanted to find out how the health and personal care needs of people living at Markfield Court were met. We spoke with people living in the home along with a visiting relative and a GP, and observed the care and support provided by staff; we also looked at the care plans and records of six people, three who were residential and three who required nursing care. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 12 We found care plans to be detailed regarding peoples’ health and personal care needs; however, the views of the individual could be expanded upon to include a person’s wishes as to how they would prefer to spend their day, for example what time they wished to get up and go to bed, where they would like to eat their meals and how frequently they wished to bathe. The Registered Manager and Operations Manager told us that the organisation, to which Markfield Court is part of, is reviewing the format of documentation, including care plans, which would enable peoples’ preferences to be recorded in greater detail and would support a Person Centred Care approach to care. Care plans were in place for each identified healthcare need, and had been regularly reviewed and updated as required. We found that risk assessments were undertaken that included nutritional needs, pressure ulcer assessments and prevention (no one in the home had a pressure ulcer), falls risk assessments and moving and handling risk assessments. Where assessments identified a risk, a care plan had been developed that provided comprehensive information to ensure that peoples’ care needs were identified and met. One person who was residential was identified as diabetic and had a plan of care to manage their diabetes which included information for care staff how to manage a low blood sugar reading. We recommend that the care plan should also contain information for care staff in the recognition to a diabetic hypo and hyper glycaemia attack so that these could be readily identified and responded to in an emergency. The AQAA identified that in addition to a hoist and new chair scales additional profiling beds, airwave mattresses and wheel on weighing scales had been recently purchased. Staff had stated that one of the hoists (a new hoist) had been broken for sometime. The Registered Manager confirmed that this was so but that they were waiting for a new part. There were sufficient hoists for the home and at the last staff meeting the Registered Manager had spoken to staff regarding the need to more careful with the equipment. We spoke with a person who required nursing care, and his visitor. They said that they were very happy with the home, that staff supported people in making choices and that the he could choose when he bathed and what he wanted at meal times. A lady, who also lived in the home, told us that she felt well cared for, and that most staff were kind and supportive. She did tell us that, although one male carer was very kind and gentle, another was ‘a bit rough’. This was discussed with the Registered Manager who will follow this up and speak with the carer concerned. We spoke with a visiting GP who cares for all the people living at Markfield Court. She said that people were well cared for and that care had improved over the last two years. She said that medical concerns were referred to her Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 13 appropriately and staff followed up any treatments she prescribed. She had no concerns about the care provided by the staff. We sent surveys to people who lived in the home and asked them about the care they received; they indicated that they received the care and support they needed. One lady wrote that her husband had been told he had but a short time to live but due to ‘loving care and attention’ by the staff there were ‘wonderful results’ and they were able to spend there days together. Observation during the inspection showed that staff had a good awareness of how to protect peoples privacy and dignity. Staff spoke to people living at the home and to visitors in a respectful, friendly, quiet and helpful way. We observed that people who remained in bed due their health care needs, had the call bell placed next to them so that they could call for assistance if required. Medication management was inspected and found to be satisfactory. For those people who received residential care, their medication was administered by a senior member of care staff, who had received training, whilst people who received nursing care, had their medication administered by a Nurse. We observed a senior carer administering medication; they followed good practice guidance, and wore a tabard asking people not to disturb them whilst administering medication. We looked at the medication and medication records of some people who received nursing care and found them to be in good order. One person receiving Percutanious Endoscopic Gastostomy (PEG) feeds (a tube that feeds a person directly into their stomach) did not have this indicated on their Medication Administration Record (MAR) as the route for giving medicines. We advised that this should be indicated on the MAR to ensure that medicines were administered by this route, not orally. This would ensure that all people received their medication safely as prescribed. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Opportunities are available for people to engage in activities and take part in recreational events as a group. Markfield Court provides a varied diet that meets the individual and specialist needs of people who live there. EVIDENCE: We wanted to find out how people spend their day, and how the staff working at the home support people to make decisions and stay in contact with relatives and friends, we did this by observing people throughout the day, talking with people at the home, and by looking at the care plans and records of six people who live in the home. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 15 There were two activities co-ordinators who organises a range of activities throughout the week. People were also able to join in with activities and use the bar in the building attached to Markfield Court used by people who live in Markfied Court Retirement Village. The Annual Quality Assurance Assessment (AQAA) submitted by the Registered Manager identified that a wide range of activities and outings that were provided and said that special dates and celebrations were acknowledged. The AQAA stated that there was a ‘Full and varied activities programme, trips out including “Mystery Tours”, Historic Points of Interest, Boat Trips, Train Rides, Museum Trips, as we have our own minibus. Regular Outside Entertainment, Bar Morning and Carpet Bowls as have social centre adjoining the home. Sponsorship of local Bowls Club and Southern Cross Trophy, Twice monthly church services, Animal Therapy, Shopping Trips, Flower Festival, Celebration and recognition of Annual Dates i.e. Easter, Chinese New Year, Homes Birthday, Wedding Anniversaries, Resident Birthday’s. Resident Meetings, Positive Marketing of events in Local Press and Company Magazine, Care Planning including a Social Profile’. We saw the weekly plan of activities and observed people taking part in organised activities throughout the day of the visit although people could choose to spend quite time in their rooms if this was preferred. We were told by a person living in the home that that there was a Church of England service held in the home every few weeks that was quite well attended and that their religious needs were well supported by staff. We found social care plans, in most cases, were brief and provided little insight into people as individuals, by providing information about family, friends, past lives, work, hobbies, likes and dislikes etc. However, this will be addressed by the introduction of person centred care plans and the use of ‘Choice’ pictorial cards - both to be introduced soon - to enable nurses and carers to provide a more individualised approach and support peoples’ expectations and preferences. We spoke with people who lived in the home and a visitor and asked them about the meals provided. Two people said that the meals were very nice and that there was always a choice. One person said that quantity and choice was not a problem but quality could be variable. Four people responded to the preinspection questionnaires. Two people were very satisfied with the food and two people said that they were usually satisfied with the food. One lady spoken with said that she preferred to take her meals in her room and this was usually well supported by care staff but she had recently been ‘positively’ encouraged to take meals with other people which she was not happy about and had declined. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 16 The kitchen had details of people’s specific needs such as soft or diabetic diets to ensure that these were catered for. Those people who required assistance were given this in a discreet and unhurried manner. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Markfield Court are able to express their concerns, and have access to a complaints procedure and advocacy services, and are protected from abuse by a knowledgeable staff team. EVIDENCE: We wanted to find out how the staff at Markfield Court promoted the safety and welfare of people living at the home. The home had a complaints policy and procedure which was incorporated into the Statement of Purpose and Service Users’ Guide, a copy of the Service Users’ Guide, which included the complaints policy, was provided for people in their bedroom. We had not received any complaints from the general public about the home but the local authority were aware of a concern raised by a relative which they had returned to the provider to investigate under their complaints procedure. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 18 The complaint had been investigated thoroughly in a professional manner and found to be unsubstantiated. People spoken with, and those people who responded to the pre-inspection surveys, said that they knew how to complain if they needed to and who to speak with if they had any concerns. The home had a copy of the local multi-agency policies & procedures on the protection of vulnerable adults. Most of the staff had had ‘Safeguarding Vulnerable Adults’ training within the last twelve months line with local authority guidelines to ensure that they know how to protect people who live in the home. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Markfield Court provides a comfortable and homely environment, which is well maintained. EVIDENCE: The home is large and accommodation was on three floors; the ground floor and first floor were mainly for people requiring nursing care, and the third floor for more able people requiring residential care. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 20 The service providers, Ashboure Life Limited, had redecorated and refurbished some areas of the home and had an ongoing programme of refurbishment. The AQAA stated (and the inspection confirmed) that the reception area had been fully redecorated with a new carpet and furniture and all three corridors redecorated and carpeted. The carpets had been replaced on the ground floor and top floor lounges; kitchen and staff area redecorated and a new fire system installed for whole home. People who lived at Markfield Court, their relatives and staff were involved in choosing wallpapers etc to ensure that their views were taken into account during the ongoing refurbishment programme. The areas of the home that were seen were decorated & furnished to a satisfactory standard and were clean & tidy. Internal doors to stairways had been fitted with key codes to ensure peoples’ safety. The Registered Manager said people who lived in the home could have the key code if they wished but most people preferred to use on of two passenger lifts to move about the home. The home had adaptations such as grab rails, and sufficient additional toilets and adapted bathing facilities. The access to the rear garden through the patio door does not have a permanent ramp and could be a trip hazard for people accessing the garden. Also, the garden at the rear is bordered by a field enclosed with a barbed wire fence that could be a potential hazard for people walking close to it. We recommend that both should be risk assessed and/or a permanent ramp put in place by the patio door, and a safer fence installed to ensure that people who may trip or fall are protected. Some of the staff told us that there were insufficient gloves for them to use when undertaking certain care tasks. Others said that there were sufficient gloves but some care staff tended to wear gloves when it was unnecessary and that, on occasions they had been ‘hidden’ by staff. We discussed the provision of gloves with the Registered Manager and Operations Manger as this is an infection control issue. This was being addressed by the Registered Manager who stated that there were always gloves available for staff, and that they had been no outbreaks of infection during the last two years since she had become the Registered Manager for the service. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are well trained and sufficient in number to meet the needs of the people who currently live at Markfield Court. EVIDENCE: We wanted to find out whether there were sufficient staff on duty to meet the care needs of the fifty-six people, many of whom required nursing care, living at Markfield Court on the day of the inspection visit. There were two Registered Nurses on duty throughout the day, and one or two Registered Nurses at night depending on nursing requirements. The nurses staff the ground and first floors, supported by care staff, where most of the people who required nursing care reside. Three carers look after people who were residential on the third floor. At night there were one or two nurses and six carers throughout the building. The Registered Manager worked in a supervisory capacity and there were additional administrative, domestic, Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 22 maintenance and kitchen staff which ensured that nurses and care staff were free to provide care for the people who lived in the home. We checked the home’s recruitment policy and procedure. There was a robust staff recruitment and selection process. We looked at six staff files. They were neat and well maintained and contained all of the necessary pre-employment checks, along with confirmation of the persons identity, and included a recorded interview, two written references and a Criminal Record Bureau (CRB) disclosure, obtained prior to staff commencing work at the home, to ensure that staff were ‘fit’ to work with vulnerable people. One nurse’s file did not contain her current Personal Identity Number (PIN) to show that she was registered with the Nursing & Midwifery Council (NMC) as a nurse, but there were computerised checks to provide proof of nurse’s ‘fitness to practice’ and ensured the safety of the people who lived in the home. The Registered Manager had a training matrix which identified training that had been provided, and shortfalls in training which needed addressing. Staffs underwent a recorded induction and were provided with annual mandatory training in key areas such as Fire Safety, Food Hygiene, Moving & Handling, Health & Safety and Safeguarding Vulnerable Adults. Information supplied by the Registered Manager during our visit told us that about 60 of care staff has attained a National Vocational Qualification (NVQ) in Care. This and the mandatory training ensured that staff were able to provide safe care for the people who lived at Markfield Court. We sent pre-inspection surveys to people who lived at the home and asked them whether staff were available when they needed them, a majority of people indicated that staff were usually available and that they did not have to wait long for attention. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Manager provides a good standard of leadership for staff and encourages and includes people who live in the home, and their relatives, to share their views to ensure that the home is run in the best interests of people who receive the care. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Registered Manager had worked in care since 1996, had the Registered Managers Award (RMA), and had worked at the home for over two years. The Registered Manager had a clear understanding of the home, and had worked hard to improve the service. Throughout the day we saw people who lived at the home, staff and visiting professionals speak with the Registered Manager along with other members of the team, including nursing staff; all were able to deal with queries well, including the questions we raised. We spoke with visitors, including a GP, about the effectiveness of communication between staff and relatives; we found that there were opportunities for staff, people who lived in the home, and their relatives to discuss issues both informally and during regular minuted meetings. A small number of staff said that they felt that the Registered Manager did not always listen to their concerns but were not specific about what these issues were. Staff received regular, recorded supervision (a formal discussion about their personal and training needs) where they had an opportunity to raise issues of concern. However, most staff said that they could speak to the Registered Manager, or her deputy, and that they would be listened to. We checked the management of people’s money to ensure that their financial interests were safeguarded. Written records were maintained. Those we checked were signed by two people and were in good order. Quality Assurance Questionnaires had been provided for people who lived at the home throughout the year to establish their views about the care and the service they received. These were sent to for collation and returned to the Registered Manager to action. Information provided by the Registered Manager in the AQAA prior to our visit detailed the regular maintenance of equipment and systems in the home, including health and electrical systems along with fire fighting equipment and systems. We looked at training records and found that staff had received training linked with health and safety; training included fire safety, food hygiene, COSHH and Health and Safety to ensure that the staff and people who lived in the home worked and lived in a safe environment. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations We recommend that diabetic care plans should also contain information for care staff in the recognition of a diabetic hypo and hyper glycaemia attack so that these could be readily identified and responded to in an emergency. We recommend that people’s social care needs should be recorded in more detail to ensure that a personalised plan of care will support their individual social, cultural, religious and recreational interests. We recommend that the access to the rear garden through the patio door should be risk assessed and/or have permanent ramp to prevent it being a trip hazard for people accessing the garden. We also recommend that the garden at the rear, bordered by a field enclosed with a barbed wire fence that could be DS0000001917.V377391.R01.S.doc Version 5.2 Page 27 2. OP12 3. OP19 4. OP19 Markfield Court Care Centre a potential hazard for people walking close to it, should be risk assessed and/or have a safer fence installed to ensure that people who may trip or fall close to it are protected from the barbed wire. Markfield Court Care Centre DS0000001917.V377391.R01.S.doc Version 5.2 Page 28 Care Quality Commission East Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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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