Care Home: Moor Villa

What the care home does well The staff team at Moor Villa has remained stable for a period of time and staff changes are infrequent. This means that staff get to know people living at the home very well and the relationship observed between staff and residents was warm, friendly and caring. People`s individual wants and needs are well known to staff so that people living at the home can be supported in the way that they like. Routines are flexible so that as far as possible, people can enjoy a life style of their choice. Staff training is considered important so that the staff group have the skills and abilities to provide a good standard of care. What has improved since the last inspection? There has been some improvement to the internal and external areas of the home. The vast majority of windows have now been replaced by double glazing units and the front door refurbished. Fascia boards, gutters and down spouts have all been renewed and new radiator guards have been provided in various areas of the home. The lounge areas and some bedrooms have been refurbished that has include new curtains, bedding and a number of beds have been replaced. The downstairs bathroom has been provided with a new toilet, new flooring and has been redecorated. All this has helped to provide a more attractive and inviting environment for people living at the home to enjoy. Further members of staff have achieved a more advanced National Vocational Qualification (NVQ) in care. A member of staff has also obtained a tutoring diploma and the registered manager has successfully completed the Registered Managers Award. Other training that has taken place includes, health and safety training, challenging behaviour training and dementia awareness training. This helps to make sure that the staff team are well qualified to care for the people living at the home. A member of staff has now been given dedicated periods of time to spend on one to one activity in the community with individual resident`s. This has included visits to a local pub for a drink and a game of pool, visits to an ice cream parlour, some resident have been escorted to visit their family and visits to the local supermarket. Another lady enjoys a walk out each day with staff, sometimes for items from the local shops that is needed by the home. This has helped the resident to feel useful and valued as well as providing social stimulation and activity in the local community. What the care home could do better: There is a requirement that the registered homeowner produces a monthly report as to the conduct of the home. A copy of this monthly report should be given to the registered manager and made available for inspection. This has not been happening. The registered homeowner must confirm in writing that the home is bring managed properly and in the best interests of the people living there. The refurbishment of the internal and external areas of the home should be completed as soon as possible in order to make sure that all areas accessed by people living atMoor Villa are bright, welcoming and well maintained. It was recommended that a staff training matrix is developed to provide clear, concise detail of the training each member of staff has successfully completed, training that is required by individual members of staff, and when refresher training is due. Although a variety of environmental risk assessments are in place, there was no evidence that these had been reviewed since 2006. These should be reviewed as soon as possible to make sure that the information remains current or updated as required. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Moor Villa 53 Moor Street Kirkham Lancashire PR4 2AU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Denise Upton     Date: 0 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 35 Information about the care home Name of care home: Address: Moor Villa 53 Moor Street Kirkham Lancashire PR4 2AU 01772682884 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) : Mrs Savitree Seedheeyan care home 16 Number of places (if applicable): Under 65 Over 65 0 dementia Additional conditions: 16 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 16 Date of last inspection Brief description of the care home Moor Villa is registered to accommodate up to 16 people of either sex who have a diagnoses of dementia. The home is conveniently located on a main thoroughfare of the town and in close proximity to local community services and resources. Moor Villa is a detached property with communal space consisting of a large combined lounge/dining room and a smaller separate lounge area. Individual bedroom accommodation is located on the ground and first floor of the property and comprises of eight single bedrooms and four shared bedrooms. Although en-suite accommodation is not provided, there are sufficient bathroom and toilet facilities to fulfil the requirements of the standard. Visitors are made welcome at any time of the residents choice. Aids and adaptations are provided as required and all people living at the home have access to appropriate medical interventions. The current range of fees at Moor Villa and what is included in those fees can be obtained from the registered manager Care Homes for Older People Page 4 of 35 Brief description of the care home at the home. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection focused on outcomes for the people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The unannounced site visit took place during a mid week day and spanned a period of approximately seven hours. At the time of the site visit, fifteen people were in residence. Twenty two of the thirty eight standards identified in the National Minimum Standards - Care Homes for Older People were assessed along with a reassessment of the requirements and recommendations made at the last key inspection. Discussion took place with the registered manager, deputy manager and some brief discussion also took place with a small number of care staff as they went about their day to day tasks. Time was also spent observing people living at the home and the relationship between staff and residents as they went about the days activities. Individual Care Homes for Older People Page 6 of 35 discussion did take place with a recently admitted resident and other residents were spoken with in a communal area of the home. All those living at Moor Villa have various degrees of cognitive impairment therefore most conversations were brief and limited. Information was also gained from the annual quality assurance assessment (AQAA) completed by the deputy manager prior to the site visit taking place. This is a self assessment that focuses on how well positive outcomes are being achieved for people using the service. A number of records were viewed and a tour of the building took place looking at communal areas of the home, laundry, bathrooms and individual bedroom accommodation. Commission for Social Care Inspection surveys were also received from three people living at the home. The comments received from these people were all very positive. This helped to form an opinion as to whether Moor Villa care home was meeting the needs and expectations of the people who live there. The last key inspection at Moor Villa took place in April 2008. What the care home does well: What has improved since the last inspection? What they could do better: There is a requirement that the registered homeowner produces a monthly report as to the conduct of the home. A copy of this monthly report should be given to the registered manager and made available for inspection. This has not been happening. The registered homeowner must confirm in writing that the home is bring managed properly and in the best interests of the people living there. The refurbishment of the internal and external areas of the home should be completed as soon as possible in order to make sure that all areas accessed by people living at Care Homes for Older People Page 8 of 35 Moor Villa are bright, welcoming and well maintained. It was recommended that a staff training matrix is developed to provide clear, concise detail of the training each member of staff has successfully completed, training that is required by individual members of staff, and when refresher training is due. Although a variety of environmental risk assessments are in place, there was no evidence that these had been reviewed since 2006. These should be reviewed as soon as possible to make sure that the information remains current or updated as required. 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 set out 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 35 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 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People moving into Moor Villa are given information about the home and have their needs assessed so they will know if their needs can be met. Evidence: In order to ensure that residents are only admitted to Moor Villa care home if their health, personal and social care needs could be met, prior to admission the registered manager undertakes an assessment of peoples current strengths and needs in order to determine if the level of care and support required could be provided at the home. The individual is visited in their own home or in some cases, in hospital. Relatives are involved in the pre admission assessment process and a visit to the home may be arranged depending on circumstances. Since the last inspection, the contribution from relatives has become more detailed. Relatives are now asked to write a pen picture of the new resident including Care Homes for Older People Page 11 of 35 Evidence: information about their interests/hobbies, important dates and people, daily routines, a life history, religious needs and food likes and dislikes. This is especially important as most prospective and newly admitted residents cannot contribute much information because of their cognitive impairment. This collective information is recorded, which in some cases is supported by a Health and/or Social Services assessment of current needs and requirements. This combined information, helps to make sure that as much information as possible is gained in order for the registered manager to make an informed judgement as to whether the home could provide the care required. Records were viewed in relation to two residents that have been admitted to the home in the last twelve months. Documentation included, a pre admission assessment undertaken by the registered manager that was quite detailed. The pre admission assessment had identified a number of risks. Appropriate risk assessments had been undertaken in relation to those risks. Information from other agencies were also on file, for one person this included a pre discharge assessment from hospital. This combined information, along with the pen picture of the new resident provided by their family, formed the basis of the initial plan of care. As identified in the last inspection report, whilst it is apparent that the needs and requirements of people living at the home were being met, there is a requirement that any person that has been assessed for possible admission to a care home must receive written information following the pre admission assessment. This should confirm the outcome of the pre admission assessment and that the prospective residents current needs and requirements could be met at the home or alternatively that they could not be met. This should be provided prior to admission. There was still no evidence that this had occurred. Intermediate care is not provided at Moor Villa care home. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Moor Villa have their needs met and their care is provided in a manner that protects their privacy and dignity. Evidence: Following the assessment and admission process, an initial care plan is developed based on the information obtained. Three individual care plans were viewed. All contained detailed information to guide staff as to the level of support required for each individual resident. Care plans identified the individual strengths and needs of the resident and the action required by staff for a satisfactory outcome for each element of the care plan. This included areas such as personal care, hobbies and social interests, religious needs and requirements, medication, physical and mental health needs. Where a risk had been identified a formal risk assessment had been undertaken with the significant outcomes incorporated in the individual care plan. Action is taken to minimise or eliminate any identified risks. There was clear evidence that care plans and risk assessments are regularly reviewed Care Homes for Older People Page 13 of 35 Evidence: on at least a monthly basis or more frequently if needed. In respect of one recently admitted resident, the initial care plan had been significantly updated and rewritten. This shows that the management team respond well to changing needs and ensure that the staff team have current, up to date information available in order to give a good standard of care that is personalised to the individual. As recommended at the last inspection, record entries are now in the main, signed and dated, and the individual care plan is signed by the member of staff and the resident or more frequently by a relative. In these instances, time is spent with relatives to explain the content of the care plan and they are encouraged to ask any questions or or make further suggestions. One of the recently admitted residents was spoken with individually. Although this resident was very vague about her individual plan of care or being asked about what she liked or wanted, she confirmed that she liked being at the home, the staff were very good and that the food was good. As identified in this residents care plan, she enjoyed a walk out with a member of staff to the local shops and said that she always went out each day for a walk with the assistance of staff. Through observation, it was clear that staff had a very good understanding of each residents support needs and responded with sensitivity and care. It was evident through discussion, observation and documentation that residents health care needs are being fully met. This was also confirmed through comments in the resident Commission for Social Care Inspection (CSCI) surveys that had been returned. These confirmed that people living at the home received the medical attention that they needed when they needed it. Staff keep good records that includes details regarding health care. Records are kept of all contact with health care professionals such as General Practitioners, (G.P.) District Nurses, Dentists, Opticians. This means that it is easy to to find information and to track any specialist input. By listening to people living at the home, the services of an alternative optician has been secured. The company now used, specialises in providing a service to people with cognitive impairment and their input has been a great success. The new optician understands the needs of the particular client group accommodated at Moor Villa and does not try to rush residents and was reported to be very patient. Medication is safely stored and all staff have received appropriate medication training that is about to be updated. Since the last inspection the medication procedures have been updated to provide staff with current best practice recommendations. Residents that wish to do so are enabled to self administer their own prescribed medication following the outcome of a successful formal risk assessment, however in reality, is it Care Homes for Older People Page 14 of 35 Evidence: rare for a resident to have the ability to administer their own prescribed medication safely. Currently staff administer all medication. In the main, the medication administration records viewed had been completed correctly. Medication records include a photograph of the individual concerned and a record is kept of all drugs entering or leaving the home. This is good practice and helps to make sure that the prescribed medication is been given to the right person. The majority of medication is provided in blister packs direct from the supplying pharmacist. However it was noted that on two consecutive day for one resident, although one of the medications had been given, this was not reflected on the medication record. Whilst this appeared to be an oversight on an otherwise good system of medication administration and recording, it is important that the medication administration record is signed immediately after the medication has been given. This would help prevent any mistakes being made, provide a clear audit and ensure that the medication had been given as prescribed. It was also noted that short life medication (eye drops) had not been dated on opening. This is good practice and helps to provide a clear audit trail and also helps to prevent short life medication being used past its use by date. The supplying pharmacist visits the home at least annually to undertake a medication audit and is available to guide and advise staff. It was observed that the privacy and dignity of residents was well respected and that staff were sensitive and mindful of residents feelings. One resident told us on a survey form that I am very happy with the care I receive, couldnt fault it. All staff receive training in respect of maintaining privacy and dignity during their induction training and National Vocational Qualification (NVQ) training, a qualification that all staff working at the home have achieved. In addition, a new policy has been developed specific to Moor Villa that covers equality, diversity and discrimination. The information provided is detailed and provides clear guidance regarding residents rights and a commitment to uphold staff rights. Care Homes for Older People Page 15 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with activities and a variety of home cooked food, which they enjoy. Evidence: Staff obtain as much information as possible about the social, cultural, and leisure needs and interests of people living at the home. This means that staff have the information they need to make sure that the care and support provided is right for that person. For one person it was recorded on file that she liked to go out for a walk every day. Although unable to go out independently, it was seen that during the afternoon of the inspection visit, a member of staff went a walk with this resident to the local shops. As well as the social activity with the member of staff, this made the resident feel valued and that she was helping, something was was of importance to this person. One member of staff has now been given designated periods of time to spend with individual residents usually on a one to one basis to undertake community activities of the residents choice. This has includes visits to the local pub for a drink and a game of pool, escorting residents to visit their relatives in the community, shopping and visits to cafes and ice cream parlours. One resident likes to visit the cemetery regularly and Care Homes for Older People Page 16 of 35 Evidence: this is encouraged and provided for. Two other residents are also escorted out individually by other members of staff for a one to one outing each Wednesday. This information is recorded in their care plan for staff to follow. The abilities of residents is varied and some residents choose to do very little, this is respected. However almost all residents enjoy and respond well music. This is very much encouraged through listening and watching programmes on the television and radio, by inviting local choirs to visit the home, two monthly visits by an entertainer who plays an organ, and regular visits from a local Buddy Holly look alike entertainer. Consideration is also being given to introducing a singing group at the home to encourage residents to participate in singing songs of their choice with the aid of television music channels and C.D.s. There are good links with the local community including a local school choir that visit the home to entertain residents especially at religious festival periods. In the summer months it is planned that residents will be be enabled to take trips out further afield with staff in the staff members car. This will provide a different interest to those in the local community. Occasionally a mini bus is hired for specific activities, on the last occasion this was to visit Blackpool illuminations followed by a fish and chip supper. Birthdays are always celebrated as well as parties at Christmas, both at the home and at external venues. Activities in-house are kept flexible and dependent on what people living at the home would like to do on any particular day. This has recently included, large skittles, dominoes, Christmas and Easter card making, knitting, pampering sessions and knitting. Since the last inspection a large fish tank has been provided for the lounge. Residents were seen to be interested in the antics of the fish and also clearly enjoyed the company of the resident dog and cat. Because of the long standing staff group, the wants, needs and wishes of each resident are well known. Some residents enjoy a chat with staff at various times of the day either individually or with one or two other people. This is sometimes valued far more by residents than formal planned activities that they may not wish to participate in. The spiritual needs of people are recorded so that they can be given opportunity to continue to follow their faith if they wish. Representatives of several local churches visit the home to offer communion or to hold a service. One resident is also enabled to visit her local church every Sunday accompanied by long standing friends that still live in the local area. This shows that staff do try and meet the individual spiritual needs and preferences of each individual. Care Homes for Older People Page 17 of 35 Evidence: Records have now recently been kept of how people choose to spend their time and what activities they have joined in with. A written account of what activities had been undertaken over a ten-month period was viewed. It is now understood that a monthly account of activities undertaken by each resident is to be maintained. Whilst this is good practice, in order to maintain confidentiality it is recommended that activities enjoyed by each resident is recorded on a separate sheet. This can be a continuing record of activities enjoyed by one person over a period of time. This does not prevent a collective record of all activities provided or arranged to be recorded. People are encouraged to maintain contact with family, so that they can continue to be part of family life. Visitors are made welcome at any reasonable time and residents can entertain their guests in a communal area of the home or in the privacy of their individual bedroom accommodation. As identified at previous inspections, there appears to be a good, comfortable relationship between relatives and staff that clearly benefits people living at the home. Wherever possible, people living at the home are encouraged to exercises choice in their day to day lives. However, people living at Moor Villa have a diagnoses of dementia resulting in various degrees of cognitive impairment. Relatives or another advocates usually take on the responsibility for financial affairs. Advocacy information is available. People are able to bring personal possessions to the home to make their bedroom more homely and comfortable. People spoken with said they were happy with the meals provided. There is a free choice of foods at breakfast including a cooked breakfast if required, that can be taken in bed, the individual residents bedroom or dining room. Although there is a set two course menu at lunchtime, an alternative of the residents choice is always made available if required. There is a four week rotating menu, however this is kept flexible and dependent on the fresh foods available. Staff have recently received nutritional training to ensure a well balanced menu. A snack type meal in the late afternoon is also served. This teatime meal is of the residents choice. People are asked individually what they would like for tea and it was seen that a variety of different teatime meals were being served. Supper is served in the evening, hot and drinks are provided at regular intervals throughout the day or on request. On occasions, a resident may require their meal blended for ease of eating, this is done in such a way as to enable the resident to taste each element of the meal. As observed, staff assist residents at mealtimes discretely to maintain the dignity of the Care Homes for Older People Page 18 of 35 Evidence: person. One resident is diabetic and their menu is determined by this. Specialist diets in respect of medical, religious or cultural requirements can be provided if required. Menus are periodically changed to reflect the seasons and residents can influence menu planning through informal chats with staff or by suggestions made at resident meetings. One resident wrote on a Commission for Social Care Inspection (CSCI) survey that they had Never had a bad meal yet and another person told us that there was Always good home made food. Care Homes for Older People Page 19 of 35 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. There are good procedures so people who live in the home and their relatives are able to express their concerns and be listened to, their rights are protected and they are safeguarded from abuse. Evidence: There have been no complaints since the last inspection. A complaint policy is in place and this is made available to those living at the home. Information is clearly provided for people living at Moor Villa in the event of them, or their relatives wanting to make a complaint about the home or its staff. Responses in the CSCI surveys completed by some people living at the home confirmed that residents knew who to speak with if they were unhappy about anything. Information within the Annual Quality Assurance Assessment (AQAA) completed by the registered manager of the home, showed that it was recognised that complaints are not necessarily negative and staff have been encouraged not to take any complaint or concern personally. Key workers have been asked to closely observe their residents during one to one conversations, to try to draw out any concern no matter how small or trivial it may appear. This ensures that the matter is acted upon immediately. The home has policies and procedures in place regarding abuse and the protection of Care Homes for Older People Page 20 of 35 Evidence: people living at the home. Staff have easy access to these documents, which included guidance for staff should they be concerned about the work performance of another member of staff. All staff undertake training regarding the protection of vulnerable people and issues regarding protection and vulnerability. This is provided initially through nationally recognised induction training for care staff and more advanced National Vocational Qualification (NVQ) training programmes. There is a rolling programme of refresher adult protection training arranged, all staff will have completed this refresher training by August 2009. Care Homes for Older People Page 21 of 35 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some improvements have been made and a more pleasant environment is now provided. Evidence: Since the last inspection, some improvements have been made to the internal and external environment of the home. A substantial number of windows have been replaced by double glazed units and the front doorway has been refurbished to good effect. Fascia boards, gutters and down spouts have all been renewed and the outside store walls, shelves and floor have all been repainted. A number of individual bedrooms have been redecorated that has included new curtains, bedding and furniture, a number of beds have been replaced. It is understood that this will be an ongoing programme until all the beds in resident accommodation have been renewed. The main lounge and small lounge have been redecorated and a number of radiator covers, that were insubstantial, have been replaced. The ground floor corridor has also been redecorated and a new carpet provided. The fridge and freezer have been replaced and a new floor covering has been fitted to the dining area. Some dining room furniture has been replaced and a new welsh dresser purchased. This has definitely made some improvement to environment of the home to provide a more modern and comfortable place for people to live. Care Homes for Older People Page 22 of 35 Evidence: However there are a number of things that still require attention. For example, the ground floor bathroom has been being redecorated with new flooring and a new toilet has been provided however the existing stained bath has not been replaced. This does not present as a pleasant facility for taking a bath and should be replaced. As identified in several previous inspection reports, the external walls and remaining external paint work and rendering still requires attention. We were again told that a quote is to be obtained for the work to be completed and it is anticipated that this work will commence in the foreseeable future. The exterior of the small room just outside the kitchen door continues to require attention to the woodwork to prevent any further deterioration. It was noted that the landing area at the front of the building on the first floor required attention to make sure that the floor boards were safe. A call bell in a shared downstairs bedroom could not be reached by the occupant when in bed. Either the call bell should be re-sited to make sure that the occupant of that bed can reach the call bell or alternatively the bed should be placed in such a position that the call bell could be used at the existing site. As stated in previous reports, the existing call bell system is of an old design and function and consideration should be given to replacing the system as soon as possible. From discussion with the deputy manager, it is understood that further improvements are planned that include replacing the carpet in the main lounge and redecorating and re-carpeting the stairs leading up from the dining area and the landing area. Bathrooms and toilets are not provided with liquid soap and paper towels which helps to prevent the risk of cross infection. The Environmental Health Department have provided some advice about this matter as paper towels and liquid soap are not always appropriate for the resident group accommodated. However it is important that wherever possible, residents only use their own towels when using the bathroom or toilet and do not rely solely on the communal towels made available. Consideration could be given to to introducing liquid soap and paper towels within a risk assessment framework. The home was clean, warm and homely. Residents are encouraged to personalise their bedrooms with important items from home. This may range from small pictures and ornaments to pieces of furniture or a chair. Residents spoken with all said that they were happy with their bedroom accommodation and the communal accommodation provided. Feedback from people living at the home who completed CSCI surveys confirmed that the home was always kept fresh and clean. There are a variety of policies and procedures in place for the control of infection and Care Homes for Older People Page 23 of 35 Evidence: safe handling of waste products. Laundry facilities are located in a designated outside area and do not intrude on residents. All laundry is washed at an appropriate temperature. The AQAA confirmed that all staff have received infection control training meaning that they know how to reduce the risk of infection within the home. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing arrangements, recruitment and training ensure that people are well cared for and supported. Evidence: At the time of the unannounced visit there were four staff on duty including the registered manager. These staffing levels remained constant in the morning and afternoon period. In the evening period staffing levels are reduced to three members of staff. It is understood that this is the normal management and care staffing complement throughout the seven day period. During the site visit the deputy manager also came on duty but this was the direct result of the inspection and was supernumerary to the staff rota. There appeared to be sufficient staff on duty to address the needs of residents accommodated and the majority of residents that completed a survey all said that staff were always available when they needed them. These staffing levels allow for some individual time to be spent with those living at the home and for regular activity to take place as well as ensuring that the physical needs of people are met. There was also a young person from a local school on work placement at the home who was spending time talking to residents, undertaking some domestic tasks and assisting with the pampering sessions that residents enjoyed. The staff team has remained stable and no agency staff are used, this means that Care Homes for Older People Page 25 of 35 Evidence: people know who is going to be helping them and helps to ensure consistency of care. Because Moor Villa is a fairly small home with a long standing staff group, residents and staff get to know each other very well and there is a very comfortable relationship. This helps people living at the home feel safe and secure. Although conversation with residents was limited because of cognitive impairment, one person spoken with described the staff as very good. During the course of the site visit, a considerable period of time was spend in the main lounge, it was directly observed that residents were very relaxed. There was a comfortable atmosphere and there was good interaction between residents and staff particularly when spending time sitting and chatting. All care staff at Moor Villa care home have achieved at minimum a National Vocational Qualification (NVQ) Level 2 in care. Nine of the eleven members of the care staff team have also achieved a more advanced Level 3 of this award. A further member of staff will have achieved this qualification within the next few weeks. These are nationally recognised qualification for care staff and well exceeds the minimum standard expected. This is to be commended and shows that all staff at the home have the skills, knowledge and understanding to provide a good standard of care. There have again been no new staff appointments since the last key inspection. As already highlighted in this report, the majority of staff at Moor Villa have all worked together for a considerable period of time and work very well together. However, there continues to be a structured recruitment and selection policy in place that includes obtaining references and a Criminal Records Bureau (CRB) disclosure before any prospective member of staff could take up their appointment at the home. This helps to protect residents and to make sure that only suitable people are employed. The registered manager confirmed that any newly appointed staff would be provided with the Skills for Care induction training programme soon after commencement of employment to ensure that they had the basic skills to provide an appropriate level of care. Good additional training is also provided that is valued by staff. Further training in specialised areas is provided specific to the individual needs of the people living at the home and to develop the skills and knowledge of the individual member of staff team. The majority of staff have obtained a level 2 certificate in dementia care that is linked to three units of the NVQ training. This helps to ensure that a good, individualised service is promoted by a well trained staff team. Recent training for some staff has included, health and safety training, challenging behaviour training, diabetes training, and protection of vulnerable adults (POVA) training. Care Homes for Older People Page 26 of 35 Evidence: Currently there is no staff training matrix available. It is recommended that a staff training matrix be developed to ensure that a clear and accurate record is maintained of all training undertaken and to highlight further training needs and when refresher training is due. Care Homes for Older People Page 27 of 35 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 organised and managed in a way to ensure that residents experience a good quality of care. Evidence: The registered manager at Moor Villa care home is very experienced and has recently successfully completed the Registered Managers Award, a qualification that all care home managers are expected to achieve to ensure they have the skills to manage the care home in the best interests of the residents. The registered manager continues to attend a variety of courses to make sure that her knowledge is up to date. There are clear lines of accountability within the home and with the homeowner. Although the registered manager has overall responsibility for the day to day management of the home, it is understood that the home owner visits Moor Villa on a regular basis. However as highlighted in several recent reports, there is a requirement that along with at least a monthly unannounced visit to the home, the home owner Care Homes for Older People Page 28 of 35 Evidence: must produce a written monthly report about the conduct of the care home. Although visits to the home have been taking place, monthly reports have not been produced. A copy of the monthly report must be given to the registered manager at the home and made available to the Commission on request. Monthly written reports must be produced covering a range of topics including the views and opinions of residents, what staff feel about the home and the outcome of the inspection of the building and some of the records held at the home. Following the site visit, the homeowner was contacted about this matter. The homeowner agreed to now complete monthly written reports, provide a copy of each report to the registered manager on a monthly basis and a copy the Care Quality Commission for at least the first six months. Because Moor Villa is a fairly small home with a good relationship between residents, staff and relatives, feedback about the home is often informal and ongoing during general discussion or one to one chats. This clearly suits the people living there and their families. People prefer the verbal approach to giving feedback as to whether the home is meeting residents needs and expectations. The deputy manager also said that other visitors such as Social Workers and District Nurses are asked for verbal feedback about how the home is meeting the needs of people living there. It was stated that the comments received are always positive. It was evident that informal resident meetings also take place that are minuted. This also gives opportunity for people living at the home to have their say and to influence change. Moor Villa has also achieved the Investors in People award. This is a national quality standard which sets a level of good practice for improving performance, with effective management being the key. This is only awarded when a high standard has been achieved. Records of staff supervision were viewed in relation to two members of staff. Staff supervision takes place on a regular basis however a variety of forms are used to record supervision and it was unclear what had been discussed and why. Some forms consisted of a self evaluation tick box appraisal for staff to completed, this seemed to mainly cover personal care tasks rather than a more rounded approach to supervision topics that should also cover the philosophy of care at the home and future training needs. However there was an individual personal development plan that identified training undertaken in the last twelve months and future training requirements but this seemed to be linked to the annual appraisal rather than regular supervision. On none of the supervision records seen were outcomes recorded or what follow on work or activity had been undertaken. It is suggested that supervision documents be reviewed and amended to make sure that they are appropriate for their intended use. Supervision records should record the Care Homes for Older People Page 29 of 35 Evidence: topics discussed, the outcome and identify any further action required. Topics without a intended outcome can be carried through to the next one to one supervision. Supervision is a specific task and it is important that supervisors have the skills and understanding to provide effective supervision for the development of the care worker and the ultimate good care of residents. All staff receive daily informal supervision as part of the day to day management role. People living at the home are encouraged to remain financially independent however, because of cognitive impairment residents are more likely to be assisted in this task by a relative or other advocate. In consequence, the home currently only holds small amounts of money in safe keeping for one resident. This is appropriately documented and held in a secure safe. As this person has the same specific items purchased each month, the resident chooses to sign the financial record on a monthly basis rather than at each transaction. Generally there are good arrangements in place for maintaining the health and safety of those living at the home. Maintenance records were available to confirm that various routine health and safety checks are maintained on a regular basis including fire safety equipment, the last one taking place in January 2009, the testing of small electrical appliances and servicing of gas equipment. A variety of environmental risk assessments were also viewed. However these were dated 2005. Environmental risk assessments were also available in respect of individual residents but again these were dated 2006. There was no evidence of any review taking place. This meant that although risk assessments had been undertaken, it was not known if the information remained current. It is important that these risk assessments are reviewed and amended as required as soon as possible. The outcome of the environmental risk assessments in respect of individual residents should, where appropriate, be incorporated in their individual care plan. Staff have received mandatory health and safety training covering a variety of topics including fire safety, first aid, infection control, food hygiene and manual handling training. Refresher training is about to be arranged. This will help ensure that staff have up to date knowledge about current best practice in how to protect residents and keep them safe. Care Homes for Older People Page 30 of 35 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 31 of 35 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 All prospective residents must receive written confirmation of the outcome of the pre admission assessment. This would confirm to the prospective resident, that their current needs and requirements could be met at the home. 01/05/2009 2 31 26 The homeowner must produce a monthly written report as to the conduct of the home. This would show that the homeowner is responsible in ensuring that the home is run in the best interests of the people that live there. 01/06/2009 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 35 1 9 All short life medication, for example eye drops, should be dated when opened. This may not be the same date as the date the prescription was made up by the supplying pharmacist. This would help to prevent medication being used past its use by date. The drug administration record should be signed immediately after the medication has been administered. This would ensure that a correct record is maintained of all drugs administered and also provide a clear audit trail. It is recommended that in order to maintain confidently, a separate record sheet is maintained for each resident to record the activities they have enjoyed on a daily or weekly basis. The external walls, rendering and remaining paintwork should receive attention as a matter of priority. Serious consideration should be given to replacing the stained bath in the downstairs bathroom to provide a more pleasing and attractive place for people to bathe. The exterior of the small room outside the kitchen door requires attention to the woodwork to prevent further deteratoration. The floorboards to the front of the building on the first floor landing should receive attention to make sure that they are safe. The call bell in a ground floor shared bedroom should be sited so that the resident can used the call bell to summon assistance when in bed. Consideration should be given to replacing the existing call bell system with one of a more modern design and function. The internal refurbishment programme should continue in a timely fashion until all resident accommodation is of an acceptable standard. Wherever possible, residents should always use their own towels and soap when using the bathroom and toilet to help prevent the risk of cross infection. Consideration could be given to providing liquid soap and paper towels within a risk assessment framework. Staff supervision should cover at minimum, all aspects of practice, philosophy of care in the home and career development needs. The outcome of individual staff supervision should be recorded. The documents used to record supervision should be reviewed to ensure that they are fit for purpose. The existing environmental risk assessments and 2 9 3 12 4 5 19 19 6 19 7 19 8 19 9 19 10 26 11 36 12 38 Care Homes for Older People Page 33 of 35 environmental risk assessments in place in respect of specific residents should be reviewed and amended as required to ensure the information remains current. Significant outcomes should be incorporated in the care plan. Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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