Care Home: Molescroft Care Home

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What the care home does well People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. What has improved since the last inspection? The way that staff give out medication and record this has got better, which helps keep people safe and well. What the care home could do better: The home needs to paint and decorate more of the communal areas and bedrooms to make sure people have a pleasant environment in which to live. The laundry floor needs to be sealed to make sure that infection control measures are adequate and effective within the environment. Newly employedMolescroft Care HomeDS0000069699.V377619.R01.S.doc Version 5.2 staff who have little or no experience of care work must undergo a comprehensive induction which meets skills for care criteria so that they can develop the skills and knowledge necessary to meet the needs of the people using the service. We would like to thank everyone who completed a survey or spoke to us during this visit. Your comments are very important to us and ensure this report includes the views of people who use the service or work within it. Key inspection report CARE HOMES FOR OLDER PEOPLE Molescroft Care Home 30 Molescroft Road Beverley East Yorkshire HU17 7ED Lead Inspector Eileen Engelmann Key Unannounced Inspection 25th August 2009 09:00 DS0000069699.V377619.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Molescroft Care Home Address 30 Molescroft Road Beverley East Yorkshire HU17 7ED Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01482 860367 01642 867357 Southern Cross Healthcare (Focus) Limited Manager post vacant Care Home 44 Category(ies) of Dementia (44), Old age, not falling within any registration, with number other category (44) of places Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home fall within the following categories: Old age, not falling within any other category - Code OP, maximum number of places 44 2. Dementia - Code DE, maximum number of places 44 The maximum number of service users to be accommodated is 44. Date of last inspection 31st August 2007 Brief Description of the Service: Molescroft Court is situated close to the centre of the market town of Beverley. The home is registered for forty-four people over the age of sixty-five, some of whom may suffer from memory impairment. The home is made up of three separate buildings, the Main House, the Haven and the Annexe. Fifteen service users live in the Main House, sixteen in the Annexe and thirteen in the Haven. The Annexe has three bungalow units to allow for more independent living. Each of the three areas has a conservatory for the use of the service users and these provide views of the well maintained and spacious grounds. Information given to us at this inspection (25/8/09) by the manager is that the range of fees charged are from £362.04 to £480.00 per week, depending on the care needs of the individual and the source of funding. A top-up fee of between £12.00 and £45.00 is applicable depending on the type of room chosen by the individual. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2* stars. This means that the people who use this service experience good quality outcomes. Information has been gathered from a number of different sources over the past 24 months since the service had its last key inspection visit on 31 August 2007, this has been analysed and used with information from this visit to reach the outcomes of this report. We made a random inspection visit to the home on 21 July 2008 in response to information we received that people were not receiving their medication correctly. A report was produced from this visit which included requirements and recommendations to improve medication practices. We completed an Annual Service Review (ASR) for Molescroft Court on 30 July 2008. We only do an annual service review for good or excellent services that have not had a key inspection in the last year. An ASR is part of our regulatory activity and is an assessment of our current knowledge of a service rather than an inspection. The published review is a result of the assessment and does not come from our power to enter and inspect a service. At the time of our visit (25/8/09) the acting manager of the service was on long term sick leave. In her absence the home is being managed by two registered managers from other Southern Cross homes. For the purpose of this report they will be referred to as ‘the manager(s)’ throughout the text. In the past six months the temporary management team in the home has worked extremely hard to improve the service provided to people and the environment of the home. Staff and people using the service are very pleased with the positive changes saying ‘the managers have turned the service around’ and ‘the refurbished environment has benefited both staff and people living in the home’. This unannounced visit was carried out with the two managers, staff and people using the service. The visit took place over 1 day and included a tour of the premises, examination of staff and people’s files, and records relating to the service. Questionnaires were sent out to a selection of people living in the home and staff. Their written response to these was good. We received 8 back from staff (80 ) and 7 from people using the service (70 ). Informal chats with a number of staff and people living in the home took place during this visit and comments from the questionnaires and face to face conversations have been put into this report. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.2 Page 6 The manager completed an Annual Quality Assurance Assessment and returned this to us within the given timescale. We have received one formal complaint about the service in the past 12 months. This complaint was around poor communication and care practices and Southern Cross (provider) investigated the complaint and responded to the complainant. Five safeguarding referrals have been made in the last 12 months, these related to staff care practices. Four of these referrals were investigated by the East Riding of Yorkshire Council safeguarding team and one was investigated by the Provider. The outcomes of the investigations resulted in three staff leaving the service after disciplinary procedures were followed and staff training in medication administration and moving/handling was revisited and refresher training provided. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People in the home are provided with a warm, safe and comfortable place to live that welcomes visitors and makes them feel at home. The home is clean and staff work hard to make sure the building is odour free. The home is welcoming and has a relaxed atmosphere. People living there said they are happy with their bedrooms and can bring in their own possessions, making it feel more like home. People being cared for have good access to professional medical staff and are able to access external services such as dentists, opticians, physiotherapists, chiropody and dieticians, so their health is looked after and they are kept well. What has improved since the last inspection? What they could do better: The home needs to paint and decorate more of the communal areas and bedrooms to make sure people have a pleasant environment in which to live. The laundry floor needs to be sealed to make sure that infection control measures are adequate and effective within the environment. Newly employed Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.2 Page 7 staff who have little or no experience of care work must undergo a comprehensive induction which meets skills for care criteria so that they can develop the skills and knowledge necessary to meet the needs of the people using the service. We would like to thank everyone who completed a survey or spoke to us during this visit. Your comments are very important to us and ensure this report includes the views of people who use the service or work within it. 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. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 and 3 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People wanting to use the service undergo a needs assessment and are given sufficient information about the home and its facilities prior to admission, to enable them to be confident that their needs can be met. EVIDENCE: Three people’s care and records were looked at as part of this visit, they each have been provided with a statement of terms and conditions/contract on admission and these are signed by the person or their representative. These documents give clear information about fees and extra charges, which are reviewed and kept up to date. Each person has his or her own individual file and the funding authority or the home, before a placement is offered to the individual, completes a need Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 10 assessment. The home develops a care plan from the assessments, identifying the individual’s problems, needs and abilities using the information gathered from the person and their family. Discussion with the manager indicated she goes out to assess individuals who have expressed an interest in coming into the home, and each person is given information about the service and life in the home. A letter offering a placement to an individual is sent out prior to their admission. Staff we spoke to said ‘people are made to feel welcome; we try our utmost to help people settle in and feel safe’. One person using the service told us ‘I am happy and content, the service looks after me well and I love my room’. The home does not have any intermediate care beds and therefore standard six does not apply to this service. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health, personal and social care needs of people using the service are clearly documented and are being met by the service and staff. The medication at the home is well managed promoting good health. EVIDENCE: Information given to us in people’s surveys, and during discussions on this visit with people using the service, indicates that individuals are satisfied with the care they receive and enjoy life in the home. Seven people said that ‘staff listen to us and take action when needed’, and one person commented that ‘the staff are wonderful and make me laugh, and this makes my day’. Discussion with the managers indicated that the care plans in the home were re-written and updated in June 2009, to improve the quality of the information within them. Those we looked at were person centred, detailed the needs and abilities of individuals and set out the actions required by staff to ensure peoples wishes and choices are respected and their care needs met. In Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 12 addition to this information there are risk assessments to cover daily activities of life, and clear information about health and input from professionals and the outcomes for people. People said that they have good access to their GP’s, chiropody, dentist and optician services, with records of their visits being written into their care plans. They all have access to outpatient appointments at the hospital and records show that they have an escort from the home if wished. Comments from the people using the service indicate they are satisfied with the level of medical support given to them. Entries in the care plans specify where individuals have dietary needs, including supplements or thickened drinks and pureed diets. The staff weighs everyone on a regular basis and evidence in the plans show that dieticians are called out if the home has particular concerns about an individual. Information from the Annual quality assurance assessment and discussion with the manager indicates that there have been five people admitted with pressure sores to the home in the past twelve months. The manager told us that the home has a good working relationship with the district nurses and tissue viability nurses. Pressure areas are monitored carefully and proactive measures include risk assessments and special mattresses and seat cushions. Checks of the medication show the home is using Boots the Chemist as their pharmacy supplier and the medication system in use is a Monitored Dosage System (MDS) where tablets are supplied in a ‘pop out’ sheet. At our last visit in July 2008 we made three requirements about medication practices and these were ‘The registered person must ensure that accurate records are kept of all medicines received, administered and leaving the home or disposed of, to ensure there is no mishandling’. ‘The registered person must ensure that medicines in the custody of the home are handled according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society and the Misuse of Drugs Act 1971. Staff must ask if people require their pain relief medication in accordance with their prescription’. ‘The registered person must ensure that people who wish to self medicate, undergo a robust risk assessment before the decision for or against the matter is decided’. Checks at this visit found the requirements have been met. We looked at the medication records and found that these are up to date and completed to an acceptable standard. Where a person is prescribed pain relief medication, the Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 13 staff are clearly recording where they have asked a person if it is required and when it is administered. Information from the manager is that staff undertake a daily audit of the medication paperwork to ensure it is completed correctly and the manager carries out a monthly audit. Checks of the controlled drugs and register showed that these are up to date, accurate and well managed. People we spoke to were very positive about the service, staff and the care they received. Three people told us ‘the staff are lovely, they are very helpful and always around when you need them’. Observation of the service showed there is good interaction between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives. One person we chatted to described their morning care routine, which involved use of the hoist for getting into and out of the bed, bath and chairs. They told us ‘I have confidence in the staff whilst using the hoist and they ensure that my dignity and comfort comes first during the care processes. I am able to decide when I want to get up or go to bed, I see the district nurse regularly for checks of my pressure areas and staff are very good about putting cream on my legs and giving me my medication’. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with choice and diversity in the meals and activities provided by the home. Individual wishes and needs are catered for and people have the option of where, when and how they participate in both eating and leisure activities. EVIDENCE: The home employs an activities co-ordinator for 16 hours a week, Monday to Friday, these hours are due to go up to 30 per week from 1 October 2009. During our visit we sat with people in the garden, they had enjoyed doing bingo and a quiz earlier on in the afternoon and then had drinks out in the sunshine. Three people told us how much they enjoyed getting outside and that they were looking forward to a trip out the following day and one to Eden Camp the next week. There is a weekly plan of activities which is on display in the reception area of the home and individuals are able to put forward ideas of any activities/outings they wish to go on. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 15 At the time of our visit in August 2009, there were no church services held within the home, although the manager said anyone wishing to attend a service would be helped to access those in the community. The home provides special meals and cakes for birthdays and helps people celebrate all major Christian festivals such as Easter, Harvest Festival and Christmas. Discussion with the people living in the home indicates that they have good contact with their families and friends. Everyone said they were able to see visitors in the lounge or in their own room and they could go out of the home with family. Visitors told us that they can come into the home when they like and that they are always made welcome. Staff told us that the manager has an open door policy for staff, relatives and visitors which works well and ensures people can talk about any issues they may have. People spoken to were well aware of their rights and said that they had family members who acted on their behalf and took care of their finances. There is some information and advice on advocacy and this is on display in the home. Information from the Annual Quality Assurance Assessment indicates that the home holds meetings for relatives and people using the service where they can discuss any issues around care or the service. Discussion with the two managers indicated that both have attended formal training on the Mental Capacity Act and Deprivation of Liberty Standards, and understood how these affected individuals within a care home. We were told that this training would be cascaded down to other staff members as part of their training programme. Staff who have completed or are doing their NVQ’s in care have received some training around equality and diversity matters, and disability discrimination legislation. This type of training ensures that staff have sufficient knowledge about human rights legislation, so they understand individual rights within the care home and out in the community. We recommended that the registered person should ensure that all staff receive training on equality/diversity and disability discrimination. Observation of the midday meal showed it to be well prepared and presented, and the kitchen staff had made an effort to provide soft diets in an attractive way. Staff were organised when serving the meal and a number of individuals were seen to offer assistance to people who need help with eating and drinking. People and relatives are pleased with the quality and quantity of the meals served, saying ‘the food is very good and there is always a choice given’. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were assessed People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system with some evidence that people feel that their views are listened to and acted upon. Visitors and people using the service are confident about reporting any concerns and the manager acts quickly on any issues raised. EVIDENCE: In April 2009 there was a meeting with the Social Services, Care Quality Commission inspector and the operations manager for Molescroft Court to discuss a number of concerns and complaints about the service. Since this meeting the service has worked hard to change care practices and improve communication with people using the service, their families and friends. A further meeting in June 2009 showed that outcomes for people were much improved and individuals were confident in the way the home was handling complaints. The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is also on display within the home. People’s survey responses showed individuals have a clear understanding about how to make their views and opinions heard and those people spoken to said ‘the manager listens to any issues and takes action when needed to sort them out’. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 17 Information from the Annual Quality Assurance Assessment (14/7/09) and checks of the complaints record showed that there have been 7 complaints made to the home in the past 12 months and that the manager has responded to four of these and resolved the issues. The remaining three complaints are still being investigated. The manager completes audits of the number and type of complaint received as part of the quality assurance system within the home. In the past 12 months there have been 5 safeguarding referrals made, two referred to falls in the home; one was around poor moving and handling, one related to medication and one around verbal abuse. These have been investigated by the East Riding of Yorkshire safeguarding team and resolved. The home followed through its disciplinary procedures for three staff members, who subsequently left the service and additional medication and moving/handling training was given to the staff. Over the past 4 months the home has improved its reporting of any safeguarding allegations in line with the Local Authorities guidelines and works with the safeguarding team to improve practises and protect those people living in the home. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of people’s money and financial affairs. People who use the service told us that ‘I am happy and content living in the home, and I have no complaints’, ‘I feel safe and well looked after’, and ‘things are done as needed, any issues are listened to’. The staff on duty displayed a good understanding of the safeguarding of adults procedure. They are confident about reporting any concerns and certain that any allegations would be followed up promptly and the correct action taken. The staff training matrix given to us on 25 August 2009 shows there is an ongoing training programme for staff to attend safeguarding of adults awareness training and that 77 of staff attended this in the past year. Information from the staffing matrix indicates that staff have attended the following training in the past year, customer care 63 , Dementia awareness 69 and challenging behaviour 57 . Information from the Annual Quality Assurance Assessment says that the home plans to improve on their recent success in handling complains and safeguarding referrals by encouraging staff to use the whistle blowing policy and by coaching individuals to improve practice through personal awareness and development. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26 were assessed People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recent investment has significantly improved the appearance of this home, creating a comfortable and safe environment for those living there and visiting. EVIDENCE: The home has an ongoing maintenance and refurbishment programme and the manager was able to show us the work that has been completed in the past 12 months and discuss work that is planned for this year. The Annexe All the accommodation in this area is provided with a bedroom and sitting room. There is a small dining area in the corridor and a small conservatory for people using the service. Information from the maintenance plan indicates that eight rooms are waiting for new carpets; redecoration and furnishings, others in this area have been refurbished. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 19 The Haven All the bedrooms in the Haven are en-suite. New furniture has been purchased for the dining room and the staff are waiting for new chairs and flooring for the corridors. Curtains and accessories for the haven have been bought and put up. At the moment the nurse’s station is in the dining area, this is not ideal but a lack of space means there is no where else for this purpose. Eight bedrooms in this area are waiting for new carpets, redecoration and furnishings, and five rooms have been updated. The House This area of the home has one lounge and a dining room with a conservatory off it. The lounge requires decorating, new carpet and furnishings, the dining room and conservatory have been decorated but the latter area needs new blinds and furniture. Seven bedrooms require decorating, new carpets and furniture and five others have been refurbished and decorated. Discussion with the manager indicates that plans are in place to have a new concrete ramp built to the front door, so people can use this as the main entrance. This work is hoped to be completed by the end of December 2009. There are plans to convert two existing toilet areas into a new shower room and toilet facility, as the toilet areas are not ideal for the current client group and are in desperate need of redecoration. Walking around the home we saw that there is damage to the side of the ‘House’ door near to the Annexe. The manager told us a new door is on order and that the area would be re-plastered when it is fitted. Discussions during this visit indicate that people using the service are satisfied with the laundry service provided by the home. The main laundry room requires the floor sealing where an old boiler has been removed to prevent seepage from infected linen/clothing into the concrete. The room itself is quite small and not ideal for this facility, but again lack of space in the home prevents it being relocated elsewhere. We asked the manager to ensure that staff keep the laundry door shut when no-one is in the room, as a fire safety precaution. Infection control policies and procedures are in place, and staff have access to good supplies of aprons and gloves for use in personal care. The staffing matrix supplied to us on 25 August 2009 indicates that infection control training is part of the rolling programme of training and that 74 of staff attended this in the last 12 months. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were assessed People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff training and recruitment practices are good, resulting in a workforce that interacts positively with people to improve their whole quality of life. EVIDENCE: There has been a relief management team in the home for the past four months and the changes this has brought about are viewed positively by the staff and people using the service. Individuals told us ‘the new management team have done a wonderful job of turning the service around and the home has improved’. Information from the Annual Quality Assurance Assessment (14/7/09) indicates that the home encourages staff towards personal and professional development and provides clear leadership with regular supervision and appraisals. Disciplinary procedures are enforced to ensure that only the best staff are there to care for people’s needs. The manager told us that staff morale is higher now than it has been for some time, and staff are beginning to feel appreciated. At the time of this visit there were 36 people in the home and the staffing levels are split between the three units. The Annex and the House each have two care staff on from 8am to 2pm and two from 2pm to 8pm; the Haven has Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 21 three staff from 8am to 2pm and two staff on duty from 2pm to 8pm. At night (8pm to 8am) there are five care staff working around the home. Information from the Annual Quality Assurance Assessment about the number of staffing hours provided, and information gathered during the visit about the dependency levels of the people using the service, was used with the Residential Staffing Forum Guidance and showed that the home is exceeding the minimum hours asked for in the recommended guidelines. 43 of care staff at the home have an NVQ 2 or above in care and there are seven staff doing the NVQ 2 training and eight doing NVQ 3. We found that the home does not have an induction for new care staff, which meets Skills for Care criteria. The registered person must ensure that new staff with no previous knowledge of caring, undertake this type of induction in order to develop the necessary skills and knowledge to meet the needs of those using the service. The majority of employees are up to date with safe working practice training including health and safety, fire, moving and handling, first aid, safeguarding of adults and infection control. The home has an equal opportunities policy and procedure. Information from the staff personnel and training records and discussion with the manager, shows that this is promoted when employing new staff and throughout the working practices of the home. The home has a recruitment policy and procedure that the manager understands and uses when taking on new members of staff. Checks of four staff files showed that police (CRB) checks, written references, health checks and past work history are all obtained and satisfactory before the person starts work. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 were assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home is satisfactory overall and the home regularly reviews aspects of its performance through a good programme of audits and consultations, which includes seeking the views of people using the service, staff and relatives. EVIDENCE: There has not been a registered manager at the home since 2007; the acting manager was due to undergo her interview with the Care Quality Commission when she went on long term sick leave. Since June 2009 there has been a relief management team in place at the home, and a number of improvements to the environment and care practices have taken place to ensure the home continues to offer a good service to the people who use it. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 23 The home has achieved the local council’s quality award (QDS) parts one and two. Feedback is sought from the people living in the home and relatives through regular satisfaction questionnaires, and the manager produces a development report as part of this process to highlight where the service is going and/or indicate how the management team is addressing any shortfalls in the service. Recent changes to the service as part of the quality audits and stake holder feedback include reviewing of the care plans, a new statement of purpose and service user guide, additional cleaning hours, re-decoration of the home, new furniture and furnishings, new moving and handling equipment, new crockery and new bedding, pillows and towels. Meetings for people using the service are held once a month and relative meetings are every three months; minutes are circulated to anyone who attended or has an interest in these. Staff have monthly meetings with the manager and everyone is encouraged to join in with discussions and voice their opinions. People and staff agreed that the open door policy used by the manager is effective and encourages individuals to feel confident about talking about issues and the service in general. Policies and procedures within the home are being reviewed and updated to meet current legislation and good practice advice from the Department of Health, local/health authorities and specialist/professional organisations. The manager completes in-house audits of the home and its service on a monthly basis, and the registered individual does spot checks and completes the regulation 26 visits. Checks of the finance systems within the home found that computerised records are kept for people’s personal allowances; the administrator on a weekly basis up dates these, and they are checked monthly by the provider. Information from the Annual Quality Assurance Assessment indicates the majority of people have their families looking after their financial affairs, and checks of the system show their relatives top up the person’s individual allowance account on a regular basis. People who have asked the home to look after their personal allowances are able to access their money on request, and receipts are kept for any transactions. All monies are kept safe and secure within the home and only the administrator or manager has access to the funds. Maintenance certificates are in place and up to date for all the utilities and equipment within the building. Accident books are filled in appropriately and regulation 37 reports completed and sent on to the Commission where appropriate. Staff have received training in safe working practices and the manager has completed generic risk assessments for a safe environment within the home. Risk assessments were seen regarding fire, moving and handling, bed rails and daily activities of living. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 24 Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23(2) Requirement The registered person must ensure that all parts of the home are reasonably decorated and furnished. The registered person must ensure that the laundry floor finishes are impermeable and readily cleanable. The registered person must ensure that new staff, who have no previous experience of care work, complete an induction which meets Skills for Care criteria. Timescale for action 01/04/10 2. OP26 13(3) 01/04/10 3. OP28 18 01/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP14 OP26 Good Practice Recommendations The registered person should ensure that all staff receive training on equality/diversity and disability discrimination. The manager should ensure that staff keep the laundry room door closed when they are not in the room. DS0000069699.V377619.R01.S.doc Version 5.3 Page 27 Molescroft Care Home 3. 4. OP28 OP31 The registered person should ensure that 50 of the staff have an NVQ 2 in care, or its equivalent by the end of June 2010. The registered person should submit an application to the CQC for the registration of a manager by the end of December 2009. Molescroft Care Home DS0000069699.V377619.R01.S.doc Version 5.3 Page 28 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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