Care Home: Mulberry Care Dementia Unit

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What the care home does well Mulberry Care Dementia Unit has a staff team who are committed to meeting the needs of the residents and keeping those residents safe. Staff treat residents with dignity and respect at all times. Staff receive the necessary training they require to meet the needs of the residents and to keep them safe, whilst promoting residents choice. Residents and their representatives know how to complain and who to speak to if they are not happy, and management within the home listens and acts upon any concerns or complaints that are raised. What has improved since the last inspection? The manager ensures she has the information that the service needs of prospective residents to be sure they are within the category of care that the service is registered prior to offering them a service. Residents have a personal picture or item within their memory board at the entrance of their bedroom that helps the person to identify their own room. Good records of residents` daily social activities and records of outings within the community demonstrate that the social care needs of the residents are met. Improvements to staff training records have been made that demonstrates staff have attended health and safety and specialist training, for example safeguarding adults and dementia awareness. The service has improved on ways to monitor the service provided. What the care home could do better: Care plans should be reviewed to reflect the social care needs of the resident and describe how the resident wants those needs to be met. Where necessary care plans must be updated to include challenging behaviour guidelines that would describe the specific challenging behaviour that a resident presents and how this is to be managed. Reports of regulation 26 inspections undertaken under regulation 26 of the Care Standards Act should be available within the home. The home must review staff numbers at night to ensure the safety of the residents. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Mulberry Care Dementia Unit 155a Wokingham Road Earley Reading Berkshire RG6 1LP     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: Yvonne Souden     Date: 1 6 0 6 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 25 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 25 Information about the care home Name of care home: Address: Mulberry Care Dementia Unit 155a Wokingham Road Earley Reading Berkshire RG6 1LP 01189261544 01189346872 satsahluwalia@tiscali.co.uk 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) : Mulberry Care Ltd care home 13 Number of places (if applicable): Under 65 Over 65 0 13 dementia old age, not falling within any other category Additional conditions: 13 0 The maximum number of service users to be accommodated is 13. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia (DE). Date of last inspection Brief description of the care home Mulberry Care Dementia Unit is attached to Mulberry House (a registered service providing care and accommodation to older people). The provider (Mulberry Care Ltd) has registered each service with the Commission as separate services. Both services share landscaped gardens that surround the building and share the same front entrance and driveway. The service is located within a residential area approximately two miles from Reading Town Centre. Car parking is available. Care Homes for Older People Page 4 of 25 Care Homes for Older People Page 5 of 25 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: Date of Last Key Inspection 21st May 2008. The manager completed an Annual Quality Assurance Assessment (AQAA), which is a legal document provided, by the commission. The AQAA was used by the manager and provider to review their service and inform the commission of their findings. The AQAA was used as part of the evidence to inform this report. Other evidence used to inform the report included a 7.5 hour site visit to the service by one inspector. This enabled the inspector to observe care practice and speak to people who use the service, staff and management of the home. Care Homes for Older People Page 6 of 25 The Commission sent surveys to people who use the service and to health and social care professionals involved in their care; surveys returned were used to inform this report. Other evidence used to inform this report was documentation viewed by the inspector at the site visit. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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 8 of 25 Care Homes for Older People Page 9 of 25 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 25 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 who want to live in the home have their needs fully assessed and are assured these will be met prior to admission. Evidence: We looked at the assessments of three residents. All showed a detailed pre-admission assessment that is regularly reviewed. For local authority funded residents a full assessment of need is received from the referring authority. In privately funded cases this is undertaken by the manager, who will visit the prospective resident and complete the assessment. The assessment includes, for example, outcomes of health care assessments and risk assessments within moving and handling. A decision about whether or not Mulberry Care Dementia Unit can meet the persons needs is then made and a place offered. Care Homes for Older People Page 11 of 25 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 use the service have their health and personal care needs met by a caring and respectful staff team, but those needs are not always fully outlined within their plan of care. Evidence: We looked at the records of three residents. All had detailed care plans in place which were reviewed regularly, but some had limited information about the residents individual social care needs, and of how those needs were to be met. Care plans covered each personal and health care need and how to meet those needs, including risk assessments, for example, falls, manual handling and pressure area care. An admission assessment and review of a resident, stated within the moving and handling section, if frustrated can hit out. The assessment detailed equipment to be used to assist with bathing/showering, and clearly states if moving and handling risk identified complete a green care plan sheet. The care plan did not identify that the resident could present challenging behaviour, or of how this was to be managed by Care Homes for Older People Page 12 of 25 Evidence: staff. Staff said that the person never hits out, but the residents long term needs assessment last reviewed in May 2009, had not identified any change to the persons behaviour since their admission. We have made reference to challenging behaviour guidelines and staff training within the complaints and protection section of this report. The manager confirmed care plans would be reviewed to include the individual social care needs of the person and would detail how the person wants those needs to be met, for example, detail of the music that the person likes to listen to, as opposed to, likes to listen to music. The manager should review all residents moving and handling assessments to identify any issues of risk that should be detailed within the persons plan of care, for example, details of challenging behaviour, with guidelines that inform staff how to manage the specific challenging behaviour that the person presents. Health and social care professionals have told us that the residents health care needs are properly monitored and attended to by the service. One comment said, Staff are extremely caring. Residents records identified that health and social care professionals visit residents within the home and monitor their health care needs. The home has a medication policy and procedure. Staff administer residents medication from a monitored dosage system as dispensed by a high street pharmacist. All staff have received medication training. We observed that residents personal care needs were met by care staff, and that care staff spoke to residents as individuals in a manner that was sensitive, caring and respectful. Residents who received assistance from their relatives to complete a survey sent by the Commission, said they always receive the care and support they require, and that staff are always available when they need them. One comment said, Mulberry care gives mum the patience and understanding she requires. The carers take their time with her making sure her welfare is taken care of. Care Homes for Older People Page 13 of 25 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 who use the service are given the opportunity to participate within the activities and lifestyle they prefer, but this is not always detailed within their care plan. Good menu planning by the home ensures people have a choice, and have their nutritional needs met. Evidence: Residents have a memory board outside their room that have a personal picture or item that helps the person to identify their own room. Staff were seen to support residents within their decision making. On the day of the visit some residents had their hair styled by the visiting hairdresser, and some enjoyed activities that included, ball games, cooking and sensory reminiscence of products used in the 50s. There was no pressure by staff for residents to take part in any activity; residents were able to choose whether they took part. We observed residents relaxing in the conservatory listening to music, and relaxing in the lounge watching TV. Physical Care Homes for Older People Page 14 of 25 Evidence: motivation classes for the elderly was advertised in the home, and a folder kept with pictures showing residents enjoy outings in the community with their relatives and staff. Residents who received assistance from their relatives to complete a survey sent by the Commission, said there are usually activities arranged by the home that they can take part in. One comment was, a member of staff will always help with activities such as drawing, playing skittles and cake making. Staff were observed to assist residents with food and drink in a respectful and patient manner, menu plans offer choice and staff have received food safety training. Residents say within surveys sent by the commission that they enjoy the meals provided at the home. Care Homes for Older People Page 15 of 25 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. Management and staff within the home listen to the people who used the service and their representatives. Complaints are taken seriously, and action is taken to protect the people who use the service from abuse. Evidence: Residents and their relatives said within a survey sent by the Commission that they know who to speak to if they are not happy about the service and know how to make a complaint. Health and social care professionals said within a survey sent by the commission that the home always responds appropriately if a person who uses the service has raised any concerns. The Commission has received one complaint about the service provided within Mulberry Care Dementia Unit. We wrote to the provider in August 2008, to bring the matters of concern to their attention and for them to investigate. The outcome of the concerns raised was not recorded within the homes complaint record. The provider should ensure all complaints are recorded with outcomes. We looked at the homes complaints register and no complaints were recorded. The manager said that the service has not received any formal complaints, adding that relatives of the residents have not wanted to register any concerns they have had, for example, laundry issues as formal complaints. Care Homes for Older People Page 16 of 25 Evidence: As part of the homes quality assurance of the service provided the manager should keep a record of concerns raised, as they do of compliments received. This would assist the service to measure both strengths and weaknesses of the service provided. The home has a policy and procedure on physical intervention, restraint and dealing with violence and aggression; both policies were reviewed in 2009. Staff said they receive challenging behaviour training (breakaway techniques on how to calm people before any aggressive behaviour); this is confirmed from training certificates viewed, and records show that other training is scheduled. As identified within the Health and Personal Care section of this report assessments should be reviewed, and where necessary care plans updated to include challenging behaviour guidelines that would describe the specific challenging behaviour that the resident presents and how this is to be managed by staff. Staff said that they receive regular safeguarding adult training; training records viewed confirm this. Staff described what they would do if anyone was at risk of abuse, and were knowledgeable of up-to-date safeguarding policy and procedures kept within the home. Staff said they would not hesitate to protect the people in their care. Since the last inspection there have been no safeguarding adult investigations and no referrals made to the protection of vulnerable adults list (POVA). The service has a whistle blowing policy and a copy of Berkshires Safeguarding Adult policy and procedure. Care Homes for Older People Page 17 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a comfortable, clean and safe environment. Evidence: The home is a purpose built building providing en-suite facilities and assisted bathrooms, and is adjoined to Mulberry House. Both Services share the same main kitchen and laundry facilities within Mulberry House. Decor and furnishings are neutral in colour and contribute to a calm, comfortable and homely environment. Residents have personalised their rooms, and all rooms were observed to be comfortably furnished, clean and bright. Safety procedures are in place, for example, weekly checks of fire safety and Containment of Substances Hazardous to Health (COSHH). Infection control policies are in place and protective clothing was observed. Records identify that staff have received infection control training. Care Homes for Older People Page 18 of 25 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 number and skill mix of staff who have been appropriately recruited and trained contribute to positive outcomes for the people who use the service. There is a potential risk of insufficient staff at night to meet the health and safety needs of the people who live there. Evidence: Staff we spoke to who work in the day, said that they feel supported by management and that there is enough staff to meet the needs of the residents. Care staff employed by Mulberry Care Dementia Unit are also employed by Mulberry House; each service has a separate staff rota and separate staff files. Mulberry Care Dementia Unit employs one night care assistant between the hours of 21:00 to 07:00 to meet the needs of 12 residents; Mulberry House also employs one night care assistant to meet the needs of up to 21 residents. The registered manager from each service said that they are on call at night should the night carer from either service require additional support. The provider said that staffing levels at night have been derived from the needs assessment of each resident, and by use of the Department of Health Residential Care Homes for Older People Page 19 of 25 Evidence: Forum staff guidance tool. The staffing tool remains available by the department of health to be used flexibly along with a number of other considerations for example the individual assessed needs of the people who use the service, and health and safety within the environment. We looked at the needs assessments of three people who use the service. One assessment said, can sometimes wander during the night, and another said about the person at night, occasional disturbance. There is a potential risk that the safety of the people who use the service is not assured at night when only one carer is on duty to meet the needs of 12 people who have dementia. The provider must review staffing levels at night to ensure they are in sufficient numbers to protect and meet the needs of the people who live there. Staff were observed to be unhurried in their work during the day attending to residents needs with dignity and respect, and with a caring attentive attitude. Staff showed awareness of health and safety. Staff are supported by management to accomplish a National Vocational Qualification in care (NVQ), and have received mandatory health and safety training, for example, moving and handling, infection control, health and safety, basic food hygiene and fire safety. Staff attend specialist training, for example, dementia awareness. We reviewed the recruitment files for three members of staff. All necessary pre employment checks had been undertaken including two references, employment history and CRB clearance. Care Homes for Older People Page 20 of 25 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 manager has the experience and skill to manage the service and protect the people who live there. Evidence: The manager holds an NVQ level 4 and a Registered Managers Award, and has over 15 years experience in elderly care. The manager has been in post since Mulberry Care Dementia Unit opened, and prior to this was the manager of Mulberry House. A social care professional completed a survey sent by the Commission and said about the home, The unit is small and has a good atmosphere. When I have visited I have found the residents to be involved in activities or sitting with others. Appropriate quality assurance procedures are in place that includes evaluation of questionnaires sent to people involved with the service. The manager confirmed that visits by the provider are undertaken under regulation 26 of the Care Standards Act. Care Homes for Older People Page 21 of 25 Evidence: The provider should ensure reports of visits undertaken under regulation 26 of the Care Standards Act are available for the purpose of inspection. Policies and procedures are regularly reviewed and there is an annual development plan. The manager holds regular staff, resident and relatives meetings to gain their view of the service provided, and staff spoken with stated the manager was supportive. There is a formal supervision plan, and regular formal supervision takes place to support staff within their learning and development needs. Mulberry Care has appropriate health and safety policy and procedures in place. Discussions with staff and records viewed show that all staff have received training within moving and handling, fire safety, first aid, food hygiene and infection control. Care Homes for Older People Page 22 of 25 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 23 of 25 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 26 18 The provider must review staffing levels at night. 17/07/2009 This is to ensure that there is sufficient staff in numbers at night to ensure the safety of the people who use the service. 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 24 of 25 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. 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. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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