Care Home: Meyrin House

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What the care home does well When people are thinking about moving into Meyrin House good systems are in place to help them feel confident that the home will be suitable for them. This includes information being available, assessments being undertaken and visits being encouraged. Meyrin House provides a smaller and homely environment for people to live in. People living at Meyrin House seem happy there, and think that the staff care for them well. The manager and deputy manager are both very experienced and have worked at the home for some time. This provides a consistency of approach and stability for people living in the home. Meyrin House has an open and friendly feeling. People living there are encouraged to express their views. What has improved since the last inspection? The environment continues to improve and provides people with a pleasant place to live. Re-decoration has taken place and some furnishings and equipment have been replaced. As the home is registered to provide care for people living with dementia some signage has been developed to help people to find their rooms and other facilities in the home. Staff at the home continue to work towards providing a good level of occupation for people by undertaking different activities. Staff knowledge and practice has been kept up to date. A lot of training in basic core areas such as food hygiene, moving and handling fore awareness and safeguarding has taken place since the previous inspection. A number of staff in the home are currently undertaking a National Vocational Qualification (NVQ) in care to enhance their knowledge and skills. Policies, procedures have been reviewed to provide staff with up to date information. Some aspects of documentation have been introduced or improved to support people`s care. What the care home could do better: Care planning and care documentation at the home has improved. However it is not always clear whether people`s recorded wishes and preferences are carried out in practice on a day to day basis. So that staff are clear about people`s needs care documentation needs to be clear, consistent and up to date. When complaints are made about the service these need to be properly recorded. Investigation reports should be made available to the manager so that lessons can be learnt and practice improved. Some staff are working in a number of homes run by the provider and there appears to be no system in place to monitor the hours that they work or their wellbeing. This could impact on the care given to people. Key inspection report Care homes for older people Name: Address: Meyrin House 35 Hobleythick Lane Westcliff On Sea Essex SS0 0RP     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: Vicky Dutton     Date: 1 7 0 4 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 28 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 28 Information about the care home Name of care home: Address: Meyrin House 35 Hobleythick Lane Westcliff On Sea Essex SS0 0RP 01702437111 01702437437 Meyrin35@tiscali.co.uk www.southendcare.com Strathmore Care care home 18 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Meyrin House is a large old building situated in Westcliff on Sea, close to Southend Hospital. It has been converted for its current use, and provides accommodation on two floors for eighteen residents of either sex. The home is registered for older people and older people with dementia. It has ten single and four double bedrooms, a large open plan lounge-diner with a small visitors/quiet area off the lounge area. There is a small patio and garden area and limited parking to the rear of the building. It has good access to local bus routes. The home has an updated Statement of Purpose and Service User Guide, which are available in the entrance hall. A copy of the last inspection report is also on display in the entrance hall. The current scale of charges as at April 2009 is from £388.01 - £535.65 per week. Rates relate to levels of dependency, single or shared rooms and respite care. Extras charged are for hairdressing, chiropody, toiletries and newspapers. Care Homes for Older People Page 4 of 28 Over 65 0 18 18 0 2 4 0 2 2 0 0 9 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key site visit. The previous site visit to the home took place on 23rd April 2008, and a random inspection to look at some specific issues took place on 24th February 2009. At this visit we (CQC, formerly CSCI) considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. The site visit took place over a period of six and a half hours. A partial tour of the premises was undertaken. Care records, staff records, medication records and other documentation was selected and various elements of these looked at to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to staff. Care Homes for Older People Page 5 of 28 The homes Annual Quality Assurance Assessment (AQAA) was sent in to us when we asked for it before the site visit. AQAA is a self assessment tool that providers are required to complete by Law. The AQAA was adequately completed and outlined how management feel they are performing against the National Minimum Standards, and how they can evidence this. Before the site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives, involved professionals and staff. We received surveys back from one person living in the home, one relative five staff and one visiting professional. The views expressed on surveys and at the site visit have been incorporated into this report. We were assisted at the site visit by the manager and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the manager, staff team, relatives and residents for their assistance during the inspection process. Care Homes for Older People Page 6 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Care planning and care documentation at the home has improved. However it is not always clear whether peoples recorded wishes and preferences are carried out in practice on a day to day basis. So that staff are clear about peoples needs care documentation needs to be clear, consistent and up to date. When complaints are made about the service these need to be properly recorded. Investigation reports should be made available to the manager so that lessons can be learnt and practice improved. Some staff are working in a number of homes run by the provider and there appears to be no system in place to monitor the hours that they work or their wellbeing. This Care Homes for Older People Page 7 of 28 could impact on the care given to people. 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 8 of 28 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 9 of 28 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 wishing to move into Meyrin House can feel confident that assessments carried out will ensure that the home is suitable to meet their needs. Evidence: A Statement of Purpose and Service Users Guide were in place. These were dated June 2008. The service users guide contained useful information including arrangements for assessment before moving in, and extras that people would have to pay for. It did not however detail the current fees charged as is now required. This was pointed out at the previous inspection. The manager confirmed that people are given a copy of the service users guide and encouraged to visit the home where this is possible. Where this is not possible families are encouraged to visit at any time. An example of this was given where a family recently visited Meyrin House on several occasions at different times of day to get a feel for the home. We looked at the file of a person who had most recently moved into the home. We Care Homes for Older People Page 10 of 28 Evidence: saw that a detailed pre-admission assessment had been undertaken by someone from the organisation. It often happens that people are not assessed by staff from the home but by an admissions co-ordinator, or another senior person. The manager said that they try to be involved when staffing levels allow. They felt that admissions were always now discussed with them, and that they had the final say regarding if the person could be accommodated at Meyrin House. Care Homes for Older People Page 11 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care and medical support to meet their individual needs. Evidence: At the site visit people looked comfortable and well cared for. Comments from people about the care provided were positive, for example, My [relative] receives very good care, and, They care for us all very well. When people needed assistance during the day staff carried this out in a caring manner. To see how well peoples care is planned for and arranged so that staff are aware of peoples needs and meet them in an individual way we looked at two care files in detail, and one other for specific issues. Each person living at the home has a care file in place containing assessments, care plans and ongoing care information. Files were well organised and contained good information to help staff deliver care in the ways preferred by people. The care file of someone who had recently moved in contained all the relevant information highlighted by the pre-admission assessment. Information was detailed and reflected individual preferences such as which toilets people preferred to use, and personal routines. Although care planning was mostly adequate some improvements could be made. For example each aspect of care had a care plan and an associated risk assessment in Care Homes for Older People Page 12 of 28 Evidence: place. We saw that risk assessments often contained useful information relating to personal preferences and so on, that would have perhaps have had more relevance in the actual care plan. Where peoples care needs can be quite variable, care information could lead to staff being unclear about a persons needs. For example for one person, from information available in different places in the care file, it was not clear if they were to use a wheelchair or use a zimmer frame, if they needed the assistance of one carer or two. Although we saw that care plans are reviewed each month the same was not true of risk assessments. For example, for one person whose needs had changed and who had been having recent falls, their risk assessment for falls dated from January 2008. It had not been reviewed or updated. We had conflicting information about whether care plans are always carried out in practice by staff. For example one persons care plan highlighted that they liked to wear make up, they were not doing so. The manager said that they no longer wished to. Another person had food likes and dislikes clearly identified in pre-admission information and care planning, but nutrition records indicated that these items were being eaten. The person said that their likes and dislikes were known and respected, and the manager said that they now ate the disliked items through choice. So either the care plan needs updating or nutrition records need to be recorded accurately. The issue of the accuracy of nutrition records was raised at the previous inspection and as part of a complaints investigation. Records showed that people access different healthcare professionals to meet their needs, such as doctors, district nurses, psychiatric support, chiropodist and opticians. A visiting professional completed one of our surveys and was happy with the service. They said that the home always sought advice and acted on it to manage and improve individuals health care needs. They responded positively to every question on the survey. Peoples health is monitored by staff, and some have had training in areas such as nutrition, catheter care and continence to enhance their knowledge and practice. Assessments are undertaken in relation to continence skin care and nutrition. Peoples weight is monitored so that any problems are identified. A random inspection was carried out in February this year to look at an aspect of medication management at the home. This followed concerns being raised with Social Services about practice. We visited the home with a CSCI (now CQC) pharmacy inspector. They found that the home was managing medication well and keeping good records. At this site visit we looked at storage and general practice in relation to medication. We found everything to be in good order. The manager was however reminded that any handwritten entries on medication administration record sheets should be checked and countersigned by a second member of staff. When we observed a medication round staff took their time with people and offered them Care Homes for Older People Page 13 of 28 Evidence: choices such as what flavour supplement dink they wanted. Training records showed us that staff administering medication had received training. One member of staff spoken with said that they were hoping to soon start a distance learning workbook in the administration of medicines. During the day staff were observed to be respectful to people and responsive to their needs. Privacy was maintained when personal care tasks were being carried out. When one person was upset and embarrassed by having an accident staff handled the situation in a kind and caring manner. Care Homes for Older People Page 14 of 28 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 will have a lifestyle that will meet their needs through access to basic activities, being able to welcome visitors and enjoying good food. Evidence: Only one person living at the home was able to complete a survey. They said that there were sometimes activities arranged that they enjoyed. During the site visit there were generally staff available to interact with residents and offer them some activity. During the morning one member of staff undertook one to one activities such as dominoes with people. During the afternoon a hairdresser was visiting. Peoples care files viewed identified their preferences and recorded activities undertaken. These included things such as one to one, board games, bingo and jig saws. Most people living at Meyrin House have care needs associated with dementia. The manager is aware that this presents special challenges in respect of providing suitable individual occupation and stimulation. The manager said that they were trying to develop this area. Information and materials were being sought through the internet. It was hoped to obtain materials to provide tactile and other sensory stimulation. We were told that activity equipment had been purchased by the organisation to be shared between the local homes. The manager said that other equipment such as a camera and colour printer would also help in making better use of materials available on the Internet, Care Homes for Older People Page 15 of 28 Evidence: and in recording activities. People living at Meyrin House are able to have visitors at any time. Visitors spoken with during the site visit said that they were always made welcome by staff. Staff were respectful of peoples wishes and they were able to go where they wished in the home. Information on advocacy services were available so that people know where they can go for independent support and advice. A tour of the premises showed that people are able to bring in their own possessions in order to make their rooms homely. The home operate a four weekly rotating menu. This provides choice and is adapted to meet individual needs and preferences as required. People spoken with seemed happy with the food provided. People said, The food couldnt be bettered, they did not know my likes and dislikes at first, but they do now and I am very happy, and, The food is good here. Homemade cakes. The main cook at Meyrin is very much in touch with what the residents like, and has a lot of contact with them. We saw that they assist with serving meals and drinks, and have direct feedback from the residents. Lunch on the day of the site visit looked appetising and was enjoyed by people. Drinks were encouraged throughout the day. The kitchen was reasonably well stocked, and fresh fruit and vegetables were in evidence. Care Homes for Older People Page 16 of 28 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 are protected through procedures and practice in the home. Evidence: We saw that there was a complaints process in place that was on display for people to refer to. On surveys all residents and relatives said that they knew who to speak to, and knew how to make a complaint. One person said, If I had a concern I would be happy to speak to the manager or deputy who are always around. Two complaints had been made about the home since the previous inspection that we (CQC) were aware of. Both were dealt with through social services working in liaison with the home, and both had also been referred through the local safeguarding team as they related to care practices and other issues in the home. One complaint was also investigated independently after the complainant had been unhappy with the homes investigation and response. The independent investigation upheld or partially upheld a number of elements of the complaint. The manager had requested a copy of the investigation report so that they could better take action on points made. However they had not received a copy. When we looked at the homes complaints records we saw that only one of the above complaints had been recorded. The manager said that they had been unclear about whether one had been a complaint relating to the home, or to other agencies as this had not been made clear by the complainant or social services. The homes training matrix, staff files and discussion with staff showed that training in Care Homes for Older People Page 17 of 28 Evidence: safeguarding people had taken place. Local guidelines relating to safeguarding practice were available, with information about actions to be taken and contact details on display on the office notice board. We also saw that since the previous inspection the homes own policies and procedures in relation to safeguarding have been reviewed. These now provide good information for staff including guidance on completing relevant forms for making a referral. Although not currently a major issue, some records viewed, and discussion with the manager indicated that the home does accommodate people who can display behaviour that challenges staff. The manager confirmed that no specific training has been undertaken in this area. At the random inspection undertaken in February this year it was advised that better processes be in place to record and monitor behaviours. This would help to identify any patterns of behaviour and provide good information for other involved professionals. The manager has actioned this and behavioural monitoring sheets are now put in place when appropriate. Care Homes for Older People Page 18 of 28 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 pleasant home. Evidence: Meyrin House provides a comfortable and homely environment for people to live in. The site visit included a partial tour of the premises. Minor issues such as broken toilet roll holders, and a very noisy extractor fan in one bathroom were fed back to the manager. A maintenance person is shared with other homes in the area, but is generally available twice a week to carry out needed works. The manager said that some redecoration had taken place since the previous inspection and that this programme is ongoing. Discussion indicated that the gradual replacement of old furnishings and equipment is also ongoing. For example, the manager said that some beds have been replaced and that five more are due to be delivered. New towels and flannels have recently been provided. Someone on a survey said, I would like the home to look a bit nicer with new furniture etc. Many rooms viewed were quite homely. People were happy with the accommodation provided. One persons records said that they would like a room on the ground floor when one became available. This had been arranged. They said, My room is very nice and I have my own things about me. Meyrin only has a very small garden at the rear of the property, but this has been made the most of and provides a pleasant area for people. Further improvements are planned. Since the previous inspection signage has improved to help people to recognise where their rooms and other facilities are located. Care Homes for Older People Page 19 of 28 Evidence: On the day of inspection the home seemed adequately clean and there no unpleasant odours. We saw that cleaning schedules are in place to ensure consistency. Staff spoken with said that they had completed training in infection control. Training records confirmed this, and showed us that most staff have undertaken this training, which should assist them in maintaining good practice. The manager said that infection control is also covered as part of National Vocational Qualification (NVQ) training that some staff have completed. The home has a laundry area where there was adequate equipment to meet the needs of people. Care Homes for Older People Page 20 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are looked after by staff who are safely recruited and adequately trained. Evidence: We received positive comments about staff working at Meyrin House. The staff are nice and I get on with everyone, The staff are nice, The staff are all very caring and friendly, and Shes a good little worker were some comments made. The AQAA indicated that staff turnover at Meyrin House is not excessive and that four staff have left within the last year. The manager reported that this is often people moving within the Company to work in other homes. The manager felt that staffing at the home was very stable and that staff had, Come on leaps and bounds since the previous inspection. On the day of inspection thirteen people were being accommodated. Staffing levels were being maintained at three staff with one being in charge during the day and two staff at night. The manager has limited supernumerary time and is generally working as part of the shift. This may limit opportunities for service and staff development. A cook and a housekeeper are only available each day until 14.20 to provide ancillary support. This means that care staff must undertake these tasks at other times. During the site visit there were generally staff around in the communal area to interact with, and assist people, although during the early afternoon this was not the case. A relative felt that the home, May need one or two more staff. On five staff surveys two felt that there were always enough staff to meet peoples needs, and three that there usually were. When we looked at rotas we saw that care staff Care Homes for Older People Page 21 of 28 Evidence: are working frequent twelve hour shifts from 08:00 to 20:20. Some night staff are covering five nights each week totaling nearly 62 hours per week. In addition to this there is a practice of sharing staff around the different homes in the area. So for example, a carer identified as working 37 hours in one week at Meyrin House is from another home where they may also be covering some shifts. A member of staff spoken with confirmed that they also work in two other homes, and that they like to work three long days and two short days with one day off. They said, If you get tired you are not as patient. The manager remains unaware of what hours staff are working in other homes. This is not good practice as staff practice and competence may become compromised if they are working long hours and tired. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. The rota identified that currently twelve care or senior care staff are employed at the home. Information provided on the AQAA and at the site visit indicated that of these two have an NVQ and a further five staff are working towards this. Although not yet achieved the home is on course to meet the 50 basic target. Staff are recruited centrally by the organisation. Management, staff or people living at the home have no input into the recruitment process. This means that potentially the staff recruited may not meet the needs of the home or fit in with the existing staff team. This was seen as an area that could improve on the AQAA. We looked at the files of two members of staff who had been most recently started work at Meyrin House to ensure that recruitment procedures protect people living in the home. One person had in fact worked for the organisation for three years but had just transferred from another home. However, we saw that recruitment procedures had been satisfactory. The second persons file showed that all proper checks had been undertaken. POVA first, and Criminal Records Bureau checks had been undertaken, references taken up and proof of identification sought. On five staff surveys everyone said that their recruitment was carried out fairly and thoroughly. On staff surveys four people said that their induction had covered everything very well and one said that it had mostly covered everything. A new member of staff spoken with said that their induction had been good. On the staff file of a new member of staff looked at looked good initial induction had been undertaken. This had been followed by a Skills for Care Common Induction Standards workbook being completed over a one month period. They have now also commenced NVQ at level two in care. On surveys staff all made positive responses to the questions about training saying Care Homes for Older People Page 22 of 28 Evidence: that training offered gave them the skills that they needed. Staff spoken with during the day identified that they had undertaken a good level of basic training. A training matrix showed that three staff have yet to undertake training in dementia care for which the home is registered. For other staff training in dementia care took place some time ago, for example 2004 and 2006. The manager said that the training manager for the organisation is looking into a new dementia care course. A training plan is in place for 2009 which identifies training coming up in continence management, basic first aid, medication and diabetes. Care Homes for Older People Page 23 of 28 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. People live is a safe and well managed home. Evidence: Meyrin House benefits from having a longstanding, qualified and experienced manager and deputy manager in post. Since the previous inspection they have worked hard to try and make improvements and move the home forward. Requirements made at the previous inspection have been met. The home was well organised and information needed to undertake the inspection was readily available. A relative said, As long as [relative] is happy, and they are, I am happy, this is a nice well managed home. Meyrin House has a friendly open atmosphere and people seemed comfortable and at ease with staff. Although most people living at Meyrin House are mentally frail we saw that the deputy manager undertakes regular informal chats and meetings with residents. These were well recorded and showed that peoples views are listened to and acted on. We saw that regular staff meetings take place where practice and other issues are discussed. Care Homes for Older People Page 24 of 28 Evidence: The provider employs an external agency to undertake quality reviews of their services. At Meyrin House a quality review last took place in May 2007. The manager confirmed however that this process is now underway again and that surveys have been sent out. Monthly visits to review the service are required by Regulation. We saw that these are being undertaken by a senior person in the organisation. The visits include talking to people about the service. Other strategies to maintain standards are in place such as audits of various areas, and regular walk rounds. The AQAA was completed by the manager. It was briefly but fully completed and gave us the information that we had asked for. People can feel confident that if they or their families ask the home to help them look after their personal monies, this will be done in a way that safeguards their interests. Monies checked were correct, with receipts in place for all transactions. The AQAA completed identified that systems and services are monitored and maintained. A sample of records looked at confirmed this. A partial tour of the premises showed that the home seemed well organised, and no particular health and safety issues were identified. The fire service visited the home last year and found everything to be in order. A fire risk assessment was seen to be in place. Fire records were well maintained. Systems are tested weekly, and regular fire drills are carried out to ensure that staff know what to do in an emergency. The last environmental health officers visit found that good standards of food hygiene were being maintained. A training matrix and discussion with staff showed that training in core areas such as moving and handling is mostly kept up to date. The manager and deputy manager are both moving and handling trainers who have recently renewed their training for this. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 12 18 Staff at the home should continue to develop activities that are meaningful to people who are living with dementia. So that staff have good skills to care for people well and appropriately they should have access to training in managing challenging behaviour. So that peoples care is not compromised by being looked after by tired staff, a system of monitoring what hours staff are working each week should be developed. 3 27 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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