Care Home: Mount Vale Care Home

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What the care home does well People can visit the home, are provided with written information and have their needs assessed before moving in. This helps people decide if Mount Vale can meet their needs and is somewhere they want to live. The home has in place good systems for care planning and recording people`s care needs. Staff are kind and helpful and people`s care needs were generally met. People`s comments about their care included `the staff are all very nice, can`t complain`, `I am well looked after by very caring staff who are warm and make a very happy environment` and `I`m more than happy with the care and attention my relative receives at Mount Vale`. The home has an activities co-ordinator who helps to plan activities and social events and visitors are welcome at the home. People`s comments included `we have (name of activities coordinator) who organises pleasant things, we play dominoes` and the relatives we spoke to confirmed that they could visit when they wanted and were made welcome. A variety of meals, snacks and drinks are provided at regular intervals throughout the day. People are protected by the homes complaints and safeguarding procedures. This means that complaints and safeguarding incidents are appropriately reported and dealt with. People we spoke to felt able to approach the home`s staff and management if they had a problem. Mount Vale provides a well maintained and comfortable place for people to live. People told us that the home is always kept fresh and clean and it was comfortable and tidy during our visit. People had made their rooms personal and individual by bringing in their own small pieces of furniture and belongings. What has improved since the last inspection? Since our last visit more staff have been recruited and the home is becoming less reliant on the use of agency staff to cover shifts. The number of staff leaving also appears to have reduced, meaning that a more stable workforce is starting to develop. Comments made to us included `I think staffing levels are quite good to be honest`. There is now a dedicated member of staff who does nothing else but monitor and develop staff training at Mount Vale. Comments made to us about training included `training is good, and it`s getting stronger with (the training co-ordinator) concentrating on it`. The manager is also planning to improve the training that is provided for staff on dementia care. Appropriate management arrangements have been put in place to ensure the effective running of the home. Comments made to us about the home included `in my opinion the organisation has improved markedly in the last six months - now providing continuity and good practice`. However, the home`s new manager still needs to register with us. What the care home could do better: Although medication is generally stored and administered safely, there are some improvements that should be made. For example, one person who has Parkinson`s disease didn`t always get given their medication at the correct times and some of the recording on the medication administration records (MARs) could be improved. People thoughts that the activities coordinator did a good job, but a number of people told us that they felt that activities could still improve. Comments included `Activities they do them when they can, but the home needs an activities person for Memory Lane. The staff are excellent but cannot always do the craft sessions etc` and `I have a small concern that my mother does not get the opportunity to many activities. Having said this, the vagaries of Alzheimer`s and the different ways it strikes individuals, plus my mother`s inherent nature, must make this difficult. Perhaps the introduction of long-term participatory activities (i.e. a garden) might help?`. People`s opinions on the food provided at Mount Vale varied and we found that our own meal wasn`t very hot when we sampled the food. People`s comments included `oh it`s good, you always get a choice`, `it`s a bit haphazard` and `cooking of meals could be improved, as well as better timed and served`. Although appropriate laundry equipment and staff are provided in the home people felt that the laundry service wasn`t as good as it could be. Comments made about things that could improve included `things like putting clearly marked (labelled) clothes in the wrong person`s wardrobe!` and `laundry collection is far from perfect`. Key inspection report Care homes for older people Name: Address: Mount Vale Care Home Yafforth Road Northallerton North Yorkshire DL7 8UE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Rachel Martin     Date: 1 7 0 2 2 0 1 0 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 29 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 29 Information about the care home Name of care home: Address: Mount Vale Care Home Yafforth Road Northallerton North Yorkshire DL7 8UE 01609775444 01609768589 mountvale@barchester.com www.barchester.com Barchester Healthcare Homes Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 65 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 65 The registered person may provide the following category of service only: Care home with nursing: Code N, to service users of the following gender: Either, whose primary care need on admission to the home are within the following categories, Dementia: Code DE, Old age, not falling within any other category: Code OP. Date of last inspection Brief description of the care home Mount Vale is registered as a nursing home and can accommodate up to 65 people. The home provides care for people whose care needs fall within the categories of old age or dementia. Mount Vale is owned by Barchester Health Care Homes Ltd and is a new, purpose built care home. The building is made up of a former Georgian maternity Care Homes for Older People Page 4 of 29 Over 65 0 65 65 0 1 5 0 4 2 0 0 9 Brief description of the care home hospital, which has recently been enlarged with modern extensions and converted into a care home. The home is located on Yafforth Road, Northallerton and stands in its own grounds, with a private car park. All of Mount Vales bedrooms are singles and have en-suite toilet facilities. Modern communal bath, shower and toilet facilities are conveniently located around the home and include equipment to help people use them. A number of communal lounge and dining rooms are also available for people to use if they want to. Enclosed gardens provide safe access to fresh air and the homes wider grounds offer more outside space. At the time of this inspection the homes fees ranged from £680 to £850 per week. These prices are dependant on what room is chosen and what nursing needs people may have. This does not includes extras such as chiropody, dental requirements, optical requirements, physiotherapy, hairdressing, newspapers, personal dry cleaning, staff escorts to hospitals and taxis. Up to date information about the homes fees and terms and conditions should always be sought from the homes manager. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection of Mount Vale. The site visit was completed on 17th February 2010 and was completed by one inspector. We followed up the requirements and recommendations we made at the last inspection, looked at a selection of records, observed care practice and meal times, looked around the building and talked to people who live at the home, the staff and management. Before our inspection visit we reviewed all of the information we had received about the service since the last inspection. This included information about events in the home, changes to the homes management, information about complaints and safeguarding incidents and the last self-assessment that the home had completed and submitted to us. We also sent out a selection of surveys to people who live at the home and their relatives, the homes staff and health and social care professionals who visit and work Care Homes for Older People Page 6 of 29 with the home. Five people who live at the home and four peoples relatives, four staff and four health professionals completed and returned these surveys to us. The survey results have been included in this report where appropriate. Since the last key inspection we have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement has to be repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: Although medication is generally stored and administered safely, there are some Care Homes for Older People Page 8 of 29 improvements that should be made. For example, one person who has Parkinsons disease didnt always get given their medication at the correct times and some of the recording on the medication administration records (MARs) could be improved. People thoughts that the activities coordinator did a good job, but a number of people told us that they felt that activities could still improve. Comments included Activities they do them when they can, but the home needs an activities person for Memory Lane. The staff are excellent but cannot always do the craft sessions etc and I have a small concern that my mother does not get the opportunity to many activities. Having said this, the vagaries of Alzheimers and the different ways it strikes individuals, plus my mothers inherent nature, must make this difficult. Perhaps the introduction of long-term participatory activities (i.e. a garden) might help?. Peoples opinions on the food provided at Mount Vale varied and we found that our own meal wasnt very hot when we sampled the food. Peoples comments included oh its good, you always get a choice, its a bit haphazard and cooking of meals could be improved, as well as better timed and served. Although appropriate laundry equipment and staff are provided in the home people felt that the laundry service wasnt as good as it could be. Comments made about things that could improve included things like putting clearly marked (labelled) clothes in the wrong persons wardrobe! and laundry collection is far from perfect. 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 29 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 29 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 can visit the home, are provided with written information and have their needs assessed before moving in. This helps people decide if Mount Vale can meet their needs and is somewhere they want to live. Evidence: The homes last self-assessment told us that people are invited to visit Mount Vale and are given written information about the home before they decide to move in. During our visit there was an information stand in the homes reception, which contained leaflets, brochures and information about the home for people to read and take away if they wanted. Four out of the five people who returned surveys about the home told us that they had received enough information to help them decide if the home was the right place for them, before moving in. The homes last self-assessment told us that all service users are fully assessed prior to admission. On the day of our visit the manager of the dementia care unit went out Care Homes for Older People Page 11 of 29 Evidence: to assess someone who wanted to move into the home. The unit manager told us that the assessment would enable her to decide if the dementia unit could meet the persons needs before they came to stay. The care records we looked at during our visit included written assessments that had been completed by the homes staff, before people moved into the home. Where appropriate the records also contained information from other professionals who had been involved in planning and organising peoples move into Mount Vale. In our surveys we asked health professionals if the homes assessments procedures ensured that accurate information was gathered about peoples needs and resulted in the right services being planned for people. One answered always and two answered usually to this question. One commented that things had improved recently because the home had recognised the importance of the unit managers and given them the right to assess potential clients suitability to be placed in their charges, while another commented that initial assessments of placements could be better, though I imagine there are always some difficulties everywhere. Care Homes for Older People Page 12 of 29 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. The home has in place good systems for care planning and the staff are kind and helpful, with peoples care needs generally being well met. Evidence: We spent time observing care practice during our visit. We saw staff interacting nicely with people. For example, explaining what they were going to do before moving someone and reassuring someone who was shouting, then providing one-to-one staff time in the persons bedroom to help them settle down. In our surveys we asked people if they receive the care and support they need at Mount Vale. Three people said always and two said usually. When we asked if the staff listened and acted on what people said, one said always and four said usually. During our visit we talked to a number of people who live in the home. Their comments included the staff are all very nice, cant complain, I get a bath once a week, if I wanted extra it would be alright as long as you fitted in with their time, I had one last night, I am well looked after by very caring staff who are warm and make a very happy environment and some of them are very nice, some can be a bit Care Homes for Older People Page 13 of 29 Evidence: sarcastic. Three relatives returned surveys to us. Their comments about Mount Vale included Im more than happy with the care and attention my relative receives at Mount vale, the staff at Mount Vale have improved my mothers outlook on her own life immeasurably. Her state of mind (she has advanced dementia) is continuously assessed and adjustments made accordingly and I feel my mother, who has Alzheimers, has changed so much since going to Mount Vale. She is now calmer in her own world. During our visit we spoke to a number of visiting relatives. Some of the relatives we spoke to told us that staff were caring and polite and that their relative always looked well kempt when they visited. Others told us that their relative seemed more settled now since hes been in here, his speech has come on brilliantly and staff tell him what they are going to do before they do it and usually monitor his health well. We looked at a selection of care records that are kept by the home. These records showed that each person had in place an assessment of their needs, care plans setting out the care they needed and how it should be provided, records of the care given and any involvement from other professionals. The records we looked at were up to date and provided good information about peoples care needs. In our surveys we asked people if they got the medical treatment they needed at Mount Vale. All five people answered always. During our visit we spoke to a health professional who works with some of the people who live in the homes dementia care unit. They were generally positive about the care that people received at Mount Vale. Their comments about the service included responsive, quick to alert to any problems, will work with us to try and manage people with challenging behaviours, generally the same staff dealing with things, so theres some consistency and always a visible presence of staff and they tend to be engaged with people in the communal areas. Three other health professionals completed surveys for us. When we asked them if peoples social and health care needs were properly monitored, reviewed and met by the care service, two said always and one said usually. We spent time with one of the homes nurses looking at medication storage and administration. Medicines, including controlled drugs, are stored securely in cupboards or refrigerators in locked store rooms, which are maintained at suitable temperatures. Since the last inspection the home has reviewed how it manages peoples medication, working with the pharmacist to make changes. The home uses the monitored dosage system (MDS) which is supplied by Boots. According to the records we looked at medication was generally being safely stored and administered, with people getting Care Homes for Older People Page 14 of 29 Evidence: their prescribed medication when they needed it. However, there are some practices that should be improved. Staff are not always carrying over the balance of medication from one medication administration record (MAR) to the next. This means that auditing the stock balances against the records isnt always possible. Staff were sometimes using the F (other) code on the records, but not defining what this actually meant. Some eye drops and creams had not been dated when opened, making it difficult to know when they stopped being safe to use. Changes to peoples warfarin doses were not being witnessed and signed by two staff and people on specialist medication for Parkinsons disease sometimes didnt receive it at the correct times. Care Homes for Older People Page 15 of 29 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. Opportunities to take part in activities and social events are provided and visitors are welcome at the home. A variety of meals, snacks and drinks are provided, although peoples opinions on the food and meal time service varied. Evidence: The home employees an activities co-ordinator, who organises activities and social events for people to take part in. In our surveys we asked people if the home provided activities and social events that they could take part in. Three people answered always and two answered sometimes to this question. During our visit people who live in the home showed us the activities timetable that they had been given for the week. We also saw staff engaging people in a game of dominoes and providing sensory stimulation by getting people to fold and touch different fabrics. One person had recently bought a laptop and the homes staff were helping them attend classes on how to use it. Another person told us we have (name of activities coordinator) who organises pleasant things, we play dominoes. People also told us that there was a regular church service held at the home and that there were no restrictions on visitors. During our visit we saw lots of visitors coming and going, some taking their relatives out of the home and others visiting in peoples rooms. The relatives we spoke to confirmed that they could visit when they wanted and were made welcome at the Care Homes for Older People Page 16 of 29 Evidence: home. However, comments made to us by relatives included Activities - they do them when they can, but the home needs an activities person for memory lane. The staff are excellent but cannot always do the craft sessions etc and I have a small concern that my mother does not get the opportunity to many activities. Having said this, the vagaries of Alzheimers and the different ways it strikes individuals, plus my mothers inherent nature, must make this difficult. Perhaps the introduction of long-term participatory activities (i.e. a garden) might help?. Peoples care records included nutritional risk assessments and showed that dietary advice and supplements were obtained if people were considered to be at risk of malnutrition. We observed the lunchtime meal in the dementia care unit. The dining room was a pleasant place to eat, with the tables set nicely. One carer served the food, which had been brought upstairs in a hostess trolley. There was soup for a starter, followed by chicken in mushroom sauce or fish and chips. Pudding was either sponge and custard or fruit salad. Staff were good at offering the different options to people, often showing people plates of each choice to help them decide what they wanted. However, it took a long time for the meals to be served and when we sampled some of the food it wasnt very hot, although it was tasty. People we spoke to confirmed that they get regular drinks and snacks during the day and on the day of our visit we saw people being offered a scone with their afternoon cup of tea. Relatives told us that they could visit and eat with their relative if they wanted, with one person saying what Ive had Ive always enjoyed, I was here on Sunday. We received mixed comments from people about the meals being provided at Mount Vale. In our surveys we asked if people liked the meals at the home. Two people answered always, two answered usually and one answered sometimes. Peoples comments included oh its good, you always get a choice, its a bit haphazard, there is always a choice of two things, but sometimes they are closely related and cooking of meals could be improved, as well as better timed and served.....hot meals frequently luke warm.....when dining room is fully occupied serving of meals takes ages, which can result in leaving the dining room before having a meal if oxygen equipment is being used. Staff felt that the food was generally of a suitable standard, but that the way the home caters for specialist soft diets could be improved. The records of a recent relatives and residents meeting also showed that some people thought that the food provided could be better. Care Homes for Older People Page 17 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the homes complaints and safeguarding procedures. This means that complaints and safeguarding incidents are appropriately reported and dealt with. Evidence: The home has in place a complaints procedure and information about how to make a complaint is made available to people. For example, information about raising concerns and complaints is displayed in the homes reception areas. The people living at the home and the relatives we spoke to told us that they could raised any concerns they had with the staff and management. Comments included I could go to (the deputy) or (the manager) if I needed to. In our surveys we asked people if there was someone they could speak to informally if they had a problem. Four people said yes and one didnt answer. We also asked if people knew how to make a formal complaint if they needed to. Three people said yes, one said no and one didnt answer. During our visit one member of staff was completing safeguarding training with the training co-ordinator. Safeguarding training is now available as an on-line training module, with staff also completing a written test to ensure they have understood the training. Staff we spoke to knew how to report any concerns they had and felt that the homes management were approachable and would listen to any concerns. Since the last inspection the home has referred appropriate incidents to the local safeguarding team and has also notified us of appropriate events. Care Homes for Older People Page 18 of 29 Evidence: We have had one formal complaint made directly to us since the last inspection. This was raised by a staff member and is been addressed by the local authority and the home. The homes complaints record showed that records are kept of any complaints and the action taken to address them. Care Homes for Older People Page 19 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mount Vale provides a well maintained and comfortable place for people to live. Evidence: We spent time looking around the home during our visit. Mount Vale is a recently refurbished listed building that has been extended and converted for use as a modern care home. The decoration, furnishings and equipment at Mount Vale are all new, good quality and in good condition. The home is pleasantly and comfortably decorated and furnished. Peoples rooms had been personalised with their own possessions and each bedroom has its own central heating thermostat, so that people can change their room temperature to suit their preferences. The furniture and decoration in Mount Vales communal areas provides very pleasant and comfortable places for people to spend their time. The upstairs dementia care unit has been decorated and designed with the needs of people with dementia in mind. For example, coloured doors and pictures to make toilets easier to find and lots of interesting items around the unit to create a more stimulating environment. We found that the home was clean and tidy and we didnt come across any unpleasant smells during our visit. People we spoke to told us that the home was always kept clean. Comments made to us included my room is cleaned everyday and they keep all rooms very clean and fresh. All five people who live at the home and returned a survey said that they home was always kept fresh and clean. Care Homes for Older People Page 20 of 29 Evidence: During our visit we looked at the laundry room and spoke to the laundry staff who were on duty. The staff member told us that she had covered the control of infection in her induction training and was using gloves to handle the laundry. The home uses a special laundry bag system that reduces the need for staff to handle dirty laundry and the washing and drying machines were in good working order. However, people who returned surveys to us thought that improvements could be made to the laundry system. Their comments about things that could be improved included things like putting clearly marked (labelled) clothes in the wrong persons wardrobe!, laundry collection is far from perfect and often laundry left in laundry bag for collection at 8am is still awaiting collection at 12 midday and no one ever checks the number of items being sent for washing or what the individual items are, and neither on return are the items checked for any discrepancies with the items owner. Not at all satisfactory. Care Homes for Older People Page 21 of 29 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. The home is developing a stable workforce of safely recruited staff, who are being provided with the training they need to do their jobs. Evidence: We looked at a selection of recruitment records. These showed us that new staff are recruited safely and that the required checks and references are obtained before people start to work at the home. During our last inspection we received mixed feedback from people about staffing levels and some concerns about the high turn over of staff at Mount Vale. When we asked what the home could do better in our surveys during this inspection one health care professional answered demonstrate stability of its workforce. The new manager told us that he has been concentrating on stabilising the homes staff. New permanent staff have been recruited and the home is now using far fewer agency staff. Staff we spoke to during our visit confirmed this and a health care professional commented in my opinion the organisation has improved markedly in the last six months - now providing continuity and good practice. Since our last inspection we have received one concern about staffing levels at Mount Vale. At the time of our inspection there were 17 people living downstairs and 25 people living on the dementia care unit. The homes rotas and discussions with staff Care Homes for Older People Page 22 of 29 Evidence: confirmed that there were usually one nurse and either three or four carers on duty downstairs, with one or two nurses and five carers on duty upstairs depending on the time of day. Staff we spoke to during our visit were not worried about staffing levels in the home, with comments including I think staffing levels are quite good to be honest. The home now has in post a member of staff whose only responsibility is organising and monitoring staff training. We spoke to them about their role and the training being provided at the home and we looked at a selection of the homes training records. These showed that a variety of training was provided and that new staff received a proper induction training programme. Staff comments about training included training is good, and its getting stronger with (the training co-ordinator) concentrating on it. At the time of our visit six of the homes care staff had achieved a National Vocational Qualification (NVQ) and another five care staff were working towards this qualification. Mount Vale still needs to achieve the minimum standard of 50 of care staff trained to NVQ level 2. Staff told us that training on dementia care and dealing with challenging behaviour has not been particularly good in the past. However, the new manager is now looking at providing this training for all the staff who work in the dementia care unit. Care Homes for Older People Page 23 of 29 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. Appropriate management arrangement have been put in place to ensure the effective running of the home. However, the new manager needs to register with the Care Quality Commission (CQC). Evidence: Since the last inspection there have been changes to the management at Mount Vale. A new general manager has been recruited, there is a deputy manager and both the dementia care and nursing unit have unit managers in place. The home is also supported by Barchester Health Cares wider management systems and processes. The new manager has been in post since October 2009 and still needs to register with us. We talked to the new manager about the home and the improvements that are being made. The manager had a good understanding of what was needed in the home and appropriate improvements were being made. A health care professional commented to us in my opinion the organisation has improved markedly in the last six months - now Care Homes for Older People Page 24 of 29 Evidence: providing continuity and good practice. The home uses the Barchester Health Care quality assurance system. This is a system of weekly, monthly, six-monthly and annual audits that are completed by the homes staff. We looked at the records of some of these audits and found that they were thorough and had been completed well. The new manager has recently encouraged a relatives and residents meeting to take place and intends for these to become regular events. We saw the records for the first meeting, which included people raising issues and making suggestions for improvements. At the time of this inspection the home encourages family or other appropriate people to help people manage their finances and personal monies. They do not handle or hold money for people living at the home. We randomly checked a selection of maintenance and safety records. The maintenance manager undertakes regular safety checks of equipment to make sure it is working properly. We saw records of these checks, which included the fire alarms, emergency lighting, fire doors and emergency exits. Appropriate maintenance contracts are in place for the fire alarm, nurse call system and equipment that is used to lift and move people. The safety inspections for this equipment are up to date. Health and safety advice is readily available from Barchester Health Cares health and safety department and regular meetings to discuss health and safety at the home have been set up. Staff training is provided in health and safety related areas, such as manual handling and first aid. The environmental health officer visited in March 2009 and gave the home an excellent rating. There was an inspection visit by the fire authority in September 2009, which highlighted a number of improvements that should be made. The homes manager told us that these had been considered and appropriate action taken where necessary. Care Homes for Older People Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 29 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 10 13 Medication should always be 31/03/2010 given at the prescribed times. Giving medication at other times can reduce it effectiveness and potentially put people at risk. 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 MARs should be completed accurately and in accordance with current good practice guidelines: Any prescribed changes made to the MARs should be witnessed and signed by two members of staff, to ensure that the changes are accurate and to prevent errors. When staff use the F (other) code on the MAR they should also record what this means. Any stock balance of medication being carried over from one month to the next should be clearly recorded on the new MAR. This helps to provide a clear audit trail. 2 10 Creams and eye drops should have the date they were Page 27 of 29 Care Homes for Older People 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 opened recorded on them, so that staff can easily tell if they are safe to use and when they need to be replaced. 3 15 The service of meals should be reviewed to ensure that people receive food promptly and while it is still hot. Peoples comments about the quality of the food should also be considered. Laundry systems should be reviewed, taking into account peoples comments about the standard of the service. 50 of the homes care staff should have achieved a NVQ level 2 or equivalent qualification in care. All staff who work in the dementia care unit should be suitably trained in dementia care and managing challenging behaviour. The homes manager should register with CQC as soon as possible. 4 5 6 26 28 30 7 31 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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