Care Home: Molyneux Park Rest Home

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What the care home does well Molyneux Park is run by experienced Registered Providers who are committed to running the home as a family business. Prospective residents are given appropriate written information about the home before they move in, enabling them to make an informed choice. Residents enjoy living in a comfortable, clean, attractive, well decorated and furnished environment. They benefit from suitable facilities and equipment, which help to maintain their independence. Residents are treated with dignity and respect and are recognised as individuals able to exercise choice over their lives. Their privacy is valued. Residents changing personal, health and social care needs are met and reflected in care plans. All current residents benefit from support from staff to manage their medication. Residents spoken with feel suitably occupied and can choose to take part in group activities or pursue their individual interests; they enjoy keeping in contact with their relatives and friends. Residents are provided with good quality and varied meals. Residents benefit from a well established staff team who care for, understand and anticipate their needs and wishes. The views of residents and their representatives are listened to and receive appropriate consideration. They benefit from their views being sought about how the home is run. Procedures are in place, which aim to protect residents from abuse. Residents are protected by the system in place for safeguarding their finances. Their health and safety is promoted by the testing and maintenance of systems and equipment in the home. What has improved since the last inspection? The Registered Providers have worked hard to address the problems highlighted at the last key inspection. Many improvements have been made. However these improvements need to be sustained in order to maintain the current Quality Rating for the home. One of the Registered Providers continues to work with hands on care duties. This practice ensures that the personal care of residents is maintained. However it is the Registered Providers responsibility to continue to ensure that all the necessary management duties are undertaken in order to comply with current legislation. Improvements since the last key inspection include the following: 1. Assessments for residents mental capacity are now in place in care plans. 2. The system for controlled drugs has been reviewed; these are now dispensed into a cassette by the supplying pharmacist and the register has been changed to that of a bound book. 3. The Registered Providers ensure that all minor complaints are recorded. . The last key inspection identified shortfalls in record keeping. Since then records have been updated. 5. The last key inspection identified shortfalls in care plan documentation. Since this time, all care plans and risk assessments have been reviewed, rewritten and use a new format. It is the Registered Providers responsibility to continue to ensure that care plans record all residents health and welfare needs and how these are to be met. 6. The last key inspection identified that some residents expressed frustration that there was insufficient stimulation. Since then the home has increased the amount of activities offered to residents and a record is now kept. 7. During this visit it was observed that there were enough staff on duty to meet the needs of residents. It is the Registered Providers responsibility to continue to ensure there are sufficient staff available at all times to meet all the needs of residents. 8. The last key inspection identified shortfalls in staff recruitment documentation. Since then no new staff have been employed; however new documentation has been developed ready for use. The Registered Providers assured us that these records would be used when recruiting new staff in future. It is the Registered Providers responsibility to continue to ensure evidence of all the necessary pre employment checks for staff applicants. What the care home could do better: 1. Residents are put at risk by inadequate staff training. Staff must be provided with all the mandatory training and updates they require to meet the needs of residents. It is the Registered Providers responsibility to comply with current legislation and a requirement has been made. This needs to be addressed in order to maintain the current Quality Rating for the home. 2. One current resident was not assessed before they moved into Molyneux Park. All residents must be assessed prior to admission to ensure the home can meet their needs. It is the Registered Providers responsibility to comply with current legislation and requirement has been made. 3. The Registered Providers are recommended as good practice to: Continue developing a formal system for evaluating the quality of the service; Ensure formal 1:1 staff supervision is undertaken and recorded more frequently; Ensure that all hand written medication administration entries are signed by two members of staff as double checked; Confirm that all risks to residents and the action needed to reduce these are recorded; care plan evaluations are recorded in detail. Consider a barrier between the car parking area and back garden. Key inspection report Care homes for older people Name: Address: Molyneux Park Rest Home 38 Molyneux Park Road Tunbridge Wells Kent TN4 8DY     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: Helen Martin     Date: 3 0 1 0 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 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) 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 33 Information about the care home Name of care home: Address: Molyneux Park Rest Home 38 Molyneux Park Road Tunbridge Wells Kent TN4 8DY 01892544322 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Colin Wallis,Mrs Sheila Wallis care home 16 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 16 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Molyneux Park Rest Home is registered to provide personal care and accommodation to sixteen older people. It is owned and managed by Colin and Sheila Wallis. The home is located in a quiet residential area of Tunbridge Wells near to local shops. There is a nearby bus service into the centre of Tunbridge Wells; the town contains a large shopping centre and local facilities. The main line railway station is near the town centre. Accommodation at the home is on three levels with access to upper floors via stair Care Homes for Older People Page 4 of 33 Over 65 16 0 1 9 0 5 2 0 0 9 Brief description of the care home lifts. Most rooms are for single use; and three of these have en-suite facilities. Communal areas consist of a lounge, dining room and conservatory. There is a staff call system and each room has a television point. There is a small garden and patio to the rear of the building with a lawned area, which is available for residents to use. The current fee levels range from 308.00 to 400.00 pounds per week, depending on the room available, and the assessed dependency needs of individual residents. There are additional costs for hairdressing, toiletries, chiropody and newspapers and magazines. 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: Molyneux Park provides care and accommodation for up to sixteen older people. Currently there are twelve residents. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This Key Unannounced Inspection included a visit to the home in Tunbridge Wells on 30th October 2009, where both Registered Providers, one Carer, the Cook and several Service Users were spoken with. Some judgements about the quality of the service provided were taken from observation and conversation. Some records and documents were looked at together with the premises and facilities of the home. For the previous two key inspections, Molyneux Park has been rated as 1 star, meaning people who use the service experience adequate quality outcomes. Because of this an Care Homes for Older People Page 6 of 33 improvement plan was requested. The main purpose of this visit was to assess any improvements or outstanding issues from the last Key Inspection undertaken on 19th May 2009. Any other information received since the last Key Inspection has also been reviewed. All of the above have been included within this inspection process and some of the gathered evidence is mentioned within this report where appropriate. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? The Registered Providers have worked hard to address the problems highlighted at the last key inspection. Many improvements have been made. However these improvements need to be sustained in order to maintain the current Quality Rating for the home. One of the Registered Providers continues to work with hands on care duties. This practice ensures that the personal care of residents is maintained. However it is the Registered Providers responsibility to continue to ensure that all the necessary management duties are undertaken in order to comply with current legislation. Improvements since the last key inspection include the following: 1. Assessments for residents mental capacity are now in place in care plans. 2. The system for controlled drugs has been reviewed; these are now dispensed into a cassette by the supplying pharmacist and the register has been changed to that of a bound book. 3. The Registered Providers ensure that all minor complaints are recorded. Care Homes for Older People Page 8 of 33 4. The last key inspection identified shortfalls in record keeping. Since then records have been updated. 5. The last key inspection identified shortfalls in care plan documentation. Since this time, all care plans and risk assessments have been reviewed, rewritten and use a new format. It is the Registered Providers responsibility to continue to ensure that care plans record all residents health and welfare needs and how these are to be met. 6. The last key inspection identified that some residents expressed frustration that there was insufficient stimulation. Since then the home has increased the amount of activities offered to residents and a record is now kept. 7. During this visit it was observed that there were enough staff on duty to meet the needs of residents. It is the Registered Providers responsibility to continue to ensure there are sufficient staff available at all times to meet all the needs of residents. 8. The last key inspection identified shortfalls in staff recruitment documentation. Since then no new staff have been employed; however new documentation has been developed ready for use. The Registered Providers assured us that these records would be used when recruiting new staff in future. It is the Registered Providers responsibility to continue to ensure evidence of all the necessary pre employment checks for staff applicants. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 9 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are given appropriate written information about the home before they move in, enabling them to make an informed choice. One resident was not assessed prior to admission; therefore the home was not sure if they could meet their needs when they moved in. Evidence: Previous inspection identified that the statement of purpose and service users guide are provided together in one folder for prospective residents and enquirers to view; these include the aims and objectives of the home, the complaints procedure and the homes philosophy about the right of residents to be treated as individuals. During this visit, the Registered Providers stated that the documents and the service provided by the home remained the same. Usually, one Registered Provider or a senior carer carry out a preadmission Care Homes for Older People Page 12 of 33 Evidence: assessment to determine if the home can meet the needs of the person concerned; they also obtain a joint assessment from Social Services. During this visit, this was confirmed for one resident. However another had no recorded preadmission information. One Registered Provider explained that this individual was admitted to the home in an emergency and that information could not be accessed from the local authority. It is the Registered Providers responsibility to comply with current legislation, which requires that accommodation is only offered after assessment to ensure that an individuals needs can be met. A requirement has been made. The home does not provide any 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. Residents changing personal, health and social care needs are met and reflected in care plans. Care plans may benefit from a review of risk assessments and evaluations. Residents are protected by the systems in place for the administration of medication, although this could be improved by double checking hand written records. Evidence: Individual plans of care for each resident are developed. These aim to identify the action required from staff to meet residents personal, social and health care needs. The last key inspection identified shortfalls in care plan documentation. Since this time, all care plans have been reviewed, rewritten and use a new format. During this visit four care plans were looked at. These are clear and easy to follow; the new format enables the different aspects of care to be separately evaluated, and Care Homes for Older People Page 14 of 33 Evidence: demonstrates the progress or deterioration of separate items. Issues identified in care plans are according to individuals needs and include: mobility, diet, personal care, continence, memory loss and monitoring for the risk of pressure sores. Assessments for residents mental capacity are now in place in all care plans seen. Residents are weighed monthly and this is recorded. Care plans now contain some biographical information, social history, and a tick list record for preferred activities. One Registered Provider stated that where possible residents and their relatives are involved in their care planning. Signatures from residents and relatives were seen. Ongoing information and any updates to the care plan are included in the daily notes; those seen were written in adequate detail, signed and dated with the time of entry. One Registered Provider explained that evaluations of care plans and risk assessments were recorded every two months from any changes highlighted in the daily notes. Evaluations seen were recorded in brief detail; one Registered Provider stated that any changes are made in the care plan. Records showed that the vast majority of records are dated between August and October 2009, however four records are dated June 2009. One Registered Provider assured us that all care plans and risk assessments will be evaluated shortly. Since the last key inspection, all risk assessments have been reviewed, rewritten and use a new format. Risks identified include bathing, using the hoist and chairlift, walking, tripping & falling. Discussion took place with the Registered Providers about specific assessments for moving and handling and nutrition. The Registered Providers assured us that any plan of care and.or risk associated with moving and handling and nutrition was adequately identified within the formats developed since the last key inspection. The same risks are identified for all residents. The Registered Providers are recommended as good practice, to review risk assessments to confirm that all risks to residents and the action needed to reduce these is recorded; care plan evaluations should be recorded in greater detail. It is the Registered Providers responsibility to comply with current legislation, which requires that care plans record all residents health and welfare needs and how these are to be met. Residents health care needs are met. These are monitored and recorded in care plans. These show that health and social care professionals are accessed to support staff to meet residents needs including consultation and referral to medical professionals. At Care Homes for Older People Page 15 of 33 Evidence: the time of this visit staff were seen to use appropriate moving and handling techniques. Systems are in place within the home regarding the administration of medication, which aim to protect residents. Currently no residents manage their own medication and all benefit from support from staff to do so. Medication is stored in a locked cupboard, and is mostly administered using a cassette system. There is a separate cupboard for storing controlled drugs, and this meets the specifications. Since the last key inspection the system for controlled drugs has been reviewed; controlled drugs are now dispensed into a cassette by the supplying pharmacist; the controlled drugs register has been changed to that of a bound book. Medication Administration Records, MAR charts, are well completed with clear details and signatures. However, not all handwritten entries are signed as double checked by two members of staff. The Registered Providers are strongly recommended as good practice, to ensure that all hand written administration entries are signed by two members of staff as double checked. Residents are treated with dignity and respect. During the visit, staff were observed to be kind and helpful, attend to residents needs in privacy and respond quickly when needed. There is a good rapport between residents and staff. Staff spoken with demonstrated a good understanding of individuals needs and described their roles well. Residents spoken with indicated that staff looked after them very well and thought them very good. One resident spoke with staff are very good and come immediately when I use the emergency buzzer. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are recognised as individuals and are able to exercise choice over their lives. Residents spoken with felt suitably occupied and choose to take part in group activities or pursue their individual interests; they enjoy keeping in contact with their relatives and friends. Residents can choose what they eat and are provided with good quality and varied meals. Evidence: People move into Molyneux Park knowing the nature of the service. The pace of daily life is relaxed. People can choose whether to spend time in their rooms or in the communal areas of the home. At the time of this visit, residents were at ease talking with staff who responded appropriately and listened to their views. Residents spoken with had no complaints. One resident spoke with said Molyneux Park is a very nice place; I could not wish for anywhere better; staff are very good. Another explained that they enjoyed living here; Care Homes for Older People Page 17 of 33 Evidence: had no complaints or concerns; the staff are very nice; everything runs smoothly; I am very happy. There is a suggestions box in the front hall, and this is occasionally used. The last key inspection identified that some residents expressed frustration that there was insufficient stimulation. Since the last key inspection the home has increased the amount of activities offered to residents and a record is now kept. Records show activities such as physical motivation exercises, Holy Communion, quiz, music and films. At the time of this visit residents enjoyed listening to an audio book; one resident enjoyed a visit from their relatives and went out for the day; they were looking forward to watching their favourite TV programme when they got back. Comments made by residents spoken with included: I enjoy listening to the audio book short stories; also the music, I enjoy singalongs to the old ones very much; I think the activities we have are good; I like the discussions we have and quizzes; I enjoy the keep fit; I enjoy listening to music; it is a pleasant life. A member of staff said that residents enjoyed bingo, card making and a visiting pet dog. Residents are encouraged to keep in contact with their relatives and friends if they wish. Visitors are welcome at any reasonable time. This includes ministers of religion, who can visit according to residents wishes. Visitors can spend time with the residents in the lounge, the dining area, the conservatory, or residents own rooms. There is a telephone available for use, and conversations can take place in private. The Registered Providers have a minibus. Residents can be taken out for trips in the summer months and this was confirmed by staff spoken with. The Registered providers explained that currently this was difficult because of staff sickness but hoped this would be resolved by the summer. The last key unannounced inspection identified that care staff are supported by a cook each day, and by a cleaner three days per week; care staff duties include preparing breakfasts and teas, dealing with laundry and providing activities for residents in addition to assistance with their personal care. This inspection identified that although the number of staff on duty has not changed, activities for residents have increased. It is the Registered Providers responsibility to comply with current legislation, which requires that there are sufficient staff available at all times to meet all the needs of residents. Residents are encouraged to bring in their own items to personalise their rooms, and are invited to choose colours for redecoration when this is taking place. Residents Care Homes for Older People Page 18 of 33 Evidence: spoken with enjoyed their meals and described the quality and quantity of the food as very good. The menu is planned in advance and shows a variety of meals. Breakfasts and teas are prepared and given out by care staff. The main meal is provided at lunchtime by the cook. As this is a small home, the cook prepares one main meal, but provides an alternative for those who do not want this. The cook demonstrated a good knowledge of individuals preferences and keeps a record of their likes and dislikes. In addition there is a list of approximately eight hot and cold choices, which are always available. A diary is kept to record residents meals and choices. On the day of this visit a carer and one owner were helping to provide the food and drinks at teatime; there was a relaxed atmosphere. The menu for the day is displayed in the dining room, which also contains a mineral water and coffee dispenser. One resident said the food is good; I can eat as much as I want and staff know what I like and do not like. Another mentioned that they particularly enjoyed the banana sandwich they had for tea; they explained that the staff gave them something different from everyone else because they knew they liked it. 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. The views of residents and their representatives are listened to and receive appropriate consideration. Procedures are in place, which aim to protect residents from abuse. Evidence: At the time of this visit, residents were at ease talking with staff who responded appropriately and listened to their views. Residents spoken with had no complaints about their care. One resident spoke with said Molyneux Park is a very nice place; I could not wish for anywhere better; staff are very good and I have no complaints. Another explained that they enjoyed living here; had no complaints or concerns; the staff are very nice; everything runs smoothly; I am very happy A written complaints policy and procedure is available for residents and their representatives. There is a suggestions box in the front hall, and this is occasionally used. The owners keep a notebook as a complaints log, which contained one entry from one resident about a minor issue. One Registered Provider stated that they would change the format of the bound book to loose leaf, in order to be in line with data protection. The Registered Providers have an understanding of safeguarding procedures, and reporting any abuse. Written procedures are available for safeguarding vulnerable Care Homes for Older People Page 20 of 33 Evidence: adults. Staff training issues are mentioned under the Staffing section of this report. 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. Residents enjoy living in a comfortable, clean and attractive environment. Residents benefit from suitable facilities and equipment, which help to maintain their independence. Molyneux Park is well maintained, although residents safety and quality of life may be enhanced by some improvement to the garden. Evidence: The premises are an older style detached house, with communal rooms and some bedrooms on the ground floor; and more bedrooms on the first and second floors. The premises are well maintained and attractively decorated. One of the Registered Providers carries out all of the day to day maintenance work. The home has a well maintained front garden, and a small back garden with a lawn and a few shrubs. There is a small area to sit out in good weather. The back garden does not have any barrier to separate it from the car parking area. At the last key inspection the Registered Providers were recommended that this should be considered for safety, as well as making the garden feel like a separate area. No changes have yet been made. Communal areas consist of a dining area with double doors through to a lounge; and double doors from the lounge lead through to the conservatory. Care Homes for Older People Page 22 of 33 Evidence: As this is an older house, the bedrooms are of different sizes, and have differing facilities. Some have ensuite toilet and.or shower facilities; and one has an ensuite assisted bath. Bedrooms are personalised according to residents choice. The first and second floors can be accessed via chair lifts. The home has a sufficient number of shared bathrooms and toilets. There is a bathroom on the first floor which has an assisted bath; and a disabled toilet and a walkin bath on the ground floor. All radiators are fitted with guards, and baths and wash basins are fitted with thermostatic valves. One of the Registered Providers checks the hot water temperatures, and carries out wheelchair checks, and checks for other equipment such as Zimmer frames and window restrictors. The kitchen and laundry area are situated on the lower ground floor. There is a keypad lock on the door at the top of the stairs to safeguard residents from the stairs. The kitchen is small but tidy, clean and well organised. The home has been given a gold good hygiene award two years running by the environmental health officer. The laundry arrangements are for two washing machines and two tumble dryers in a large cupboard space. The premises were clean in all areas and free from offensive odours. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well established staff team who care for, understand and anticipate their needs and wishes. Residents are protected by the improvements put in place for future staff recruitment. Residents are put at risk by inadequate staff training. Evidence: A good rapport was observed between residents and staff, who were attentive and respectful during the visit. Residents spoken with indicated that staff are good and look after them well. One resident spoke with said Molyneux Park is a very nice place; I could not wish for anywhere better; staff are very good and come immediately when I use the emergency buzzer. Another explained that they enjoyed living here; the staff are very nice; everything runs smoothly; I am very happy. The staff team is mainly well established and very familiar with the needs and personalities of residents. Staff spoken with enjoyed working at the home. The last key unannounced inspection identified that the usual staffing levels are for two care staff throughout the day, and one waking night staff, and one sleeping night staff; one of the Registered Providers was carrying out hands on care duties; they stated that this can occur frequently to cover for other staff shifts. During this visit it Care Homes for Older People Page 24 of 33 Evidence: was identified that this situation continues to be the same; one of the Registered Providers continues to work with hands on care duties. This practice ensures that the personal care of residents is maintained. However it is the Registered Providers responsibility to ensure that all the necessary management duties are undertaken in order to comply with current legislation. The last key unannounced inspection identified that care staff are supported by a cook each day, and by a cleaner three days per week; care staff duties include preparing breakfasts and teas, dealing with laundry and providing activities for residents in addition to assistance with their personal care. This inspection identified that although the number of staff on duty has not changed, activities for residents have increased and numbers of residents have decreased. During this visit it was observed that there were enough staff on duty to meet the needs of residents at this time. It is the Registered Providers responsibility to comply with current legislation, which requires that there are sufficient staff available at all times to meet all the needs of residents. During this visit the procedures for staff recruitment were looked at. The last key inspection identified gaps in documentation needed to evidence appropriate recruitment procedures. Since the last inspection staff files have been updated. Three staff files were looked at during this visit. These showed appropriate pre employment checks, although they did not show the dates of education received nor the date the applicant started work in the home. One Registered Provider assured us that no new staff had been employed since the last key inspection. Following the last key inspection, the home has developed new documentation for the future employment of staff, which includes the facility to record reasons for gaps in employment, interview questions and answers, including qualifications and the date the applicant started work in the home. The Registered Providers assured us that these records would be used when recruiting new staff. It is the Registered Providers responsibility to comply with current legislation, which requires evidence of all the necessary pre employment checks for staff applicants. The last key inspection identified that, as a staff training matrix was not available, we were unable to confirm that all staff had received all mandatory training, and relevant updates. Since the last inspection staff training records have been updated. Three staff training records were looked at during this visit. Although two out of three staff have obtained a National Vocational Qualification and can evidence induction booklets, records clearly show that staff are not being provided with all the mandatory training and updates they require to meet the needs of residents. For example, two staff have not received food hygiene training, whilst another undertook this last in 2004; in addition the cook is overdue to undertake an update in food hygiene training Care Homes for Older People Page 25 of 33 Evidence: as their previous certificate expired in March of this year. Whilst two staff have up to date training in moving and handling, one has none. One member of staff received training in the protection of vulnerable adults in 2007, provided by a previous employer, whilst the other two have none. Entries for training in the prevention of fire show dates of 2009, 2007 and none. It is the Registered Providers responsibility to comply with current legislation, which requires that all staff must be provided with all the necessary training to meet all the needs of residents. A requirement has been made. Care Homes for Older People Page 26 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. The home is run by experienced Registered Providers. Residents benefit from their views being sought about the care they receive and how the home is run, although this may be improved by the continued development of a formal system for evaluating the quality of the service. Residents financial interests are safeguarded. Residents are protected by the homes record keeping policies and procedures. Residents benefit from well supported staff, although this may be improved by an increase in formal recorded supervision. The health and safety of residents is promoted by the testing and maintenance of systems and equipment in the home. Care Homes for Older People Page 27 of 33 Evidence: The Registered Providers are committed to running the home as a family business, and work long hours to ensure that residents care needs are met and maintenance is undertaken. The last key inspection identified that one of the Registered Providers was carrying out hands on care duties; they stated that this can occur frequently to cover for other staff shifts. During this visit it was identified that this situation continues to be the same; one of the Registered Providers continues to work with hands on care duties. This practice ensures that the personal care of residents is maintained. However it is the Registered Providers responsibility to ensure that all the necessary management duties are undertaken in order to comply with current legislation. The providers are on hand most days, and know the residents very well. At the time of this visit, residents were at ease talking with staff who responded appropriately and listened to their views. Residents spoken with had no complaints about their care. One resident spoke with said Molyneux Park is a very nice place; I could not wish for anywhere better; staff are very good. Another explained that they enjoyed living here; had no complaints or concerns; the staff are very nice; everything runs smoothly; I am very happy. There is a suggestions box in the front hall, and this is occasionally used. The last key inspection identified that the Registered Providers were in the process of asking residents or relatives to complete a very detailed survey. During this visit, one Registered Provider stated that these had now been returned and that one formal residents meeting had taken place. Residents benefit from their views being sought about the care they receive and how the home is run. However, the Registered Providers are strongly recommended as good practice, to continue developing a formal system for evaluating the quality of the service. Staff are very supportive of residents, and many have worked at the home for some years. The Registered Providers stated that staff are supported to undertake their roles on a day to day basis. Staff spoken with confirmed this and described how the Registered Providers were helpful and available. Formal 1:1 supervision does take place, although records showed that this should be more frequent. The Registered Providers are recommended as good practice, to ensure that formal 1:1 supervision of staff is undertaken and recorded on a regular basis. The providers do not handle any residents monies. If residents are unable to manage their own finances, then a representative is arranged. Assessments for individuals mental capacity are now in place in all care plans seen. One Registered Provider stated that where possible residents and their relatives are involved in their care planning and signatures from residents and relatives were seen. Care Homes for Older People Page 28 of 33 Evidence: A number of records have been looked at as part of this inspection and these have been mentioned within this report where appropriate. Any accidents and incidents are usually recorded in both daily notes and on accident and incident forms. One incident which took place on 19th October 2009 is recorded in daily notes only. One Registered Provider stated that this was an oversight which would be corrected immediately. Records generally indicate the testing and maintenance of systems and equipment within the home. The premises and the accommodation are monitored with the aim that potential hazards to the health and safety of residents can be identified and addressed. The kitchen is small but tidy, clean and well organised. The home has been given a gold good hygiene award two years running by the environmental health officer. Care Homes for Older People Page 29 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 30 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 3 14 The Registered Person shall not provide accommodation to a service user at the care home, unless the needs of the service user have been assessed, The Registered Person has obtained a copy of this; the home is suitable for meeting the service users needs. In order to ensure that the home can meet the needs of service users when they move in, assessments must be undertaken prior to admission. 02/11/2009 2 30 18 The Registered Person shall: 31/03/2010 ensure that at all times suitably qualified, competent and experienced persons are working at the care home; ensure that the persons employed to work at the care home receive training appropriate to the work they are to perform Page 31 of 33 Care Homes for Older People 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 In order to protect service users, all staff must be provided with all the necessary training to meet all the needs of service users. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 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). 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. 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