Care Home: Moor Cottage

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• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
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• The Maypole Nursing Centre
• The Briars

What the care home does well Arrangements for pre admission assessments ensure no service user moves into the home without having his or her needs assessed and being assured that these can be met. Care plans contained a good level of detail to ensure staff would be aware of residents` preferences in relation to their care. During the inspection staff were observed to be respectful to residents, and all four relatives who returned surveys to the Commission ticked `Always` to the question about whether the service respected peoples` privacy and dignity. Residents are offered a balanced diet including home cooked meals and cakes and those spoken with commented favourably on the food at the home. Special diets are arranged as necessary, and those who required a soft or liquidised meal had this presented in an appetising way. Specially adapted plates and cutlery have been supplied for residents who need these to enable them to be more independent at meal times. Moor Cottage offers a very well furnished and homely environment, and is kept clean, pleasant and hygienic. Residents` bedrooms are comfortable and personalised and it was noted that many people had brought their own furniture as the majority of rooms were quite spacious. All residents spoken with commented positively on their rooms, and surveys returned from relatives commented on the good standards, including one who said `The home is spotlessly clean.` The garden is well laid out with colourful flowerbeds and a rockery for residents to enjoy. There are also vegetable beds which some residents help to water, and plenty of seating areas. Those residents spoken with said the garden was well used when the weather was nice. The home exceeds the recommended percentage of staff who have a qualification in care work, with all 15 staff having at least an NVQ Level 2 in care. The AQAA stated that the home has good relationships with the local professional community. A local authority care manager who was spoken with following the inspection confirmed this. She said that in relation to assessing new clients, she felt the home was `Service user orientated, and had good working relationships with local health and social care professionals.` Four surveys were returned from relatives and they had only praise for staff at the home. All four ticked `Always` to the question about whether the care service responded to the diverse needs of individual people, and several positive comments were added, such as `I find all the staff at Moor Cottage cheerful, helpful and extremely dedicated.` The manager responded very positively to the inspection process. The majority of shortfalls identified during the inspection had been either partially or completely remedied by the time this draft report was ready to be sent out. What has improved since the last inspection? The Requirements and Recommendations made at the previous inspection have all been met including revising the statement of purpose, reviewing the security of medication storage, and developing the home`s safeguarding adults policy. A handrail that needed to be re fixed has been completed, and servicing of hoists is up to date. An improved format is being used for the initial assessment of new residents, and for their care plans, in line with the Berkshire Care Association recommended format. Residents now have individual activities care plans. A number of environmental improvements have taken place including employing a permanent gardener who has improved the grounds of the home and made the garden much more pleasant and interesting for residents to enjoy. A shower room has been refurbished to provide a wet room, making it more accessible for residents with a mobility impairment. New furniture has been purchased for the lounge providing a stylish yet homely environment for residents who use this room. The home now has a website which provides all the necessary information for prospective residents. In house training has been improved and the home now uses an accredited trainer, who is the manager of another local home, to carry out training at Moor Cottage. What the care home could do better: Arrangements for the administration of medication need to be reviewed. Staff numbers, as well as recruitment procedures, also need further work. Requirements have also been made in relation to quality assurance and health and safety. Key inspection report Care homes for older people Name: Address: Moor Cottage High Street Cookham Berkshire SL6 9SF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Dickens     Date: 0 9 0 9 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: Moor Cottage High Street Cookham Berkshire SL6 9SF 01628526036 01628530621 info@moorcottagecare.co.uk www.moorcottagecare.co.uk Mrs Rana Rezajooi care home 17 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 17. The registered person may provide the following category/ies 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 Moor Cottage is a three storey house located toward the end of the High Street in the picturesque village of Cookham in Berkshire. It is close to village amenities, such as shops, pubs and restaurants and there is a church nearby. A regular bus service running between Maidenhead and High Wycombe stops outside of the home and there is a railway station outside of the village, connecting with mainline services. The home has accommodation for up to 17 people but recently has changed some double occupancy rooms into singles, reducing maximum occupancy to 14. The home is set in well maintained gardens and is well decorated and furnished. People can bring Care Homes for Older People Page 4 of 33 Over 65 17 0 Brief description of the care home in their own furniture as most rooms are quite spacious. Work has now been completed on creating the new conservatory which has improved facilities for residents. Fees ranged from £550 to £900 per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key Inspection was unannounced and took place over 8 hours. The inspection was carried out by Mrs. Helen Dickens, Regulatory Inspector. The Registered Manager Mrs. Helen King, represented the establishment. A tour of the premises took place and a number of files and documents, including four residents care plans, staff training records, two recruitment files, and quality assurance information, were examined as part of the inspection process. Residents, staff and a visiting relative were spoken with, and the results of surveys returned to the Commission prior to this inspection were also included in this report. The Annual Quality Assurance Assessment, completed by the manager and returned to CQC before the inspection, was used during the inspection, and in writing this report. The inspector would like to thank the residents, staff and the manager for their time, assistance and hospitality. Care Homes for Older People Page 6 of 33 Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 33 The Requirements and Recommendations made at the previous inspection have all been met including revising the statement of purpose, reviewing the security of medication storage, and developing the homes safeguarding adults policy. A handrail that needed to be re fixed has been completed, and servicing of hoists is up to date. An improved format is being used for the initial assessment of new residents, and for their care plans, in line with the Berkshire Care Association recommended format. Residents now have individual activities care plans. A number of environmental improvements have taken place including employing a permanent gardener who has improved the grounds of the home and made the garden much more pleasant and interesting for residents to enjoy. A shower room has been refurbished to provide a wet room, making it more accessible for residents with a mobility impairment. New furniture has been purchased for the lounge providing a stylish yet homely environment for residents who use this room. The home now has a website which provides all the necessary information for prospective residents. In house training has been improved and the home now uses an accredited trainer, who is the manager of another local home, to carry out training at Moor Cottage. 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. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements for assessments ensures no service user moves into the home without having his or her needs assessed and being assured these can be met. Evidence: The AQAA states To help residents decision making process before selecting a home we have created an online website that includes all the necessary information. Prospective residents and their families are encouraged to visit Moor Cottage before a choice is made. A pre-admission assessment is always carried out by a member of staff qualified to do so. Four residents files were sampled during the inspection, including the file for the most recently admitted resident. This person was also interviewed and raised no concerns in relation to the admission process. They had had the opportunity to visit the home in advance of moving in. Care Homes for Older People Page 11 of 33 Evidence: All residents have the homes own assessment on file, and this covers basic information for example on their past medical history, and their needs in relation to activities of daily living. Risk assessments are drawn up at this stage including for example on the subject of falls, nutrition, their dependency profile, and use of the bath chair. The inspector advised that more detail is needed e.g. for personal care. The manager said that when the full care plan was drawn up, more detail would be sought. This was found to be the case when care plans were seen for other residents. Those clients admitted through the local authority also have a care managers assessment. Four relatives completed surveys prior to this inspection and ticked that the home Always or Usually ensured accurate information was gathered and that the right service was planned for people. A local authority care manager who was spoken with following the inspection said that in relation to assessing new clients, she felt the home was Service user orientated, and had good working relationships with local health and social care professionals. Care Homes for Older People Page 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by having their care needs set out in an individual plan of care, and by the arrangements in place for meeting their social and health care needs in a respectful way. Arrangements for the administration of medication need to be reviewed to ensure the safety and welfare of service users. Evidence: The AQAA stated that each individual has their own care plan and they are involved in setting up the plan. Four care plans were seen and each covered the same relevant areas for example personal care, communication, mobility (keeping safe and comfortable) and nutrition. Specialist assessments and guidance had been sought as necessary for example speech and language therapy assessments, and referrals to the falls clinic. The manager said care plans are drawn up with the service user and their family as appropriate, though those seen which had been signed off, only had a family members signature. It was suggested residents be asked to sign these off. It was noted that care plans did contain detailed guidance for staff on each residents Care Homes for Older People Page 13 of 33 Evidence: preferences e.g. personal care. A separate template is on file for activities which looks at peoples strengths and weaknesses in relation to activities, though more detail was needed on these. Each residents file had a social history for that resident, records of doctors visits, and records of any other appointments such as the optician or chiropodist. All the care plans seen had been reviewed each month. The home ensures peoples health needs are met in a number of ways. Residents files showed specialist assessments are sought as needed, and residents have a variety of risk assessments in relation to maintaining their health. For example everyone has a nutritional risk assessment (using the recommended MUST tool) and is weighed monthly. In addition, the cook was interviewed and found to be knowledgeable on residents dietary needs including those who required a soft diet, and those who were diabetic. Some residents also have dietary supplements. Waterlow risk assessments are carried out for each resident to assess their risk of pressure sores and action is then taken to minimise the risk. The manager also does a monthly dependency assessment for each resident so that the home can monitor their changing needs. During discussions with the inspector, it was clear that the manager was very knowledgeable on the individual health and social care needs of each resident at Moor Cottage. She said that being a small home, and having a hands on approach, means she does know all the residents well. Records showed that continence advice has been sought and recorded, and the GP visits the home once per month and reviews all the residents. District nurses also visit the home and records are kept of what treatment or advice is given. Visits by other health professionals are arranged and recorded for example the dentist, optician and chiropodist. Care plans clearly noted if residents had dentures, hearing aids and other aids, and how the staff needed to support them, for example making sure their hearing aids had batteries. The surveys returned from four residents relatives all showed that the social and healthcare needs of residents are properly monitored, reviewed and met by the care service. The AQAA stated that the home ensures residents receive medication in a safe and consistent manner. The home uses the Nomad system of medication administration and their arrangements are inspected six monthly by the local pharmacist. The last report from the local pharmacist in March 2009 showed no significant shortfalls. The medication administration records (MARS) for each resident had a photograph as a means to identify the correct resident during medication administration, and there was a list of sample signatures from the staff who are trained to give medication. Each Care Homes for Older People Page 14 of 33 Evidence: MAR sheet contained a note of allergies, and in addition to the medication policy, there was also a homely remedies policy. During the inspection the Controlled Drug records were examined and some shortfalls were noted in relation to record keeping and the measurement of liquid medication. The following day advice was sought by the inspector, from the CQC Pharmacy Inspector, and this was passed to the registered manager. In the meantime, the registered manager had already contacted the local pharmacist who carries out inspections at the home, and asked if further staff training could be arranged. This has now been planned for the end of September. An appointment has also been made by the manager for the local pharmacist to visit the home and look at their arrangements for administering controlled drugs. During the inspection the manager was also asked to review the way as required medication is recorded, and also the use of a keysafe to store the medication keys. On both matters, the manager sought advice the following day, and agreed to make the changes advised by the local pharmacist immediately. A Requirement is made at the end of this report in relation to medication. Staff were seen to be respectful to residents throughout the day and were seen to knock on doors before entering. Residents were heard being given choices, and generally spoke highly of the staff, with the only complaint being that there werent enough of them sometimes. All four relatives who returned surveys ticked Always to the question about whether the service respected peoples privacy and dignity. The current practice of having various notices around the home, for example in relation to bathing, and of not ensuring that incontinence pads etc are stored away out of sight could be detrimental to maintaining residents dignity, and certainly detracts from the otherwise homely ambience that the manager and staff are trying to maintain. The manager said these shortfalls would be remedied, and more suitable arrangements made. Care Homes for Older People Page 15 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More work needs to be done to ensure residents have the opportunity for purposeful and stimulating activities. Arrangements for maintaining contact with family and friends are satisfactory, but there is limited opportunity for being part of the local community. Service users are given some opportunities to exercise choice and control over their daily lives. Residents are offered a balanced diet including home cooked meals and cakes, in pleasant surroundings, though the mealtime experience could be improved by having more staff on hand. Evidence: The AQAA states that Moor Cottage provides a flexible approach to the daily life and social activities for residents. It also states that there is a varied weekly programme of activities, and a healthy varied diet is offered to residents daily. During the inspection it was noted that each resident has an activities care plan in place which outlines their interests. There is also a weekly programme of activities which the manager said care staff follow with residents.The home has a lovely garden and residents were seen to be using this. The new gardener has provided very attractive flower beds, and there are now two separate vegetable gardens; the manager said two residents in particular have shown an interest in these and now help Care Homes for Older People Page 16 of 33 Evidence: with watering. Communal and individual TVs are available in the home, and some residents said they liked listening to their radio. Some residents were also seen to be enjoying their daily paper. There is a visiting hairdresser and all residents looked well groomed. The manager said three staff (including herself) are trained in the provision of activities. Some one to one activities take place such as assisting one resident with flower arranging, and another who likes to grow vegetables has been supported to have tomato plants in their room. However, Moor Cottage has no dedicated activities worker and the inspector observed that staffing numbers are not sufficient for the home to provide activities support in any significant or consistent way. There were two afternoon staff to monitor fourteen residents whose bedrooms are over 3 floors, (and on a nice day some may be in the garden), ensure any personal and toileting needs are met, serve afternoon tea, and carry out social activities. Comments from relatives, including those made on surveys, noted that one way to improve the service would be to enable residents to be taken out. When asked, the manager said the planned summer outing hadnt happened yet but they were hoping to arrange a river trip. Another relative thought it would be nice to see more attention to activities as there did not seem to be much happening in the afternoons. The home will be asked to review their current arrangements to ensure that all residents have the opportunity to take part in stimulating and purposeful social activities. The home welcomes visitors and one relative who was interviewed said staff were always friendly and offered them a refreshment when they were at the home. Another wrote on their survey to the Commission; I find all the staff at Moor Cottage cheerful, helpful and extremely dedicated. One lounge can now be used as a quiet area for visitors, though most residents have large bedrooms which can comfortably accommodate their visitors. Those residents who were spoken to said their visitors were always made welcome. In relation to choice and autonomy, residents were seen to be given choices and to have a say in how they spent their day. Residents are encouraged to bring personal possessions and those rooms seen were very personalised. As most rooms are spacious, there was plenty of room if residents wanted to bring their own furniture, pictures and other memorabilia. Those residents spoken with all said they were happy with their rooms. Choice in relation to meals was somewhat limited and this is Care Homes for Older People Page 17 of 33 Evidence: discussed below. The limited choice of activities has already been discussed. The dining room offers a pleasant dining experience and residents are served home cooked food prepared by an experienced cook. The cook has qualifications in catering and is currently doing a further course in nutrition. She was interviewed and found to be knowledgeable on residents dietary needs including soft diets and diabetic meals. Those who needed special diets had their meals presented in an attractive way. Special adaptations for example cutlery and plates are provided as necessary to support residents to be independent. The manager ensures a nutritional risk assessment is carried out on all residents, and they are weighed regularly. Those who need to see a dietitian or other specialist are supported by the home to do this. One resident was referred to the speech therapist in relation to swallowing difficulties. Some residents have also been prescribed food supplements. On the day of the inspection residents had toad in the hole for lunch, and home made fairy cakes for afternoon tea. The inspector spoke with residents at several tables in the dining room at lunchtime and a number of favourable comments were made on food including: Food very nice here; Cant complain. Todays lunch was good; and Food is enough. Variation is reasonably good. A number of issues were raised with the manager for attention in relation to meals. The dining room is cramped and it was difficult for staff to sit near residents who needed help to eat; one staff member stood to assist a resident who needed occasional help, and the manager dealt with this immediately. Some residents required meals and assistance in their rooms, and others needed help in the dining room, so staff were stretched as one resident commented, and staffing arrangements will need to be reviewed to ensure there are sufficient staff on duty to support residents in a relaxed manner over the lunch period. It was also noted that only one hot main course is offered daily and the alternative was a cheese sandwich. The cook said residents could ask for other alternatives such as an omelette. The manager and cook said they would review arrangements to ensure there is a choice of hot main course each day, and the options would be clearly stated on the menu. They also agreed to display a menu on each table in the dining room. Following the inspection, the manager confirmed by telephone that she had done this. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users and their relatives are confident that their complaints would be listened to, though the arrangements in place for carrying out recruitment checks could potentially compromise the safety of residents. Evidence: The complaints procedure is displayed in the home, and the manager said she ensures that she speaks to each resident at least once per week to check that everything is alright and they have no concerns. There is a suggestions box and a complaints book and the home has a whistleblowing policy in place. Four relatives who completed surveys for the Commission all ticked that the service had responded appropriately if they had raised any concerns. Two complaints have been made to the Commission since the last inspection which were passed to the local authority to consider under their safeguarding procedures. The manager had noted in the AQAA that a complaint had been made and that a safeguarding investigation had been carried out. In relation to safeguarding vulnerable adults, the AQAA returned by the service states that the home has: -Zero tolerance to any form of abuse of residents -Straightforward policy and procedure to respond to any complaint or incident reported -Whistleblowing policy that safeguards and protects -Training -All staff have CRB and Povafirst clearance. Care Homes for Older People Page 19 of 33 Evidence: The home has a copy of the local authority safeguarding procedures and the manager said she would refer to these in the first instance. There is also an in-house policy though this needs to be reviewed. This was discussed with the manager who was clear about how the wording needed to change. Following the inspection she confirmed this had been done following consultation with the local authority. On the issue of CRBs etc, there were shortfalls in staff recruitment records which were found during the inspection that could have had an impact on the safety of residents, and these shortfalls are outlined under the section on staffing. In addition, a shortfall in the administration of medication was found and passed to the local authority for consideration under their safeguarding adults procedures. Care Homes for Older People Page 20 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. Moor Cottage offers a very well furnished and homely environment, and is kept clean, pleasant and hygienic. Evidence: The AQAA states the home provides a safe, clean and comfortable environment. A tour of the premises took place and all the communal areas and four residents bedrooms were visited. Residents bedrooms were comfortable and personalised and it was noted that many had brought their own furniture as the majority of rooms were quite spacious. All residents spoken with commented positively on their rooms. A number of environmental improvements have been made since the last inspection including building a conservatory which several residents said they enjoyed sitting in; this was well used throughout the day. They have also replaced a shower with a wet room which was nearly finished on the day of the inspection. New furniture has been purchased for the lounge, and communal areas were seen to be very comfortably furnished. The home is maintained in a very homely way throughout. The garden is well laid out with colourful flowerbeds and a rockery for residents to enjoy. There are also vegetable beds which some residents help to water, and plenty of seating areas. Those residents spoken with said the garden was well used when the weather was nice. On the day of the inspection some residents were seen walking in the garden. Care Homes for Older People Page 21 of 33 Evidence: The home was found to be clean and pleasant throughout and there were no unpleasant odours. A survey from a relative noted that Moor Cottage is spotlessly clean. Domestic staff were seen cleaning bedrooms and bathrooms. The AQAA states that the home has and action plan to deliver best practice in the prevention and control of infection, and 8 staff have received training in infection control. Care Homes for Older People Page 22 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 would benefit by a review of staffing levels to ensure there is sufficient support to meet their needs in a relaxed and unhurried way. The home exceeds the National Minimum Standards recommendation about the percentage of their staff with a qualification in social care. Recruitment arrangements need to be reviewed to fully protect service users. Residents benefit by the training arrangements in place at this home. Evidence: A staff rota is in place and the manager went through this with the inspector. There are two staff plus the manager each morning and afternoon, two staff in the evening, and one waking staff member overnight. On the day of the inspection the manager was on leave and came in especially when she realised there was an inspection. A third person introduced herself as a volunteer helping with administration. Training records showed staff had a range of skills, training and experience. Domestic staff are employed to keep the home clean and to provide the main meals for residents. The manager completes a monthly dependency risk assessment for each resident to enable her to monitor whether staffing levels are appropriate to meet residents needs. Some discussion followed as the inspector felt there were insufficient staff. A number of issues highlighted throughout the day showed the staffing arrangements must be reviewed. For example, the care staff do not have time to support residents Care Homes for Older People Page 23 of 33 Evidence: in any meaningful or consistent way with stimulating activities and there is no activities organiser at this home. Staff were observed to be very busy at lunchtime as some residents needed assistance to eat, and some remained in their rooms and needed support there. One person commented to the inspector that staff are stretched at supper time. This was observed by the inspector as there were still only two staff and they also had to prepare the light supper, serve it, and assist residents who need help to eat. Having only one staff member at night must also make it difficult to manage the current residents. Residents rooms are over 3 floors and some have moderate to high needs, including needing help to eat and drink, to get to the toilet, or may be confused and need supervision. Two service users have been assessed as needing to move to nursing care so will require even more support until their move can be arranged. A Requirement is being made that the provider review the staffing levels to ensure the safety and welfare of residents. The AQAA states that all 15 staff have at least an NVQ Level 2. During the inspection the manager said that some staff are qualified nurses from overseas but can only be counted as trained to NVQ level. This exceeds the NMS recommendation that at least 50 of staff should have a qualification in social care. In the AQAA summary, the home stated that All staff employed have been CRB checked and are safe and fit to practice. The inspector asked to see four staff files, and two of these were examined in detail. For the other two, the inspector only asked to see their CRB checks. One of these two had a CRB check, and the other did not. The two files which were examined in detail showed staff had an application form on file, a record of their induction and training, and a copy of their photographic identification. Where applicable, the manager also seeks evidence that overseas staff are allowed to work in this country. Neither had a full employment history or complete references. There was no record of when they completed their full time education so it was difficult to know when a full employment history would have started. One person had no CRB or pova first check. The home had obtained a copy of a previous CRB and this person was working under supervision. The other person had also started without a CRB or POVAfirst check, but the full CRB had come through a month after they started working at the home. Care Homes for Older People Page 24 of 33 Evidence: Staff must not work in a care home without the information set out in Schedule 2 of the Care Homes Regulations, and a copy of this was taken by the manager. This covers references, including from the staff members last care employer, and a full employment history. Staff may, in extenuating circumstances, start work without the full CRB as long as a POVAfirst, and all other checks have been carried out and are satisfactory. Extenuating circumstances may include for example, a care worker who needs to start soon as the home is short of care staff which may put service users at risk. The manager said she was now clear about recruitment checks and would ensure the home followed the relevant Regulations and Guidance. Following the inspection she confirmed by telephone that she had gone through all staff files and was in the process of addressing any shortfalls found. Asked whether the home had followed the local authority recommendation to them to get the free immigration service check on their staff, the manager said they are intending to do this and their administrator was collating staff details ready to send off. Training arrangements are well developed at Moor Cottage and the manager has a central training record containing details of all staff training. The records of the two new staff members were sampled. Both had done training on moving and handling, safeguarding adults, infection control, nutrition and fire safety. Training is mainly provided in-house by a trainer from another care home. New staff work through the skills for care induction folders. A third staff training record was sampled for a staff member working at the home that day and they had also received relevant training including medication training and Mental Capacity Act training. Four surveys were returned from relatives and they had only praise for staff at the home. All four ticked Always to the question about whether the care service responded to the diverse needs of individual people, and several positive comments were added, such as I find all the staff at Moor Cottage cheerful, helpful and extremely dedicated. Care Homes for Older People Page 25 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit by the competency and professionalism of the current manager. Quality assurance processes could be further developed to ensure the home is monitoring the quality of the service provided, and that they are making any improvements in a timely way. Service users benefit by the arrangements for assisting them with their personal spending. Health and safety arrangements need to be reviewed. Evidence: The new manager has been in post since November 2007 and is Registered with the Commission. She was the deputy manager for two years prior to being appointed as the manager. She has recently completed her NVQ 4 in Care and is starting the new registered managers qualification at Thames Valley University. The manager demonstrated that she is knowledgeable on the needs of residents and has a professional approach to her work. She had a positive response to the inspection process and was keen to rectify any shortfalls, and take any advice on current best Care Homes for Older People Page 26 of 33 Evidence: practice. She keeps her own knowledge and training up to date, for example medication training from the local pharmacist. There are clear lines of accountability within the home, with a deputy standing in for the manager in her absence. The home has a number of quality assurance processes in place including monthly Regulation 26 visits on behalf of the provider. The manager described how an environmental audit is carried out each month including bedrooms and communal areas in the home. Service user surveys are given out 6 monthly, and a summary of responses is collated. Other audits include medication audits of the Nomad boxes which are now done at each handover, and ad hoc checks of medicines contained in other packaging. Care plans are reviewed monthly, and the the manager also checks that reviews are carried out on risk assessments and other care records. There is currently no annual development plan, though clearly there is ongoing maintenance and development at the home, for example improving facilities (a new conservatory and a wet room), internal decor, and the much improved garden. However, shortfalls outlined during the inspection demonstrate the homes own quality assurance processes are not working well and a Requirement is being made for these to be reviewed. The home does not manage residents finances but they do allow individuals who wish to, to keep money securely at the home. Each resident has a separate wallet and they or their family will supply the initial cash balance. A written record is kept of money going in and out and receipts are obtained. One wallet was checked and the written record corresponded with the cash in the wallet. The home currently gives the relatives the receipts and the written record once the money has been spent. It was suggested that the manager keep copies for her own records. The manager said she is responsible for health and safety and a number of health and safety checks and procedures are in place. Staff are trained in health and safety which is a mandatory course at this home, and equipment such as hoists and bath seats are regularly checked and serviced. The gardener does minor maintenance work and larger jobs are done by external contractors. Annual checks are carried out on the gas, and PAT tests are carried out on electrical appliances. Policies are in place on moving and handling, health and safety, COSHH (hazardous substances such as cleaning materials), and fire safety. The manager said a fire risk assessment is in place and fire extinguishers are serviced annually. The manager said she does weekly tests on fire alarms, and monthly tests on emergency lighting. Care Homes for Older People Page 27 of 33 Evidence: However, a number of shortfalls were noted during the inspection. Risk assessments are needed for the toiletries which are left out in bathrooms and bedrooms. One resident needs a risk assessment in their own right due to their particular circumstances, and this was discussed with the manager. There were unclear arrangements for the prevention of legionella, and the manager was not aware of any risk assessment in relation to legionella. It is recommended that the local environmental health officers advice be sought, and the manager should consult the health and safety executive website for information and guidance on the prevention of legionella in care homes. Following the inspection the manager confirmed by telephone that these risk assessments had been carried out and toiletries had been put away. She was awaiting confirmation from the environmental health officer that the new legionella risk assessment was satisfactory. The issue relating to recruitment shortfalls, which could also have an impact on the safety of residents, has been dealt with earlier in this report. A number of positive comments were made on the manager and staff during the day and on the surveys returned to CQC. These included The service provides a gentle, sympathetic attitude to all residents and all four surveys ticked Always to the question about whether the manager and staff had the right skills and experience to support peoples social and health care needs. Throughout the inspection the manager had a very positive attitude to correcting any shortfalls and the majority of these had been either partially or completely rectified by the time the draft report was sent to the home. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be reviewed to ensure the safe administration of medication, including training in relation to the administration and clear recording of the use of Controlled Drugs. For the health and welfare of service users. 30/09/2009 2 12 16 Arrangements must be improved to enable residents to engage in local, social and community activities. Residents should be consulted on improving these arrangements. To improve the well being of residents and ensure there is suitable stimulation available. 09/11/2009 3 27 18 A review must be carried out 09/10/2009 to ensure there are sufficient staff employed to ensure the personal, health and social Page 30 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 care needs of residents are met. For the safety and welfare of service users. 4 29 19 All the information set down 09/10/2009 in Regulation 19 and in Schedule 2 of the Care Homes Regulations 2001 (as amended) must be sought for all staff including a CRB and POVAlist check, a full employment history, and satisfactory references. For the safety and welfare of service users. 5 33 24 The home must review the current quality assurance processes to ensure any shortfalls are identified and dealt with in a timely way. For the welfare of service users. 6 37 13 Health and safety arrangements must be reviewed to ensure any potential risks to residents are identified and reduced as far as possible. For the safety and welfare of residents. 09/10/2009 09/11/2009 Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 10 Arrangements for the recording of as required medication should be reviewed to ensure staff record the use of this medication in a consistent way, and in line with advice from the pharmacist. The home should ensure that there are too main meal options each lunchtime as discussed during the inspection. The in house policy on safeguarding vulnerable adults should be reviewed to ensure it closely reflects the local authority procedures and guidance on this subject. The home should obtain the Guidance from the CQC website relating to CRB checks for staff and ensure this is incorporated into the homes employment and recruitment policy. The manager should consult the local environmental health officer, and the HSE website, for advice and guidance on the prevention of legionella in care homes. 2 3 15 18 4 29 5 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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