Care Home: Merrie Loots Farm Residential Home

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What the care home does well Prospective people wishing to live at Merrie Loots, are assessed prior to admission so that they are able to meet the individual`s needs. Staff working at the home, have a good rapport with individual people and demonstrated a good knowledge and understanding of peoples care needs. Visitors to the home are made to feel welcome and staff morale at the home is good. Many members of staff have been employed at Merrie Loots for some considerable time, providing stability and continuity of care to the people who live there. People who live at the home and their representatives can raise concerns about the service freely and any complaints received are listened to, taken seriously and acted upon in a timely manner. The quality of meals provided at the home for residents is good and people`s comments in relation to meals provided were positive and are recorded within the main text of the report. People who live at the home are enabled to participate in a range of activities, which meet their social care needs. Staffing levels remain appropriate for the numbers and needs of people who currently live at the home. Recruitment procedures within the home are robust so as to protect people who live at Merrie Loots. There is a quality assurance system in place so as to seek the views of residents and their representatives, staff and other stakeholders about the services and facilities provided at the home. Where comments have been made these have been incorporated into the main body of the report. What has improved since the last inspection? Improvements are continually being made to redecorate and refurbish the care home environment, so as to provide a nice, warm and inviting ambience within the home for people who live there. The quality of daily care records written by staff have now improved so as to evidence care and staff interventions provided. Additionally there is better evidence recorded depicting how people spend their day. Some aspects relating to medication practices and procedures have now improved. These relate specifically to the medication trolley not being left unattended with medication easily accessible to others and there being a sufficient supply of medication available. What the care home could do better: A better system needs to be implemented to ensure that all staff working within the care home receive regular formal supervision, as currently this is not undertaken as frequently as it should.Practices and procedures for the safe handling, administration and recording of medicines must be improved to ensure that people at the home are protected, as detailed within the main text of the report. As stated previously, the care planning system within the home would benefit from further detail and from ensuring there are support plans and risk assessments in place for all of the identified needs of the person concerned. Specific examples are detailed within the main text of the report. Key inspection report Care homes for older people Name: Address: Merrie Loots Farm Residential Home East Tilbury Road Linford Stanford-le-hope Essex SS17 0QS     The quality rating for this care home is:   one star adequate 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: Michelle Love     Date: 1 9 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Merrie Loots Farm Residential Home East Tilbury Road Linford Stanford-le-hope Essex SS17 0QS 01375673178 07939456162 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Chigwell Homes Limited care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 28 The registered person may provide the following categories of service only: Care Home only - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Merrie Loots Farm Rest Home is registered to provide care and accommodation for up to twenty eight older people, who may or may not have a diagnosis of dementia. The building was orginally an old farmhouse and retains much of its old charm and character. There are single and double bedrooms (none have en-suite facilities) and the home offers a choice of lounge and dining areas as well as a conservatory area. All areas of the home can be accessed via a passenger lift. Care Homes for Older People Page 4 of 30 3 1 1 2 2 0 0 8 28 0 Over 65 0 28 Brief description of the care home The home is set in its own farmland and has beautiful gardens that overlook the fields and stables. There is a large car parking area with open gates leading to a busy road; a fence has been fitted around the garden area to ensure residents safety. There is a small parade of shops almost opposite the home and it is half a mile from the main line station (Fenchurch Street Line). Care Homes for Older People Page 5 of 30 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: one star adequate 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 an unannounced key inspection. The visit took place over one day by one inspector and lasted a total of 9 hours, with all key standards inspected. Additionally progress against previous requirements and recommendations from the last key inspection were also inspected. Prior to this inspection, the registered manager had submitted an Annual Quality Assurance Assessment (AQAA). This is a self assessment document, required by law, detailing what the home does well, what could be done better and what needs improving. Information given in this document has been incorporated into this report. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. Additionally a partial tour of the premises was undertaken, residents and members of staff were spoken with and their comments are used throughout the main text of the report. Prior to the site visit, surveys for Care Homes for Older People Page 6 of 30 people who live at the home, staff and healthcare professionals were requested to be sent to the home. From discussions with the manager at the time of the site visit, we were advised that they had not been received. The registered manager and other members of the staff team assisted the inspector on the day of the site visit. Feedback on the inspection findings were given on two separate occasions during the day. On one occasion feedback was given to the registered provider and registered manager and later in the day the rest of the inspection findings were discussed solely with the registered manager. The opportunity for discussion and/or clarification was given. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: A better system needs to be implemented to ensure that all staff working within the care home receive regular formal supervision, as currently this is not undertaken as frequently as it should. Care Homes for Older People Page 8 of 30 Practices and procedures for the safe handling, administration and recording of medicines must be improved to ensure that people at the home are protected, as detailed within the main text of the report. As stated previously, the care planning system within the home would benefit from further detail and from ensuring there are support plans and risk assessments in place for all of the identified needs of the person concerned. Specific examples are detailed within the main text of the report. 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 30 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 30 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. The care needs of people are assessed before they are offered a placement. Evidence: There is a formal pre admission assessment format and procedure in place, so as to ensure that the staff and management team are able to meet the prospective persons needs. Admissions are not made to the home until a full needs assessment has been undertaken. In addition where appropriate, supplementary information is provided by the persons Placing Authority or Primary Care Trust. On inspection of the care files for the three newest people admitted to Merrie Loots Farm, records showed that a pre admission assessment had been completed for each person by the registered manager and prior to their admission to the home. There was evidence to show that the information recorded was informative and detailed. The AQAA details that prospective people are provided with a Statement of Purpose and Service Users Guide which details the services and facilities provided at the home. Care Homes for Older People Page 11 of 30 Evidence: Additionally people and/or their representative are offered the opportunity to visit the home, to see the facilities and to meet with care staff and existing residents. Records showed that following the pre admission assessment, the manager had written to each person confirming that the home could meet their needs. One person spoken with confirmed that the admission process for them had been smooth and both staff and other people who live at the home had made them feel welcome. The home does not provide intermediate care. Care Homes for Older People Page 12 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shortfalls in care planning, risk assessing and some medication practices and procedures means that people cannot be assured that their needs will always be met or that their health and wellbeing will be maintained. Evidence: There remains a formal care planning system in place to help staff identify the care needs of individual people and to specify how these are to be met by staff who work in the home. In addition to the care plan, formal assessments are completed in relation to manual handling, nutrition and pressure area care. Of those people case tracked, each person was observed to have a plan of care. Records showed that since the last key inspection to the service, changes have been made to the care plan format to make them more detailed, comprehensive and person centred. The registered provider advised us that a new computerised care planning system is to be introduced in due course in 2010 following staff training. The registered provider advised that other homes within the organisation are piloting the new system and the results so far have shown to be very favourable. Care Homes for Older People Page 13 of 30 Evidence: While we acknowledge some improvements in the general recording of peoples care needs, further development is required so as to ensure that the specific care needs of individual people are clearly documented, including peoples strengths, abilities and weaknesses. As part of the inspection process we looked at 5 peoples care files (3 in full and 2 in relation to specific healthcare needs). One care file examined showed that some aspects of their care plan were person centred and detailed. For example their care plan relating to their night care programme clearly recorded their personal preferences, likes and dislikes, preferred routine and there was evidence to show that some of the information had been provided in conjunction with the persons family. A lot of emphasis was placed on ensuring the persons self image was maintained and promoted as this was determined to be very important to them. It was evident from discussions with some members of the staff team that they were aware of the importance of this and throughout the day positive reinforcement was given to the resident by ways of complimenting them on their physical appearance. Records showed that one person recently admitted to the home had a plan of care, however this contained limited information relating to their specific care needs, making reference to only three specific areas; personal care, mobility and meals and nutrition. The care plan format was seen to be comprehensive covering 14 separate areas however it was unclear as to why the care plan was incomplete. Both the pre admission assessment and commissioning plan made reference to the person having other care needs relating to their dementia, being anxious and requiring reassurance from staff, wandering and requiring observation from staff as they were at risk of falls. With regards to the latter daily care records recorded on more than one occasion that the person had been found wandering in the corridors and by the fire escape and fire exits. No manual handling assessment had been completed at the time of the site visit. No other elements of the care plan were completed in relation to their night care programme and lifestyle and social care needs. The pre admission assessment and commissioning plan for this person made reference to them being underweight and requiring a high calorie diet. Although there was brief reference relating to their dietary needs, the latter was not detailed within the care plan and no risk assessment was completed. On inspection of daily care records, these showed that since the persons admission there had been occasions whereby they had refused some meals and/or eaten little. There is a comprehensive personal risk screening tool format in place covering 17 areas however none of these areas had been completed. We discussed our findings with the manager and they confirmed that in hindsight the care plan should have been completed more fully. Care Homes for Older People Page 14 of 30 Evidence: The care plan for one person made reference to them displaying agitation and/or hostility towards others on occasions. A risk assessment was in place for this, however there was little information recorded detailing how this was to be proactively managed or to provide clear strategies for staff if their behaviours should escalate. On inspection of daily care records since their admission, records showed that distractions and deterrents deployed by staff were not always successful and the person could display inappropriate behaviours towards both staff and other people they lived with. Although there was a clear audit trail detailing incidents, records did not always include staffs interventions. Records continue to show that people have access to a range of healthcare professionals and services e.g. Chiropodist, GP, Dentist, Optician, District Nurse Services as and when required. The manager confirmed there is a good relationship with the local GP and a regular surgery is held at the home each week. Interaction between care staff and people who live in the home was observed throughout the day and seen to be provided in a respectful and dignified manner. It was evident that staff are knowledgeable about individual peoples care needs. The manager showed us a recent record of compliment from one persons placing authority following their emergency admission to the home. The record stated I would just like to inform you about the good co-operation and joint working we received from the staff at Merrie Loots Residential Care Home. The manager was very willing to assist in any way she could and the care staff went out of their way to ensure the service user was warmly welcomed and settled in the home. This co-operation went far to ensure a smooth transition from the hospital setting. Practices and procedures for the safe storage, handling and recording of medication were examined as part of this inspection. A list of staff who are deemed competent to administer medication is listed at the front of the Medication Administration Records (MAR) folder. For each person who has medication there is a resident assessment sheet which includes a photograph, the name of the person, date, name of assessor and a list of questions relating to the administration of medication and peoples understanding of the medication prescribed. A PRN protocol is also completed for those people who are prescribed as and when required medication. This includes information relating to the name of the medication, dose prescribed, rationale for taking the medication, start date/end date and any special instructions. Medication was observed to be stored securely, however the temperature of the storage facility where medication is stored was noted to not be recorded each day, however records showed these were within recommended guidelines. Where Care Homes for Older People Page 15 of 30 Evidence: medication requires cold storage, the temperature of the fridge was not recorded on some occasions and records showed there were instances when these were outside the recommended guidelines. This means that there is potential for medication to deteriorate and/or lose its effectiveness. On inspection of MAR records for a random sample of 12 people, records showed there was no record of some medicines having been given to the resident when they were due, as the entries on the MAR record had been left blank and not signed or initialed by staff for 7 out of 12 records examined. Records also showed there was a stock discrepancy for one person whereby the number of tablets received and administered did not tally with the number of tablets remaining in the packet. We discussed the latter with the manager however no rationale could be provided as to the reason for the discrepancy. As part of good practice procedures not all bottles and packets of medication were observed to be signed and dated when opened. The current and archived care file records for two people who regularly refuse medication were examined following inspection of their medication records. Neither person had a care plan or risk assessment relating to the refusal of medication to evidence how this was being proactively managed. Additionally one of the care files made reference to them suffering with diabetes, however no care plan or risk assessment was devised. This means that staff may only become aware of a problem with this persons blood sugar levels when they go into crisis or become unwell. On inspection of the staff training matrix, records showed that staff who administer medication last undertook training in August 2008. The manager advised that competency assessments for staff were last undertaken approximately 6 months ago. Care Homes for Older People Page 16 of 30 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 have their social and recreational needs met and receive a varied diet that meets their needs. Evidence: As stated at the previous inspection to the home, it remains the responsibility of all staff working within the home to promote and encourage people living at Merrie Loots to participate within a varied programme of social activities. A rolling weekly programme of activities planned is available within the two lounge areas and this is provided in both a written and pictorial format. The manager was advised that the activity planner should be enlarged so as to enable people with sensory impairment to make an informed choice. Activities available to people include bingo, manicures, massage, music, board games, hoopla, gentle exercise, ball games, reminiscence, dominoes, film afternoons, cake making, Pat Dog, sing-a-long and themed activities. On the day of the site visit some people were observed to play hoopla and ball games, while others read newspapers, books and/or magazines. During the afternoon the registered provider showed us photographs of recent activities undertaken by residents on his laptop. People spoken with confirmed that they have the option and opportunity to join in with activities. Care Homes for Older People Page 17 of 30 Evidence: Of those care files inspected, all but one were noted to have specific information recorded relating to specific social care needs, including past hobbies and pastimes. There remains an open visiting policy at the home whereby visitors can see their member of family and/or friend at any reasonable time. There was evidence to show that people living at the home are actively encouraged and supported to maintain friendships and relationships. Relatives spoken with confirmed that they can visit the home at any time and are always made to feel welcome when they visit. Relatives visiting the home were observed to have a good relationship with staff and members of the management team. People spoken with who live at the home confirmed they are enabled to maintain friendships with others and to see members of their family when they choose. One person said Oh they can come and go as they please, its very relaxed. There is a rolling 4 week menu which offers people a varied diet of good home cooking, however this is flexible and alternatives to the menu can be provided at short notice. A board displaying the menu of the day was readily available within the main dining area and there are pictorial cards available to enable people to make an informed choice. The lunchtime meal was observed within the main dining area. The tables were attractively laid with table mats, serviettes, condiments and a vase of flowers. Meals provided were seen to be plentiful and nicely presented. Where people require a pureed and/or soft diet, each food item was portioned separately to retain a nice appearance. Where people were assisted by staff to eat their meal, support was provided in a respectful and unhurried manner. People were given a choice of drinks throughout the day. We spoke with the homes cook and they continue to evidence a good understanding and knowledge of peoples dietary needs and personal preferences, likes and dislikes. People spoken with confirmed that they enjoyed the meals provided. Comments included oh that was lovely, I enjoyed that and the food is fine. Care Homes for Older People Page 18 of 30 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 expect that their concerns are dealt with proactively and that they will be listened to. Evidence: There is an appropriate complaints policy and procedure in place at Merrie Loots. Since the last key inspection to the home there has been one complaint which came directly to the Care Quality Commission. As we are not a complaints agency, this was referred back to the management team of the home to formally investigate using their complaints procedure. The complaint was investigated by the manager and we are satisfied that this was undertaken appropriaetly. People spoken with who live at the home confirmed that if they had an issue or a complaint, they would discuss this with a member of staff or the manager. Compliment records were also inspected and comments included To all staff at Merrie Loots we wanted to thank you all for the wonderful compassionate care given to our relative at all times but especially at the end. We can never thank you enough and To [name of staff member] who have looked after me so well over the last week. Thank you so much. No safeguarding issues have been highlighted over the past 12 months. Appropriate safeguarding policies and procedures are in place and staff spoken with were able to demonstrate an understanding and awreness of safeguarding procedures. On Care Homes for Older People Page 19 of 30 Evidence: inspection of the staff training matrix this showed that all but 5 people have received safeguarding training. Records showed that training is planned in due course for the 5 people who do not currently have this. The training matrix shows that currently only 6 people had received training to deal with challenging behaviour and this was in 2006. Care Homes for Older People Page 20 of 30 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 safe, comfortable, homely and well maintained environment which meets their needs. Evidence: A partial tour of the premises was undertaken during the site visit with the registered manager. Since the last key inspection the kitchen has been refurbished with new units and new floor and wall tiles have also been fitted. In addition to this, new equipment has been purchased for the laundry room. Also the home is in the process of having some communal areas and corridors redecorated, with new pictures and items of furniture purchased. The AQAA details that existing carpets are to be replaced with lighter coloured carpet and a washable floor covering is to be fitted in the dining room. Curtains have been replaced within some communal areas. A random sample of peoples bedrooms were inspected and all were observed to be personalised and individualised. There was evidence to show that prospective people are enabled and encouraged to bring with them as many personal items as possible, including pets by prior arrangement and agreement with the management team of the home. All areas of the home were observed to be clean, tidy and odour free. Records showed that a visit was undertaken to the home by Environmental Health in September 2009 and improvements were noted since their last full inspection. The report detailed that the premises were found to be in excelllent condition regarding structure and Care Homes for Older People Page 21 of 30 Evidence: cleanliness. A maintenance person is employed for 20 hours per week at Merrie Loots. There is an on-going maintenance programme of redecoration and refurbishment at the home. A random sample of fire records were inspected and these showed that the fire alarm and emergency lighting system are regularly tested and the homes fire extinguishers were serviced in May 2009. A fire risk assessment for the home was in place and the manager confirmed that this is due to be reviewed. A record of fire drills was evident and this showed that these are undertaken approximately every 3 months. It was unclear from the staff training matrix as to the maintenance persons training. The manager was advised that this should be recorded so as to evidence their training in key specific areas e.g. health and safety, infection control, COSHH (Control of Substances Hazardous to Health) and fire awareness. Care Homes for Older People Page 22 of 30 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. People are supported and protected by the numbers, skill mix of staff and by the homes recruitment procedures to ensure their safety and wellbeing. Evidence: We were advised by the manager that staffing levels at the home are 1 senior and 4 members of staff between 07.00/08.30 a.m. to 1.30/2.30/3.30 p.m. and 1 senior and 3 members of staff between 2.30/3.30/4.30 p.m. to 8.30/8.45/10.00 p.m. seven days per week. At night there is 1 senior and 1 member of staff (waking) on duty between 8.30 p.m. to 08.30/08.45 a.m. In addition to the above a laundry person is employed for 2 hours each day. The managers hours remain supernumerary to the above figures. On the day of the site visit there were 27 people living at the home. The AQAA details there is a long standing core team of staff who have worked at the home for some considerable time. On inspection of 4 weeks staff rosters, staffing levels as detailed above were being maintained. On the day of inspection the staff roster was observed to be accurate and reflected staff working within the home. As stated previously staff work a set roster that does not change from week to week. This enables staff to create a stable atmosphere for people who live at the home and residents know who are on duty on any given day of the week, providing continuity of care. The deployment of staff within the home was observed to be appropriate for the numbers and needs of existing Care Homes for Older People Page 23 of 30 Evidence: people who live at the home. We observed people throughout the day being provided with care and support by staff in a timely manner. We looked at 2 staff files for those people newly appointed since the previous key inspection. Records showed there is a good recruitment procedure in place that meets statutory requirements and the National Minimum Standards. A detailed and comprehensive record of induction was fully completed for one person however we noted that the induction for the other person was incomplete at the site visit, despite them being employed at the home for a period of 6 months. This was discussed with the manager and a rationale provided. The training matrix provided to us evidenced that since the last key inspection some staff have received training relating to dementia awareness, food hygiene, fire safety, infection control, moving and handling, SOVA (Safeguarding of Vulnerable Adults) and visual impairment awareness. The manager is fully aware of the training shortfalls for some members of staff and these have been identified and are either booked and/or planned to be undertaken in 2010, including distance learning opportunities through local adult education centres. The training matrix showed that currently 6 people have attained NVQ Level 2, 4 people NVQ Level 3 and the manager has attained the Registered Managers Award. Records also showed that 2 people are undertaking NVQ Level 2 and NVQ Level 3. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and in the best interests of the people who live at Merrie Loots. Evidence: The manager has the required qualifications, experience and competence to run the home. The manager has a clear understanding of the focus of the service and what needs to be achieved so as to improve the service provided at Merrie Loots. The manager remains hands on and has a good relationship with the people who live at the home, staff who work at the home, visitors and healthcare professionals. Relatives spoken with confirmed they had confidence in the manager to ensure good care practices were adopted and that there were positive outcomes for people who live in the home. Staff spoken with confirmed they felt the manager was approachable and understanding of their role and that the atmosphere in the home was relaxed and informal. It is evident from this inspection that while there are many positives and outcomes for people are generally good, further development is still required in relation to care Care Homes for Older People Page 25 of 30 Evidence: planning, risk assessing and some aspects of medication practices and procedures. All sections of the AQAA were completed and the document returned to us when requested. Information recorded was informative, detailing the changes that have been made and where they still need to make improvements. There is a quality assurance system in place and records showed that questionnaires were provided to residents and their representatives and staff. Comments received were generally very positive and comments included My relative has improved so much health wise. It is so nice to see, [name of relative] is on lots of meds for various ailments and is always given these at appropriate times and the care home is very friendly and the staff are excellent. In addition to the above monthly Regulation 26 visits and reports are completed by the registered provider or area manager. A copy of the staff supervision tracker was provided to us and this was examined fully following the site visit. Records showed that regular formal supervision is not being undertaken in line with regulatory requirements and National Minimum Standards recommendations. However where supervision records are in place, records were comprehensive and detailed and staff spoke positively about the supervision process and its benefits. Health and safety policies and procedures are readily available for staff to access. The AQAA provides a list of policies and procedures currently available within the home. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 13 Risk assessments must be 01/02/2010 devised for all areas of assessed risk so that risks to residents can be minimised. Records must be explicit, detailing the specific area of risk, how this impacts on the person and steps taken to reduce the risk. Previous timescale of 10/2/09 not met. This will ensure that risk areas are identified and staff aware of the associated risks to individuals health and wellbeing. 2 7 15 Care plans for individual people must identify all of their assessed care needs. Previous timescale of 10/2/09 not met. To ensure that residents are cared for safely and in a way that meets all of their care needs. That information recorded provides sufficient information to staff, enabling them to offer residents assistance and consistent care. 01/02/2010 Care Homes for Older People Page 27 of 30 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 1 9 13 Medication must be stored under suitable environmental conditions and records of the temperatures of the storage areas must be kept to show this. This will ensure that people receive medicines that are effective. 31/12/2009 2 9 13 Ensure that when medication is not administered to people, records clearly record this, the rationale why they are not and any action taken to address the above. This is to ensure a clear audit trail and to ensure peoples health and welfare. 31/12/2009 3 9 13 The MAR record and amount 31/12/2009 of medication available must tally at all times. Care Homes for Older People Page 28 of 30 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 So as to ensure there is a clear audit trail depicting medication administered. 4 36 18 Ee that staff receive regular supervision. So that staff feel supported. 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 31/01/2010 Care Homes for Older People Page 29 of 30 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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