Care Home: Merevale House

What the care home does well Detailed assessments were carried out on all perspective residents and people are only admitted if the home is able to meet their needs. Peoples plans of care clearly identified their needs and give details of how to meet their needs. Peoples choice and capacity are also taken into consideration to ensure they have choices and make decisions regarding their care. We call this person centred care. The medicine management in the home was very good. The staff have worked had to achieve the high standard seen and this is commended. The home creates a friendly and welcoming atmosphere where people can personalise their rooms to reflect preferences and tastes. Health and safety is well managed to ensure people`s safety. Staff recruitment policies and practices are robust and help to minimise the risk of harm to people. People are supported by well trained staff who understand how to assist people to meet their needs. Staff treat people with respect and maintain their dignity. People who live at Merevale House told us: "The staff are fantastic and are my friends. Merevale House is my home. What more can I say." "There is nothing they could do better." Relatives told us: "The home provides the highest levels of person centred care you could possibly expect. It`s an example of how care for dementia sufferers should be delivered in all care homes." "Staff treat residents with the utmost respect. I would not want to put `X` in any other home." "They do everything well. The care is second to none. They care for residents and families feel welcome." Staff told us: "I feel that Merevale has a family atmosphere and has a `best friends` approach. I really enjoy working at Merevale House." "We have a big family atmosphere. We always work around person centred care and make people who live here feel loved and happy." What has improved since the last inspection? No requirements were made following the last inspection of the home. The manager told us in the AQAA how they have improved in the last twelve months. For example, the service is regognised nationally as a centre of excellence, accredited by the Alzheimer`s Society. They have appointed a `Dementia Champion` to ensure that during the care planning process people have equal opportunities for participation within the local community. What the care home could do better: High standards continue to be maintained and no requirements or recommendations have been made following this inspection. The manager told us that they constantly research and monitor their methodology, approach and practice as a means of improving the delivery of the care, so people at the home can live life to the full. Key inspection report Care homes for older people Name: Address: Merevale House Old Watling Street Atherstone Warwickshire CV9 2PA     The quality rating for this care home is:   three star excellent 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: Patricia Flanaghan     Date: 1 1 0 3 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 29 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 29 Information about the care home Name of care home: Address: Merevale House Old Watling Street Atherstone Warwickshire CV9 2PA 01827717866 01827717866 merevalehouse2@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Merevale House Residential Home Ltd Name of registered manager (if applicable) Mrs Anne Fretwell Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 31 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 16, Dementia - over 65 years of age (DE(E)) 15 Date of last inspection Brief description of the care home Merevale House is registered to provide a home for both younger adults and elderly people with dementia. The original part of the house provides accommodation for people over the age of 65 whilst the extension known as The Lodge provides accommodation for those who are under 65. Merevale House is a converted detached Victorian house with enclosed patio and Care Homes for Older People Page 4 of 29 Over 65 15 16 Brief description of the care home garden area to the front and landscaped gardens to the rear, which adjoin the towpath of the Coventry/Lichfield Canal. The part of the house known as The Lodge has been built onto the back of this house. There are four young people with early onset dementia in Fifth Lock Cottage, which is adjacent. However, since the purpose of the home is to meet the very individual needs of each service user, there is of necessity some fluidity about these arrangements The main house has two lounges. There are thirteen single bedrooms and one double bedroom and all have en-suite facilities, or, in some cases, share one en-suite toilet between two bedrooms. There is a Stannah chairlift for access to the first floor accommodation. The Lodge is a purpose built accommodation, situated at the back of the main house. This has twelve single bedrooms, all with en-suite facilities. There are two lounge/dining rooms and a small kitchenette, which is used for drink and snack making. Fifth Lock Cottage, which is in the grounds of Merevale House, provides four single rooms, each with ensuite facilities. Communal space also includes a small kitchen, lounge and bathroom. People should contact the manager for details of the current scale of fees for accommodation in the home. Care Homes for Older People Page 5 of 29 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: three star excellent 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 was a key inspection visit and was unannounced. This means that the home were not aware that we were going to visit. The visit took place on 11 March between 10:30am 5:00pm. The last key inspection visit to this service was on 12 April 2007. Before the inspection, we looked at all the information we have about this service, such as notifications of accidents, concerns, complaints or allegations and previous inspection reports. We do this to see how well the service has performed in the past and how it has improved. An Annual Quality Assurance Audit (AQAA) was completed by the manager and returned to us. This document gives information on how the home thinks it is performing, changes made during the last twelve months, how it can improve and statistical information about staffing and people who use the service. We used a range of methods to gather evidence about how well the service meets the needs of people who use it. We talked to people living in the house and observed their Care Homes for Older People Page 6 of 29 interaction with staff. We looked at the environment and facilities provided and checked records such as care plans, risk assessments, complaints records, staff training records and health and safety records. We sent surveys to ten people who use the service, their representatives and staff so they could let us know their opinion of the service. We received two completed surveys from people, six from relatives and nine from staff. Their comments are included in the report. We spoke with some of the people who live at Merevale House and they told us that they are happy living in the home. Two people using the service were identified for case tracking. This is a way of inspecting that helps us to look at services from the point of view of some of the people who use them. We look at peoples day to day life in the home to see whether the service meets their individual needs. Our assessment of the quality of the service is based on all this information plus our own observations during our visit. Throughout this report, the Care Quality Commission will be referred to as us or we. Care Homes for Older People Page 7 of 29 What the care home does well: Detailed assessments were carried out on all perspective residents and people are only admitted if the home is able to meet their needs. Peoples plans of care clearly identified their needs and give details of how to meet their needs. Peoples choice and capacity are also taken into consideration to ensure they have choices and make decisions regarding their care. We call this person centred care. The medicine management in the home was very good. The staff have worked had to achieve the high standard seen and this is commended. The home creates a friendly and welcoming atmosphere where people can personalise their rooms to reflect preferences and tastes. Health and safety is well managed to ensure peoples safety. Staff recruitment policies and practices are robust and help to minimise the risk of harm to people. People are supported by well trained staff who understand how to assist people to meet their needs. Staff treat people with respect and maintain their dignity. People who live at Merevale House told us: The staff are fantastic and are my friends. Merevale House is my home. What more can I say. There is nothing they could do better. Relatives told us: The home provides the highest levels of person centred care you could possibly expect. Its an example of how care for dementia sufferers should be delivered in all care homes. Staff treat residents with the utmost respect. I would not want to put X in any other home. They do everything well. The care is second to none. They care for residents and families feel welcome. Staff told us: I feel that Merevale has a family atmosphere and has a best friends approach. I really enjoy working at Merevale House. We have a big family atmosphere. We always work around person centred care and make people who live here feel loved and happy. Care Homes for Older People Page 8 of 29 What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are considering moving into the home benefit from having their care needs assessed before admission so that they can be sure the home can meet their needs. Evidence: As part of the pre-admission process the annual quality assurance assessment (AQAA) told us that a full, competent needs assessment is underaken prior to admission. The home has a a person centred philosophy which is based on peoples strengths, enabling people who move into the home to achieve positive outcomes. We looked at the records for two people who had come to live at the home since our last inspection visit. The records show that the home has a full admission process involving pre-admission assessments undertaken by the manager and senior staff to ensure that they can meet the persons needs. The assessments included input from the person themselves, their relatives and health professionals where appropriate. Care Homes for Older People Page 11 of 29 Evidence: They also included personal information completed by the person or their family about lifestyle choices and routines. This helps to ensure people settle quickly and well, and that the routines as far as possible will be familiar to them. The home has also reviewed their pre admission assessments to include sections that relate to The Mental Capacity Act and Deprivation of Liberty Safeguards. People have the opportunity to visit the home as often as they need in order to decide if they want to live there. A prospective resident may come for meals, have overnight stays and be introduced to other people who live at the home at a pace suitable to the individual. For example, at present a person is visiting the home once a week and joining in the daily routine. This gives them the opportunity to get to know the staff and other people living there and make an informed choice about whether they wish to live at Merevale House. Care Homes for Older People Page 12 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be confident their health and personal care needs will be met. Evidence: We were told in the AQAA that the home have strength based care plans which include needs and personal goals. They are reviewed every three months to take into consideration physical, psychological and emotional health needs. We looked at two care plans during our visit. Both care plans were written in an individual way detailing the persons needs and how they should be met by staff. Care plans reflected that thought had been given to personal preferences and likes and dislikes of an individual. This is good practice and helps demonstrate that people are involved in deciding how they wish to receive care. Care plans also contained a useful social history which provided staff with a short description of the persons life before coming to live at Merevale House. This helps the service respond appropriately to people with dementia and engage them in meaningful discussion or reminiscence. Care Homes for Older People Page 13 of 29 Evidence: Health care needs are monitored and documented in peoples care files. Nutritional assessments are completed on admission and reviewed monthly, people are weighed monthly as part of this review. Care plans are written for people who are nutritionally at risk and how this is to be managed. Specialist health care support is often sought and referrals are made to community dietitians and speech and language therapists. Care plans were seen to be reviewed regularly and incorporated updates to peoples changing needs. Family members are also involved in care reviews where possible. This allows the opportunity to discuss and evaluate care and any issues or concerns people might have. The home has good relationships with local General Practitioners (GP). All visits and the outcomes are recorded in peoples care files. Where possible people are taken to see the GP at the surgery, enabling them to get out and to maintain their independence. We saw evidence of regular medication reviews so that people could have the most appropriate medication for their health care needs. Specialist referrals and visits from other professionals including chiropodists, dentists and opticians were also seen. We spoke with staff who demonstrated good relationships with individuals and were knowledgeable about the care needs of those living in the home. Staff also told us in their surveys that they are given up to date information about the people they support and the way the home shares this information works well. The systems for managing peoples medication were seen. The home uses a monitored dosage system, which means that medication is supplied from the local pharmacist in a series of blister packs which are colour coded for different times of the day. This system helps to ensure that staff can easily check whether medication has been given, and reduces the risk of errors. Medication is only administered by senior staff who have received training. The local pharmacist also inspects the medication management in the home. The home has a good system to check the prescriptions prior to dispensing and to check the medicines and medication administration records (MAR) received into the home. All the quantities of the medicines were recorded together with any balances carried over from previous cycles. Each set of MAR charts for each person had a photograph to aid identification. Protocols had been written to enable staff to administer medicines prescribed on a when required basis (PRN) as the doctor intended, which is good practice. We checked Care Homes for Older People Page 14 of 29 Evidence: the medication records and medicines for the people we case tracked. Audits indicated that the medicines had been administered as prescribed and records reflected practice. It was evident throughout the inspection that people receive good care and staff were supportive and friendly towards them. The privacy and dignity of people at the home was seen to be respected throughout the inspection. People using the service were well presented and staff knocked on their doors before entering and all personal care was undertaken in private. We spoke to both of the people whose care plans we looked at. They both confirmed that their needs are met by a caring and kind staff group, who respect their privacy and dignity. Comments made include: We are looked after very well here. I have a very active life here. Im more than happy. Some of the comments received from relatives in their surveys include: Everyone is so well looked after. They look after X to a very high standard. The home provides the highest levels of person centred care you could possibly expect. Its an example of how care for dementia sufferers should be delivered in all care homes. Care Homes for Older People Page 15 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident their social needs are met and they are supported to maintain relationships with families and friends. Meals are well balanced and nutritious. Evidence: The AQAA told us that the home provide appropriate and meaningful opportunities to enhance peoples living experience, so it is fulfilling and valued. Tailor made experiences are offered to suit individual choice and life plan. People are empowered and their rights and equality are promoted. As we found at previous inspection visits people are supported to make choices and have control over their lives. People we spoke with told us that they were happy with the daily routine. They said that they were free to get up and go to bed whenever they chose. They also said they were satisfied with the range of social and leisure activities provided in the home. Throughout the inspection the people who live in the home were either engaged in activity or spending time chatting with staff. All of the residents spent some or all of the time engaged in a meaningful activity, these included looking at their life history books, reading newspapers, playing dominoes, singing and dancing, knitting, Care Homes for Older People Page 16 of 29 Evidence: embroidery, playing pool and hand massage. People are supported to access the local community and take part in activities which promote their independence, such as bedroom cleaning, peeling vegetables for meals, cooking and participating in individual hobbies. Hobbies pursued include going to night clubs, tea dances, fishing, gardening, and DIY. Some people have expressed a wish to have a camping holiday and the deputy manager is currently arranging this. Other outside visits have included picnics at a country park, trips to RAF base at Cosford and Coventry Motor Museum. A person told us that they will be shortly going to see a musical in London. There is evidence that people are able to maintain links with their families and friends. One person told us that their family would be coming to visit for a weekend. We saw from the files that this is a regular occurrence and the family stay at a nearby hotel. Other people visit their families in their homes and stay overnight, or longer. There are visits from members of the clergy to the home to enable people to practise their faith. Staff also support people to visit their chosen places of worship. The home uses pictorial prompts to assist the residents to make choices about what they would like to eat. For some people the ability to make a choice or communicate wishes is reliant upon the positive relationships that have been built between the staff and themselves, the observation skills of the staff and use of a variety of communication methods, including gestures and non-verbal cues. This was observed throughout the inspection. The manager told us that there are two sittings at the main lunch time meal. This enables staff to provide assistance to those people who need help with eating their meals ensuring that all people have a positive mealtime experience. We saw that one person has their food specially prepared in accordance with their religious beliefs. A person spoken with told us they enjoy meals, commenting, Its 100 times better than anything I could do. A relative commented in their survey, The food is very good, Xs waistline is evident of that. I am so pleased they are now eating healthy nutritious food. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that any complaints or allegations of suspected abuse are taken seriously and managed appropriately. Evidence: Discussion with people who use the service and staff showed us that there continues to be an open and positive approach regarding the service at Merevale House. The manager told us that she is committed to encourage an open culture within the home so that people feel comfortable and able to make a complaint or a suggestion without fear of reprisals People living in the home said they felt safe in their environment and with the people who were caring for them. People said that they are able to talk to the manager or any member of staff about things that concern them. Comments from people include: Theres nothing to grumble about. No, I have no complaints. Staff have received training in Safeguarding Adults, which should help to protect Care Homes for Older People Page 18 of 29 Evidence: people living at home from abuse or abusive practises. The management team had also in received training in the Mental Capacity Act and Deprivation of Liberty Safeguards and said care staff willl also receive this training. This new legislation helps to ensure that peoples rights are protected. Information recorded in the homes AQAA and details received through notifications show us that the manager has acted appropriately reporting suspicions of abuse through the adult protection process. Staff spoken to were aware of the action to take to report any suspicions of abuse. Care Homes for Older People Page 19 of 29 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 live in a well maintained home that is homely, clean and hygienic. Evidence: During the inspection visit we toured all areas of the home, looking at issues such as cleanliness, decor and suitability for the people who live there. All areas of the home seen on this visit were clean, warm and comfortable. Merevale House is well maintained, decorated and furbished to a high standard, providing a safe, homely, peaceful environment for people living there. The garden is secure and private, it is a area that has been designed to provide people with a very pleasant place to enjoy. There is an attractive courtyard providing plenty of sunny and shady areas for people to sit. The borders are well stocked, there is a water feature, various planters and trailing plants. Communal space in the main house includes two lounges. The smaller lounge is used as a quiet area. The second lounge is L shaped and divided to include lounge and dining areas. Bedrooms are located on the first and ground floor of the home. These are decorated and furnished to reflect the preferences and personalities of the residents to whom they belong. Each bedroom has a wash hand basin and en suite toilet. Specially adapted bathrooms and toilets are available on each floor. Care Homes for Older People Page 20 of 29 Evidence: There are twelve single bedrooms in The Lodge, eight of which are on the first floor. All have en suite facilities including a toilet and sink. In addition there is a shower room on the first floor and a large bathroom, with bath chair, and separate toilet on the ground floor. The Lodge also has a shaft lift. Communal areas include a large lounge/diner, which is also used for activities and a smaller television lounge. A small kitchen enables the residents to make drinks and snacks. Fifth Lock Cottage, which is in the grounds of Merevale House, provides four single rooms, each with en suite facilities. Communal space also includes a small kitchen, lounge and bathroom. People who use the service are encouraged to see the home as their own and are able to move around easily and freely and to go to their bedroom if they wish. A person commented on their survey Merevale House is my home, what more can I say. People spoken to on the visit said they liked their rooms, and many rooms showed evidence of peoples belongings and personal interests. Most people had chosen to spend time downstairs in the communal areas on the day of the inspection, and these were busy and active areas for people. There are established policies and procedures in place for the control of the risk of infection in the home and staff practices during the visit were seen to be safe. Infection control training is included in mandatory training for all staff. Laundry facilities are located in the grounds of the home and these meet the needs of the home. People who live at the home and relatives told us the home is always clean and welcoming. Comments included: They provide an environment that is non clinical and a home from home. The home is well maintained and always clean. There are no odours when you walk in. Care Homes for Older People Page 21 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff who are appropriately trained and recruited to meet peoples needs and keep them safe. Evidence: It was stated on the completed AQAA that peoples needs are met by sufficiently trained staff of various skill mix dictated by the residents requirements. Additional support staff are employed to ensure that care staff are designated for more specific care duties. We looked at the staffing arrangements at the home. This included the numbers of staff on duty, the arrangements for recruitment and selection of new staff, and the training and support provided to them in their role. It was confirmed by the manager that staffing levels are determined by the current needs of people living at the home. For example, when a person recently required palliative care, a member of staff was allocated to stay with the person at all times in their room, so they were never alone. We saw sufficient staff cover on the day of the inspection and staff spoken to on the day told us the staff ratio is good. Staffing rotas reflected the home is currently staffed to meet the needs of the people currently living at the home. We looked at the files of a member of staff employed since our last inspection to make sure that pre employment checks are undertaken so that staff are checked as being Care Homes for Older People Page 22 of 29 Evidence: suitable to work with vulnerable adults. The file was well organised and contained all the checks required under regulation. All people consulted as part of the inspection told us that the staff treat them well and that they are happy with the care and support they receive. We observed staff supporting people throughout the day. They did this with respect and were professional at all times. Staff told us that they are given regular updates about people living at the home during handover on each shift, and supported through updated care plans. The home has put considerable investment into training staff, particularly in understanding dementia. The staff spoken to on this visit had a clear understanding of the needs of people with dementia and of the homes philosophy of care. Staff are encouraged to undertake further ongoing personal development and training. For example, three members of staff have recently obtained the Registered Managers Award, which is a qualification usually only held by management. We looked at training completed by staff and saw the relevant training certificates on staff files. Training included dementia, moving and handling, protection of vulnerable adults, health and safety, and fire safety. Staff told us that they thought the training at the home is good. The manager stated in the completed AQAA that 97 of the care staff have obtained a nationally recognised care qualification (NVQ) at level 2 and above. This exceeds national minimum standards and ensures that staff have the skills and knowledge to care for people at the home. Staff told us in their surveys that they receive training relevant to their roles. Some of the comments include: We are offered great opportunities and training. I am happy with the training we are offered. Its not like coming to work, its like being part of a family. I enjoy my time at Merevale House. I enjoy coming to work and feel fulfilled in my job. I feel that Merevale has a family atmosphere and has a best friends approach. I really enjoy working at Merevale House. Care Homes for Older People Page 23 of 29 Evidence: People and their relatives told us they had good relationships with staff, both on the day of the visit and through their surveys. Comments include: The staff are fantastic and are my friends. Staff are caring and efficient. I cant say a bad word about them. In my opinion the staff are fantastic, they all speak to you and make you feel at home. Care Homes for Older People Page 24 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager ensures the home is run in a competent manner and in the best interests of people living there. Evidence: The registered manager is also the owner of the home. She is suitably qualified to manage the care home and has a wealth of experience of dementia care. The staff receive clear guidance on how to perform their role and there is a clear understanding from staff of what is expected of them. This ensures that people living at the home receive consistent care and support of a good standard. She completes training courses to keep her knowledge up to date. This should ensure that she has the knowledge to support staff and ensure the home is run in the best interests of the people who live there. Both the manager and deputy demonstrated good effective leadership and management skills that relate to the aims and purpose of the home. Care Homes for Older People Page 25 of 29 Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the manager was done to a high standard. A range of information was provided as supporting evidence to tell us about what improvements have been made, any changes and areas that require action to be taken. The home has a system for quality assurance, which has included questionnaires, internal and external audits and the production of a development plan. This helps to ensure that people have a say in the way the home is run and that it is working well to support people. The deputy manager meets with small groups of people on a monthly basis. Minutes are taken of these meetings and any action to be taken to address issues or suggestions raised is recorded. Regular audits are carried out in the home including health and safety care documentation, medication and other procedures in the home. We looked at the way the home manages small amounts of money left with them for safekeeping on behalf of people living there. We checked the individual balances against accounts and found them to be consistent. All purchases made on behalf of people living in the home are receipted and individual accounts kept. Staff receive regular supervision and appraisals. Supervision is a system combining personal development and practice management. It should help to ensure that people are being supported by staff who are working to their full potential and in a consistent fashion. All checks required such as of the fire safety systems, lifting equipment and electricity are in place. People are protected through regular maintenance of systems and equipment. Care Homes for Older People Page 26 of 29 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 27 of 29 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 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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