Care Home: Metfield Grange

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What the care home does well Metfield Grange presented as a warm and caring environment. On the day of the visit the environment was found to be homely, clean and generally well maintained. Residents appeared relaxed and content and the management and staff team were observed to engage with residents in a respectful and dignified manner. Feedback received from the people using the service and their representatives confirmed they were very satisfied with the overall standard of care provided. Information on the service had been produced in the form of a Statement of Purpose and Service User Guide and a care planing system was in operation to provide staff with information on the needs of residents. Residents were supported to follow their preferred routines and participate in a range of activities. Family and friends were seen to visit residents at different times of the day and visitors spoken with confirmed they were always made to feel welcome. A programme of quality assurance had been established and a range of policies and procedures had been developed to provide guidance to staff and to ensure an appropriate response to suspicion or evidence of abuse and any concerns or complaints about the service. The owners / manager continued to live on the premises and there were sufficient staff on duty to meet the needs of residents. Staff continued to have access to supervision and a range of core training to ensure safe working practises. Overall, comments and feedback received from residents, relatives and staff was very positive and included: "Excellent." "Always friendly staff. Food lovely and Nuala the singer very good. We all join in and try to dance." "Keep doing what you`re doing." "Well done." "X [a resident] never stops talking about the home." "Very clean." "Staff very helpful and look after me. Sarah always makes sure if I need anything." "Lovely." "Very kind." "I think it`s great. Home from home." "Food lovely." "Treats residents as individuals, respects privacy and dignity. Promotes independence. Residents are given choice with meals and times of baths. Join in all activities and outings. There are regular entertainers who visit the home, as well as church services etc. Visiting hairdresser, chiropodist. The home is kept clean and in good decorative state. Furniture, carpets, beds etc are updated on a regular basis, making sure residents are comfortable and cared for." "Unable to think of any areas which could be done better." "Metfield is a small friendly home with caring staff who all work together for the needs of residents, which includes both owners, who are very approachable and supportive." "Linda and Dave [owners and manager] always respect my views." "Keep up the standards they are producing." "I find the home friendly, very caring staff get on together." "Hope they stay for a few more years - David and Linda [owners and managers]." "Making sure residents are looked after really well. I like the way Linda and Dave live at the home." "Looking forward to the BBQ`s." "They care for residents and staff very well." "It is a very friendly care home. Residents get cared and looked after to a very high standard and a very friendly atmosphere with all staff. Linda and Dave Wallace are a pleasure to work for and I can see my self working here for many years to come." "Very friendly clean environment." "I`m very happy with place of work." What has improved since the last inspection? This section is not applicable as no requirements or recommendations were made at the previous inspection which was undertaken on 10th May 2007. What the care home could do better: Assessment systems should be developed and utilised to ensure the assessed and changing needs of residents who are not funded or referred through care management arrangements are assessed and periodically reviewed. This will help the service to identify, monitor and respond to the diverse needs of prospective and current residents. Care plans should also set out in more detail the action that needs to be taken by staff to ensure best practice. Systems for recording the outcome of health care appointments should be reviewed to ensure information is more easily accessible. This will help the service to verify that it is meeting all the health care needs of residents. All potential / actual risks should also be assessed to ensure the health and safety of the people using the service is safeguarded. Schedule 2 Controlled Drugs must be stored in a Controlled Drugs cabinet. This will ensure medication is correctly stored in accordance with the Misuse of Drugs [Safe Custody] Regulations 1973. Furthermore, Medication Administration Records must be signed by staff following the administration of Medication. This will provide evidence that medication has been administered in accordance with the prescribed instructions. Records must also be maintained of the quantity of each medication, date received and name of the person responsible for checking medication received into the care home. This will enable the service to maintain an audit trail for medication received. The complaints log record should be located and available for inspection to provide information on any concerns, complaints or allegations received by the service. A menu plan should be developed in consultation with residents and a record of individual meal choices should be maintained. This will ensure best practice and provide an accurate record of each resident`s dietary intake. The owners / registered managers should work towards completing a level 4 National Vocational Qualification in Care, to ensure they have the necessary qualifications for their role. The rota should also be updated to include the capacity of staff and the hours / shifts worked by the owner / manager. The application forms should be reviewed, to provide sufficient space for job applicants to record their full employment history. Furthermore, the training programme should be extended to include other training relevant to the care of older people and staff should be inducted in accordance with the Skills for Care - Common Induction Standards to ensure compliance with national training standards. The format and content of the fire risk assessment should be reviewed in consultation with the local fire officer to ensure best practice. Key inspection report Care homes for older people Name: Address: Metfield Grange 59 Hartwood Road Southport Merseyside PR9 9AW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Daniel Hamilton     Date: 0 2 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 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Metfield Grange 59 Hartwood Road Southport Merseyside PR9 9AW 01704538691 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr D R E Wallace,Mrs Belinda Wallace Name of registered manager (if applicable) Mrs Belinda Wallace Type of registration: Number of places registered: care home 13 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies 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 The maximum number of service users who can be accommodated is: 13 Date of last inspection Brief description of the care home Metfield Grange is a small, friendly, family run residential home, which provides personal care and support for up to thirteen elderly people. The proprietors (Mr and Mrs Wallace) are registered as managers with the Care Quality Commission and live on the premises. Both Mr and Mrs Wallace are involved in managing the day to day running of the home, working hands on with both the residents and staff and providing supervision, support and direction. Nursing care is provided by the nursing care Care Homes for Older People Page 4 of 33 Over 65 13 0 Brief description of the care home service, when required. The home is located within a quiet residential area, within easy reach of the town centre of Southport. A local bus route provides access to all the amenities of the coastal resort. These include a large shopping area, cinema, theatre, parks and lake. The accommodation comprises of 3 double rooms and 7 single rooms. There is a stair lift, which provides access to the first floor and a communal lounge and a dining room located on the ground floor. All areas are provided with emergency call points. Access is provided to front and rear landscaped gardens. The weekly cost for the service is £389.00 per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This unannounced inspection took place over one day and lasted approximately 9 hours. Twelve residents were living in Metfield Grange at the time of the visit. A site visit took place as part of the unannounced inspection and a tour of the premises was completed. Two of the residents care files were case tracked (their care files were examined and views of the service obtained). This process was not carried out to the detriment of the other residents who also took part in the inspection process. A selection of staff and service records were also looked at. The two owners / registered managers, deputy manager, five relatives, eight residents and two care staff were also spoken with during the visit. Care Homes for Older People Page 6 of 33 Reference was made to an Annual Quality Assurance Assessment (AQAA) which was completed by the owners / registered managers before the visit. This document enables a registered person to undertake a self-assessment of the service, prior to an inspection. Survey forms were also distributed to a number of residents, relatives and staff before the inspection. Comments included in the report are taken from the survey forms and from discussion with residents and their relatives during the inspection. All the key standards were reviewed as part of the inspection process. Care Homes for Older People Page 7 of 33 What the care home does well: Metfield Grange presented as a warm and caring environment. On the day of the visit the environment was found to be homely, clean and generally well maintained. Residents appeared relaxed and content and the management and staff team were observed to engage with residents in a respectful and dignified manner. Feedback received from the people using the service and their representatives confirmed they were very satisfied with the overall standard of care provided. Information on the service had been produced in the form of a Statement of Purpose and Service User Guide and a care planing system was in operation to provide staff with information on the needs of residents. Residents were supported to follow their preferred routines and participate in a range of activities. Family and friends were seen to visit residents at different times of the day and visitors spoken with confirmed they were always made to feel welcome. A programme of quality assurance had been established and a range of policies and procedures had been developed to provide guidance to staff and to ensure an appropriate response to suspicion or evidence of abuse and any concerns or complaints about the service. The owners / manager continued to live on the premises and there were sufficient staff on duty to meet the needs of residents. Staff continued to have access to supervision and a range of core training to ensure safe working practises. Overall, comments and feedback received from residents, relatives and staff was very positive and included: Excellent. Always friendly staff. Food lovely and Nuala the singer very good. We all join in and try to dance. Keep doing what youre doing. Well done. X [a resident] never stops talking about the home. Very clean. Staff very helpful and look after me. Sarah always makes sure if I need anything. Lovely. Very kind. I think its great. Home from home. Food lovely. Care Homes for Older People Page 8 of 33 Treats residents as individuals, respects privacy and dignity. Promotes independence. Residents are given choice with meals and times of baths. Join in all activities and outings. There are regular entertainers who visit the home, as well as church services etc. Visiting hairdresser, chiropodist. The home is kept clean and in good decorative state. Furniture, carpets, beds etc are updated on a regular basis, making sure residents are comfortable and cared for. Unable to think of any areas which could be done better. Metfield is a small friendly home with caring staff who all work together for the needs of residents, which includes both owners, who are very approachable and supportive. Linda and Dave [owners and manager] always respect my views. Keep up the standards they are producing. I find the home friendly, very caring staff get on together. Hope they stay for a few more years - David and Linda [owners and managers]. Making sure residents are looked after really well. I like the way Linda and Dave live at the home. Looking forward to the BBQs. They care for residents and staff very well. It is a very friendly care home. Residents get cared and looked after to a very high standard and a very friendly atmosphere with all staff. Linda and Dave Wallace are a pleasure to work for and I can see my self working here for many years to come. Very friendly clean environment. Im very happy with place of work. What has improved since the last inspection? What they could do better: Assessment systems should be developed and utilised to ensure the assessed and changing needs of residents who are not funded or referred through care management arrangements are assessed and periodically reviewed. This will help the service to identify, monitor and respond to the diverse needs of prospective and current residents. Care plans should also set out in more detail the action that needs to be taken by staff to ensure best practice. Systems for recording the outcome of health care appointments should be reviewed to ensure information is more easily accessible. This will help the service to verify that it is meeting all the health care needs of residents. All potential / actual risks should also Care Homes for Older People Page 9 of 33 be assessed to ensure the health and safety of the people using the service is safeguarded. Schedule 2 Controlled Drugs must be stored in a Controlled Drugs cabinet. This will ensure medication is correctly stored in accordance with the Misuse of Drugs [Safe Custody] Regulations 1973. Furthermore, Medication Administration Records must be signed by staff following the administration of Medication. This will provide evidence that medication has been administered in accordance with the prescribed instructions. Records must also be maintained of the quantity of each medication, date received and name of the person responsible for checking medication received into the care home. This will enable the service to maintain an audit trail for medication received. The complaints log record should be located and available for inspection to provide information on any concerns, complaints or allegations received by the service. A menu plan should be developed in consultation with residents and a record of individual meal choices should be maintained. This will ensure best practice and provide an accurate record of each residents dietary intake. The owners / registered managers should work towards completing a level 4 National Vocational Qualification in Care, to ensure they have the necessary qualifications for their role. The rota should also be updated to include the capacity of staff and the hours / shifts worked by the owner / manager. The application forms should be reviewed, to provide sufficient space for job applicants to record their full employment history. Furthermore, the training programme should be extended to include other training relevant to the care of older people and staff should be inducted in accordance with the Skills for Care - Common Induction Standards to ensure compliance with national training standards. The format and content of the fire risk assessment should be reviewed in consultation with the local fire officer to ensure best practice. 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 10 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information on Metfield Grange prior to admission however assessment systems for people not referred through care management arrangements are in need of review. This will help the service to identify and respond to the diverse needs of prospective and current residents. Evidence: The Annual Quality Assurance Assessment for Metfield Grange confirmed policies and procedures were in place for Referral and Admission and that all prospective residents were offered a months trial period. Residents spoken with also confirmed that they had been invited to visit the home prior to admission. A combined Statement of Purpose and Service User Guide document had been developed in a standard format to provide prospective and current residents and their representatives with key information on the service provided at Metfield Grange. A copy of the document dated May 2006 was viewed during the visit and some parts Care Homes for Older People Page 12 of 33 Evidence: were noted to be in need of review. A prospectus had also been produced for people to refer to. Feedback received from residents and their representatives via surveys and through discussion confirmed people had received enough information on Metfield Grange before they had decided to move into the home. Two of the residents files were case tracked during the visit. One file was for a resident who had recently moved into Metfield Grange and the other was for a resident who had lived in the home for a longer period of time. Only one file was found to contain an assessment of need which had been completed by a local authority social services department, responsible for funding the residents placement. Advice was given to the management team regarding assessment tools and the need to assess and keep under review the assessed and changing needs of residents who are not funded or referred through care management arrangements. Standard 6 is not applicable as the service does not provide intermediate care. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are treated with dignity and respect however medication storage and recording systems are in need of review, to fully safeguard the health and welfare of the people using the service. Evidence: The Annual Quality Assurance Assessment for Metfield Grange confirmed that policies and procedures had been developed for Individual Planning and Review, the Control, Storage, Disposal, Recording and Administration of Medication and the value base of social care. Two of the residents files were selected to view during the inspection. One file was for a resident who had recently moved into Metfield Grange and the other was for a resident who had lived in the home for a longer period of time. Each file contained a care plan, which outlined Problems / Needs; Aims / Goals and Actions and Initial Review Date. Care Plans viewed contained basic information on the needs of residents and the actions required by staff. For example, one resident Care Homes for Older People Page 14 of 33 Evidence: had an assessed need of Short term memory problems and the recorded staff actions detailed Observe X [Resident] as much as possible and Remind X [Resident] where she is. Plans viewed were easy to read and had been kept under monthly review in consultation with residents or their representatives. Feedback received from residents and their representatives via discussion confirmed the people living in Metfield Grange received the medical support they required. Access to the district nurse service was also available should residents require this input for their care. Health care appointments were recorded in a central diary and following appointments information was transferred to care plans. Advice was given to the management team on how to improve the accessibility of health care records as difficulty was experienced in following up the outcome of some previous health care appointments. For example, evidence of a residents appointments with a hospital specialist, general practitioner and chiropodist could be located, but it was not possible on the day of the visit to identify the most recent optician or dentist appointments. Each file viewed contained a copy of a resident handling assessment however other potential / actual risks had not been recorded. For example, one resident who was case tracked was known to be at risk of falling due to poor mobility resulting from a medical condition. Although this had been identified in the care plan a risk assessment had not been completed to address the risk of falling. Other supporting documentation including personal care records and daily reports from staff were recorded in another diary and accident records and personal information / profiles were available for reference. Medication storage and recording systems were checked with the management team during the visit. The deputy manager reported that all staff designated with responsibility for the administration of medication had completed medication training. Information on the individual wishes of residents concerning the administration of medication was not available for reference at the time of the visit and this should be addressed to ensure best practice. Medication was found to be stored in a lockable cabinet in the kitchen area of the home. On the day of the visit the service was found to also be storing a controlled drug in the medication cabinet which was not compliant with the Misuse of Drugs [Safe Custody] Regulations. Care Homes for Older People Page 15 of 33 Evidence: Examination of a selection of medication administration records highlighted that staff had not consistently signed medication records to account for the administration of medication. Furthermore, none of the medication administration records viewed contained audit trail information as the date, details of the person receiving medication into the home and quantity of medication received had not been recorded. Separate audit trail records had not been maintained. The management team and staff were observed to communicate and engage with residents in a respectful and dignified manner. Likewise, feedback received from the people using the service and their representatives confirmed they were very satisfied with the overall standard of care provided. No issues of concern were received regarding the laundry service and residents reported that they felt valued and were treated with respect. Comments received from residents and relatives included: Staff very helpful and look after me. Sarah always makes sure if I need anything; Treats residents as individuals, respects privacy and dignity. Promotes independence. Residents are given choice with meals and times of baths. Join in all activities and outings. There are regular entertainers who visit the home, as well as church services etc. Visiting hairdresser, chiropodist. The home is kept clean and in good decorative state. Furniture, carpets, beds etc are updated on a regular basis, making sure residents are comfortable and cared for; They Owners and managers care for residents and staff very well; Lovely; Very kind; I find the home friendly, very caring staff get on together; I think its great. Home from home. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Daily life, social activities and meals at Metfield Grange are generally flexible and varied in order to respond to the different needs, preferences and expectations of residents. Evidence: A set programme of activities was not in place as the service wanted to offer residents flexibility, variation and choice with daily living and activities. Daily activities at Metfield Grange were displayed on a notice board which was also used to record daily meals. Records of activities were recorded in a file however this did not identify the names of the participants. Activities were generally coordinated within a large, comfortably furnished, smoke free lounge area. On the day of the visit an outside entertainer (vocalist) was observed to be on-site and residents were seen to enjoy and participate in the sing-a-long sessions. Another outside entertainer also visited the home each week and other activities on offer included: video afternoons, manicures and luxurious hand massages, beauty therapy, hairdressing, chair-based exercises, household activities, bingo and games, garden activities and the use of I-pod television and a lap-top Care Homes for Older People Page 17 of 33 Evidence: computer. Two residents also visited local community support groups. Representatives from the local Roman Catholic and Church of England churches continued to visit residents in the home on a monthly basis or more often, subject to each individual residents beliefs and wishes. Feedback received from residents confirmed they were generally satisfied with the range and frequency of activities provided however one resident spoken with reported that he would like to see different activities being introduced. This feedback was shared with the owner / manager for action. Residents spoken with during the visit confirmed they were able to receive visits from family and friends at different times of the day. Likewise, relatives spoken with reported that Metfield Grange had a homely atmosphere and confirmed they were always made to feel welcome in the home and that there were no restrictions on visiting times. The service did not have a menu plan in place at the time of the inspection. Records of meals served were recorded in a book however it was not possible to determine individual meal choices from the records and two residents spoken with reported that there was not always a choice for the mid-day meal. The Annual Quality Assurance Assessment detailed that the service provided a wholesome and varied diet as noted at the last inspection and confirmed the service was able to cater for different dietary requirements. Meals were served in the homes dining room, which provided a pleasant area for residents to eat their meals. The dining area was attractively decorated and equipped with tablecloths and condiments etc. Additional snacks and drinks were served throughout the day and residents were able to eat their meals in their room if they preferred. The mid-day and tea-time sittings were discreetly observed and residents were seen to enjoy their meals. Care staff were observed to also be present during mealtimes to offer support for residents as required. Comments received from residents, relatives and staff included; Always friendly staff. Food lovely and Nuala the singer very good. We all join in and try to dance; Care Homes for Older People Page 18 of 33 Evidence: X [a resident] never stops talking about the home; Food lovely; Activities are organised but I would welcome more variation; Looking forward to the BBQs; I would never go hungry here. The food is good and there is plenty to eat; Keep up the standards you are producing. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems have been developed at Metfield Grange to listen and respond to complaints and to safeguard and protect residents from abuse. Evidence: The Annual Quality Assurance Assessment (AQAA) for Metfield Grange confirmed a policy and procedure on Concerns and Complaints had been developed for the service. An easy read complaints procedure was displayed in the reception area of the home and feedback received from residents and their representatives via surveys and discussion confirmed people knew how to complain and that they had confidence that any concerns or complaints would be listened to and acted upon. No concerns were raised with the inspector during the inspection process however the management team were recommended to display a copy of the full complaints procedure in the reception area of the home for people to view. Residents were observed to be relaxed and comfortable in their home environment and communication between staff and the people using the service was positive. The owners / managers remain in daily contact with the residents and visitors as they live on the premises. Feedback received from residents and relatives included; I have the greatest Care Homes for Older People Page 20 of 33 Evidence: admiration for the home; Linda and Dave [Owners and managers] always respect my views and Ive never had to complain and if I did Im sure I would be listened to. The AQAA detailed that there had been no complaints or safeguarding referrals in the last 12 months. This could not be verified at the time of the visit as the complaint log could not be located. No comments, complaints or allegations had been brought to the attention of the Care Quality Commission in the past year. Policies and procedures were in place to provide guidance to staff and to ensure an appropriate response to suspicion or evidence of abuse. These included; a Guarding Against Abuse, Whistle blowing and a copy of the local authoritys Adult Protection Procedures. Discussion with the management team and examination of training records confirmed staff had completed refresher training in abuse awareness during February 2010. The manager and deputy manager were spoken with during the visit and demonstrated a good awareness of the different types of abuse and reporting procedures. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Metfield Grange is generally well maintained and provides residents with an attractive, comfortable and homely place in which to live. Evidence: Metfield Grange employed a part-time handyman who was responsible for minor maintenance tasks including the upkeep of the gardens. Contractors were also hired when required to undertake specialised maintenance work and the servicing of equipment. On the day of the visit the handyman was observed to be painting the rear fencing of the home. The grounds appeared tidy and safe and are used by the residents in the summer months for Barbecues and other recreational activities. The front and rear gardens are accessible, with the exception of two steps at the front entrance. The owners / registered managers continued to live on-site and were able to therefore monitor the condition of the environment on an ongoing basis. At the time of the visit records of maintenance tasks and work completed could not be located however records of quarterly room audits and the resultant action plans were available for inspection. Examination of the Annual Quality Assurance Assessment (AQAA) for Metfield Grange confirmed the premises had continued to receive investment since the last visit. Care Homes for Older People Page 22 of 33 Evidence: In the last 12 months, nine rooms had benefited from redecoration and / or different aspects of refurbishment; two bathrooms had been fitted with non-slip flooring; the basement had been redecorated and the basement ceiling had been re-sealed and the intumescent doors had been re-painted. External parts of the building had also benefited from investment. For example, the eaves at the front of the house had been replaced, the front pillars and gates had been re-painted and the fences in the back garden had been replaced and the garden wall repaired. Residents were observed to have access to personal mobility aids, subject to individual needs and rooms viewed appeared comfortable, clean and generally well maintained. Residents had placed personal possessions, pictures and other memorabilia in their rooms to make them more homely and personalised. Previous reports also identify that all residents had a lockable drawer in their own rooms. (Please refer to the Brief description of the Service section for more information on the premises). Areas viewed during the inspection appeared to be generally well maintained and clean however one resident reported concerns regarding a broken wardrobe door which the owner / registered manager confirmed was due to be repaired. The AQAA detailed that policies and procedures were in place for Communicable Diseases and Infection Control and the Control of Substances Hazardous to Health. Training records detailed that the majority of the staff team had completed refresher training in infection control during February 2010. Records revealed that the last fire officers visit was during February 2008. The report highlighted that some remedial work was required which the owner / registered manager reported had been completed. The date of the last environmental health officers visit and the resultant report could not be located. Comments included: Very friendly clean environment and the home appears well maintained and is kept clean. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements and systems for the recruitment and training of staff help to protect the welfare of the people living at Metfield Grange. Evidence: At the time of the visit there were 12 residents living at Metfield Grange. Examination of the rotas highlighted that the home was usually staffed with a minimum of two care staff in the morning and afternoons. At night the home was staffed with one waking night staff and the owners undertook sleep-in duties. Details of the job roles of staff and the shifts / hours worked by the owners / managers had not been included on the rota. This should be addressed. Feedback from residents or their representatives via care home survey forms and through discussion confirmed the people living in the home received the care and support they needed and that staff were available when required. The management and staff team were observed to interact with residents in a friendly and caring manner and were attentive to the needs of the people they cared for. The Annual Quality Assurance Assessment (AQAA) for Metfield Grange detailed that 12 care staff were employed at the home. Records highlighted that 4 (33.33 ) staff (including the deputy manager) had completed a National Vocational Qualification (NVQ) at level 2 or above. The owners / managers reported that a further three staff Care Homes for Older People Page 24 of 33 Evidence: (24.99 ) were also working towards a NVQ. The Annual Quality Assurance Assessment (AQAA) for Metfield Grange confirmed a policy for Recruitment and employment including redundancy was in place. The personnel files of two care staff and a handyman who had commenced employment since the last inspection were viewed. Overall, the necessary records required under the Care Home Regulations 2001 had been obtained for the new employees however some issues of concern were noted. For example, one applicant had not provided the details of any referees on their application form and there was insufficient space on all application forms viewed for job applicants to record their full employment history. Staff confirmed that that they had received an induction and ongoing training upon commencing employment however examination of induction records revealed that staff had not been inducted in accordance with the Skills for Care Common Induction Standards. Advice was given to the owners / managers on how to obtain guidance, induction logs and certificates. As part of their induction, staff also receive a handbook and are encouraged to read and sign the policies and procedures for the home. The training matrix for Metfield Grange was viewed together with a selection of individual staff training records. The documents provided evidence that staff had completed mandatory health and safety training together with abuse training. It was recommended that other key training i.e. medication etc be included in the matrix together with the job roles of staff and that the training programme be expanded to include other training relevant to the care needs of older people. Records of regular staff supervision and appraisals were also stored on files. Comments received from staff included: It is a very friendly care home. Residents get cared and looked after to a very high standard and a very friendly atmosphere with all staff. Linda and Dave Wallace [owners and managers] are a pleasure to work for and I can see my self working here for many years to come; Im very happy with place of work; We get access to supervision, induction and other training. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and quality assurance systems are in place and subject to ongoing review, to ensure Metfield Grange is run in the best interest of residents. Evidence: Metfield Grange is owned and managed by Mr and Mrs Wallace who are both registered with the Care Quality Commission and in day-to-day contact with the residents and their relatives. Previous inspection records confirm that both Mrs and Mrs Wallace have gained several years experience in the care of older people and that Mr Wallace holds a level 4 National Vocational Qualification (NVQ) in Management. Mr Wallace reported that the deputy manager had also completed the level 4 Registered Managers Award in addition to NVQ level 4 in Care. The training matrix was viewed during the visit and this highlighted that the management team had also continued to keep their safe working practice / core training up-to-date. Care Homes for Older People Page 26 of 33 Evidence: Feedback received from residents, relatives and staff confirmed the management team were helpful, approachable and supportive. The owners / managers reside at Metfield Grange and are therefore in a good position to respond promptly to any queries and issues of concern. Comments received regarding the management of the home included: Metfield is a small friendly home with caring staff who all work together for the needs of residents, which includes both owners, who are very approachable and supportive; I like the way Linda and Dave [owners and manager] live at the home and Hope they stay for a few more years David and Linda. Prior to the inspection, the owners / manager completed an Annual Quality Assurance Assessment (AQAA). This document enables a registered person to undertake a selfassessment of the service and to provide statistical information. All sections of the document were completed and feedback from quality assurance questionnaires had been included for reference. Some sections would have benefited from more supporting evidence / information to illustrate what the service does well and this should be taken into consideration when completing future AQAA documents. Records showed that the owners / managers continued to commission an external consultant to undertake an annual quality assurance assessment each year. This was last completed during June 2009. The assessment involved distributing quality assurance questionnaires to residents and their relatives each year, to find out their views on the service provided. The certificate and results had been published and were displayed in the entrance of the home for people to view. Previous inspection records confirmed that a formal supervision and appraisal system was in place to support the staff and that a range of policies and procedures were available for staff to reference. Examination of the Annual Quality Assurance Assessment revealed that the last review date for the majority of policies and procedures was May 2006 and this should be kept under review to ensure best practice. Residents were encouraged to manage their personal finances independently or with support from family members or personal representatives. The owners / managers did not act as an appointee for any residents however they looked after personal expenditure for the majority of residents. Systems were in place to invoice residents or their relatives on a monthly basis for any personal expenditure and written financial records for all transactions were maintained. Care Homes for Older People Page 27 of 33 Evidence: A range of Health and Safety policies and procedures had been developed and examination of the AQAA confirmed that test, maintenance and / or associated records were in place and up-to-date for all key areas. A selection of fire safety records were viewed during the visit. Records confirmed that the fire alarm system had been tested on a weekly basis and that the emergency lighting and fire extinguishers had been tested / visually inspected each month. Up-todate service certificates were also in place to verify that the fire alarm system and extinguishers had been serviced periodically. A fire risk assessment had been completed during July 2009 however it was recommended that this be reviewed in consultation with the fire officer as the assessment contained limited information. Records confirmed that there had been a recent fire drill and staff had fire safety refresher training during January 2010. The owner / manager reported that thermostatic valves had been fitted in all bedrooms and communal bathrooms within Metfield Grange. Periodic checks had also been undertaken on the hot water outlets to monitor the temperature. It was recommended that the checks are undertaken on a monthly basis. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Records must be maintained 09/04/2010 of the quantity of each medication, date received and name of the person responsible for checking medication received into the care home. This will enable the service to maintain an audit trail for medication received. 2 9 13 Schedule 2 Controlled Drugs 09/04/2010 must be stored in a Controlled Drugs cabinet. This will ensure medication is correctly stored in accordance with the Misuse of Drugs [Safe Custody] Regulations 1973. 3 9 13 Medication Administration 09/04/2010 Records must be signed by staff following the administration of Medication. This will provide evidence that medication has been Care Homes for Older People Page 30 of 33 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 administered in accordance with the prescribed instructions. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Assessment systems should be developed and utilised to ensure the assessed and changing needs of residents who are not funded or referred through care management arrangements are assessed and periodically reviewed. This will help the service to identify, monitor and respond to the diverse needs of prospective and current residents. All potential / actual risks should be assessed to ensure the health and safety of the people using the service is safeguarded. Care plans should set out in more detail the action that needs to be taken by staff to ensure best practice. Systems for recording the outcome of health care appointments should be reviewed to ensure information is more easily accessible. This will help the service to verify that it is meeting all the health care needs of residents. A menu plan should be developed in consultation with residents and a record of individual meal choices should be maintained. This will ensure best practice and provide an accurate record of each residents dietary intake. The complaints log record should be located and available for inspection to provide information on any concerns, complaints or allegations received by the service. The rota should be updated to include the capacity of staff and the hours / shifts worked by the owner / manager. Staff should be inducted in accordance wth the Skills for Care - Common Induction Standards to ensure compliance with national training standards. The application forms should be updated, to provide 2 7 3 4 7 8 5 12 6 16 7 8 27 29 9 29 Care Homes for Older People Page 31 of 33 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 sufficient space for job applicants to record their full employment history. 10 30 The training programme should be extended to include other training relevant to the care of older people to ensure best practice. The Owners / Registered Managers should work towards completing a level 4 National Vocational Qualification in Care, to ensure they have the necessary qualifications for their role. The format and content of the fire risk assessment should be reviewed in consultation with the local fire officer to ensure best practice. 11 31 12 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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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