Care Home: Peel Moat

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What the care home does well People involved with Peel Moat feel that the home has a warm, friendly and welcoming atmosphere. People living at the home told us that staff were kind, and they felt cared for. They told us: `The staff care for the residents very well, they see that they have everything needed and always have a kind word for everyone.` Access to health care is provided in a timely manner and staff follow the instructions given by health professional, accurate records of the actions they have taken is maintained, and they provide a good standard of personal care. People are supported in keeping their individuality and opportunity to make choices about the their daily life. The systems in place ensure that staff are able to promote and maintain the safety of people in the home. The environment of Peel Moat enables people to remain independent and provides spacious communal and private living space. Staff are provided with an extensive program of training, they appear dedicated and work as a team. The manager fosters good relationships with people, their relatives and professionals dealing with the home by listening to them and having honest dialogue. She understands the importance of continual training and appears open to suggestions and eager to continually improve the service provided. The manager responds to complaints and concerns openly and fairly, and she deals with adult safeguarding issues in line with the accepted protocol. What has improved since the last inspection? An activities program has been introduced that goes some way to meeting the recreational needs of the residence. Meals are now more varied and people living at Peel Moat told us that they enjoy the food. There is now more opportunity for people living at the home to influence how the home is run. All shared bedrooms now have privacy screens. Additional staff are now on duty and the way that they are deployed has improved to ensure that there is always someone on the floor available to provide assistance to residents. What the care home could do better: The registered person needs to make sure that all medication is stored and monitored in line with pharmaceutical guidelines and the homes medication policy, this is to reduce the risk of medication been misappropriated so that it is always available for the person it is prescribed for. The registered person should make sure that people are weighed as frequently as their nutritional assessment dictates so that any weight loss can be dealt with quickly and monitored effectively. The registered person needs to ensure that activities offered is age appropriate and that equipment is suitable for the service user group this will help to encourage people to join in and get more pleasure from the activity. The registered person needs to ensure that people are supported in line with the Deprivation of Liberty Safeguarding guidance so that peoples rights are protected and they are supported to take risks if they want to. The registered person should ensure that all parts of the home are clean and free from bad odours, this will help to confirm that people live in clean environment and also shows that people are respected because an effort has been made to make where they live attractive, pleasant and comfortable. The registered person should provide a report about the results of the the homes Quality Assurance exercise, this will show that peoples opinions have been taken into account and so encourage them to participate further. Key inspection report Care homes for older people Name: Address: Peel Moat 2 Peel Moat Road Heaton Moor Stockport Cheshire SK4 1PL     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: Michelle Haller     Date: 2 4 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 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 34 Information about the care home Name of care home: Address: Peel Moat 2 Peel Moat Road Heaton Moor Stockport Cheshire SK4 1PL 01614422597 01619755126 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Grosvenor Care (Cheshire) Ltd care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies 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: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 31 Date of last inspection Brief description of the care home The home is detached and stands in its own grounds. There are ample car parking facilities to the rear of the home and a ramped front access enables all service users and visitors to enter the home without restriction. Accommodation comprises of three communal lounges and a dining room. There are 22 single and four double bedrooms. The home is equipped with aids and adaptations to support those with mobility difficulties. A passenger lift enables people to reach all parts of the home. Care Homes for Older People Page 4 of 34 Over 65 31 0 Brief description of the care home The home is close to the main shopping area of Heaton Moor, which includes cafes, restaurants, public houses, banks, post office and a cinema. There are churches of most denominations, a library and a selection of health centres, surgeries, dentists and opticians. Stockport town centre, motorway network and public transport are easily accessible. The previous key inspection report was available on request. The home charges between £428 and £508 each week. Care Homes for Older People Page 5 of 34 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: We conducted this inspection without informing the manager before hand and looked at all of the most important or key Care Homes for Older People National Minimum Standards (NMS). This is called a Key Inspection. The inspection involved looking at the information we had received about the service during the previous year and before visiting the home. This information included notifications or events that the manager has told us about, information from other sources such as social services, health workers or people using the service. We also considered the outcome of the Annual Service Review (ASR) which we conducted in 2008. The ASR includes reviewing all the information received about the service to check that it continues to be well run. We do not visit the service for the ASR. We also looked at the way in which the manager handled complaints about the service that we asked her to look into using the homes complaints procedure. Care Homes for Older People Page 6 of 34 We received five completed Care Quality Commission (CQC) surveys from people working in the service. And four surveys from people living at Peel Moat. All the information received prior to this key inspection indicated that outcome for people living at Peel Moat continued to be Good. We visited the home and checked through written information including service user care files and staff employment records. We read through policies, guidelines and other documents concerned with running the home. We also talked to people and their relatives about their experiences in dealing with Peel Moat. We interviewed members of staff and the manager of the service. The manager returned to us the Annual Quality Assurance Assessment (AQAA). The information requested included data about staff training, development of policies and procedures and compliance with health and safety checks when applicable. This information also influenced the outcome of the inspection. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 34 The registered person needs to make sure that all medication is stored and monitored in line with pharmaceutical guidelines and the homes medication policy, this is to reduce the risk of medication been misappropriated so that it is always available for the person it is prescribed for. The registered person should make sure that people are weighed as frequently as their nutritional assessment dictates so that any weight loss can be dealt with quickly and monitored effectively. The registered person needs to ensure that activities offered is age appropriate and that equipment is suitable for the service user group this will help to encourage people to join in and get more pleasure from the activity. The registered person needs to ensure that people are supported in line with the Deprivation of Liberty Safeguarding guidance so that peoples rights are protected and they are supported to take risks if they want to. The registered person should ensure that all parts of the home are clean and free from bad odours, this will help to confirm that people live in clean environment and also shows that people are respected because an effort has been made to make where they live attractive, pleasant and comfortable. The registered person should provide a report about the results of the the homes Quality Assurance exercise, this will show that peoples opinions have been taken into account and so encourage them to participate further. 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 34 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 34 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 are given a good chance of settling into the home because the manager makes sure that peoples health, emotional and social needs are assessed prior to admission, so she can be confident that their needs can be met at Peel Moat care home. Evidence: We read through four care files and each contained a detailed assessment of needs which had been completed by the registered manager prior to the date of a persons admission in to the home. We found that the assessments were based on the activities of daily living which identified strengths and needs related to, for instance, communication, moving and handling, continence, diet, general health, psychological state and social preferences. We also found that people had assessments completed by their social workers and that this information was included in the homes assessment and subsequent care plans. We found that for some attention had been paid to assessing peoples previous and Care Homes for Older People Page 11 of 34 Evidence: current interests. We found that the majority of staff who returned surveys felt that they were always provided with enough information to meet peoples needs. We were informed by residents who returned surveys that they had received sufficient information before moving into the home to help them make a decision about whether their needs would be met. One relative confirmed that: Matron went to the intermediate care unit and assessed that home could manage her needs. Care Homes for Older People Page 12 of 34 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 at Peel Moat benefit from having effective health and personal care which is provided with dignity and respect which promotes a feeling of positive wellbeing. Evidence: We looked at four care files with documents, correspondence and care plans concerned with peoples health and personal care. We found that each file contained care-plans that provided clear information about peoples general and specialist health needs and how staff must meet these needs. We saw that specialist risk assessments such as moving and handling, dietary needs, skin care and falls prevention, were in place. We noted that risk assessments were detailed and identified the potential risk and the actions staff were expected to take. We found that risks identified at the time of admission and the initial assessment had been included in the written care plans. We found that signatures and amendments provided evidence that care-plans and risk assessment were reviewed on a monthly basis, or more frequently if needed. Care Homes for Older People Page 13 of 34 Evidence: We found that records, reports and other correspondence confirmed that people received input from health care professionals and were supported in attending outpatient appointments, general practitioner consultations, and routine and specialist examinations including eye-tests, dental checks and podiatry. We were informed on the day of inspection that no one at Peel Moat had a pressure sore. We noted that pressure area care provided in the home was affective in safeguarding against the development of pressure wounds. We looked at records such as, turning charts, body maps and weight charts. These confirmed that monitoring was completed. We saw that intervention such as pressure area care cushions and mattresses was in place in keeping with best practise in this area. We noted that some people who lost weight did not have the intervals between the dates they were weighed decreased to weekly or alternate weeks. This would be expected in relation to the best practise in reducing the risk of malnutrition, as it provides an indication of when additional input in this area is needed and helps to monitor the success of any intervention. This matter was discussed with the manager. We found that the language used by staff when writing daily records and diary entries demonstrated that they related to people in a positive manner, tried to meet their needs and respected their choices. We found that daily records related directly to the care plans and provided a detailed indication of how people living at Peel Moat were progressing. We noted that some staff have written what activities people had done during the day and commented on their general contentment and wellbeing, this provided a useful picture of how people had spent their day. We were told by people who returned surveys that were satisfied with the health care provided. Each person confirmed that they received the care and support they needed, that staff listened and acted on what they said and that they got all the medical attention they required. We looked at the management of medication in the home. We looked at the way medication was received into the home. We found that this was in the main safe, however, the manager needs to audit the way in which staff sign and count medication into the home to make sure that each person does the same thing and that this is always in keeping with the homes medication policy. We also found that Care Homes for Older People Page 14 of 34 Evidence: staff were not following best practise in relation to hand written instructions on the medication administration record sheet. This is because we saw that only one person checked and wrote up the medication, when best practise and the homes policy dictates that two staff check the medication in and sign as correct. This helps to protect against mistakes in translating the original prescription. This matter was discussed with the manager. We looked at the way medication was administered by staff. We noted that medication administration record sheets (MARS) were completed using the codes expected and so it was possible to confirm whether medication had been offered and taken. We saw that the majority of MARS held pictures of the residents to aid with identification thereby reduce the risk of people getting the wrong drugs. We looked at the way in which medication that needs to be stored and monitored closely were managed at Peel Moat. We found that the manager needs to take additional steps to ensure that the storage and monitoring meets with best practise in relation to storage and monitoring of this medication. This matter was discussed with the manager on the day of the inspection. We entered the medication storage room and found that there is no thermometer to check that the temperature remains with acceptable limits. We discussed this with the manager. We checked the medication fridge and found that the temperature was checked and recorded daily. The records showed that this remained within acceptable temperature parameters. We looked inside the fridge and saw that it needed to be defrosted. This matter was brought to the attention of the manager. We were told by the manager and training workbooks confirmed that staff had received medication training from Lloyds Pharmacy. This training is validated by and affiliated to Keel University. We saw in peoples records that they were asked about their preferences in relation to personal care for example, would they be comfortable with a carer of a different gender providing support? We observed that in the main staff supporting people with sensitivity. We noted that treatment or personal care was carried out with discretion and in privacy. We saw that staff interacted with people in a relaxed, warm and respectful manner. We noted that the staff made an effort to communicate effectively with people who did not speak English. They did this through learning about the persons likes and dislikes and getting to know the persons routines. They also did this through close liaison with Care Homes for Older People Page 15 of 34 Evidence: the persons family so that a communication picture book could be produced and through accepting support and guidance from the persons social worker. We observed that people were clean and tidy and appeared comfortable. People were fully dressed with socks or tights and slippers or shoes which were clean. People were well groomed. It was noted that people wore glasses and hearing aids. We were told about health and social care that: Staff are generally considerate and on the ball. And a resident told us: Staff are very obliging and helpful- if you need the doctor they are got and he is very good. And the district nurse comes. Staff come and cream my legs. I cant say I have any complaints. Care Homes for Older People Page 16 of 34 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 living Peel Moat are supported to participate in a variety of activities, the routines of the home a flexible and people receive a choice of wholesome meals that they enjoy. Evidence: We talked to people about the activities at Peel Moat. In the main people were satisfied with the activities and felt that there were enough things to do at the home. They said: A girl comes in 3 hours each day for activities -drawings, bingo during the week, nothing at weekend. A Baptist minister comes monthly. She plays dominoes. People are given a choice about joining in. They bring her word searches, an effort is made. And I get 2 newspapers every morning- it keeps me occupied. Furthermore the four people who returned Care Quality Commission surveys confirmed that there was enough activities to meet their needs. We looked at the activities record and found that leisure activities included, bingo, ball games, arts and crafts and completing a life-history project. The activities calender Care Homes for Older People Page 17 of 34 Evidence: indicated that a different activity was routinely offered each day, for example Mondayarts and crafts; Tuesday-bingo; Wednesday-jigsaws; Thursday-flower arranging; Friday- arm-chair aerobics. We also saw pictures of people participating in different events such as a visit from a pat dog. We looked at some of the craft-work on display and assessed that subjects and materials used were infantile and therefore inappropriate. We saw that the colouring pages were of childrens cartoons. The outcome in this area would improve further if age appropriate art and crafts materials were offered. We observed games been played with the residents by staff and noted that some of the equipment is not suitable for people who have visual impairment or impaired hand movement. For example the game of Connect 4 was travel size and the pieces were very small. The outcome in this area could improve further if equipment were appropriate for the people with sensory needs. We were told by the manager that outside entertainers came to the home and these had included a ladies choir and musicians. We were also told that staff do not always show confidence in dealing with the recreational needs of people who do not have dementia but that they always ask for relevant support if problems arise. We found that assessments now include some information about peoples past lives or current interest. And people were been supported to complete life stories that detailed where they worked, their family tree and other information important to them. This is good because it means that staff will know more about the person, such as the makeup of their characters and events and activities that could be important to them as individuals. The manager needs to ensure that this process is completed for everyone and that this information is then used to devise individual and group activity plans. This will help staff to introduce activities that people can enjoy because they are of specific interest to them. We found that although leisure activities and events had been increased at Peel Moat some people who returned surveys felt that a further improvement would be more trips out. They said: The residents should have more trips out, And I would like to go out more-they Care Homes for Older People Page 18 of 34 Evidence: should arrange some days out. We discussed the role of the key worker as the manager told us that this system has been more firmly established since the previous inspection. Staff who we spoke with told us that they had special responsibility for up to four people and that the role included getting to know the person, making sure that the wardrobes were well managed and that the correct clothes were returned. We saw that there was list of when different denominations had a chance to participate in Acts of Worship at Peel Moat. This is positive because it means that people have the opportunity to feed their spiritual needs if this is important to them. We saw that night-care assessments had been completed and that bedtimes were completely flexible and people were able to get up when they liked. We observed that the routines in the home were flexible and people received guests throughout the day. The manager confirmed in the information she returned to us that There is an open door policy in respect of people receiving visitors. We assessed that people receive nourishing food that is varied and meets their needs. People have their nutritional status assessed and are provided with additional nutritional sustenance if needed. We were informed that people are weighed using a sit and weigh scale and so the weight of people who cannot stand is now more accurate. We noted that on the day of inspection the lunch time meal was a choice of beef casserole or steak and kidney pudding with vegetables. We were also told that if something different was wanted this would be provided, for example a salad. The meal looked very appetising and people enjoyed the food. We looked at the soft diet and noted that this was well presented with each item of food served separately on the plate. We saw that lunchtime was a pleasant occasion, there was plenty of food and people were offered extra. People were observed enjoying the meal and commented to each other how good it was. We looked at the menu which is on a two week rota. Meal choices at lunchtime included:- beef casserole, pork steak in a tomato sauce, lamb hot pot, roast gammon, pork sausages, battered cod and chips, shepherds pie, Cornish pasty and chips, roast Care Homes for Older People Page 19 of 34 Evidence: beef with trimmings. And for tea time:- fish fingers, soup, sandwiches, beans on toast, buttered crumpets, mushrooms on toast, egg on toast, egg and chips, cheese on toast. The manager said that they were about to introduce making smoothies and going to produce photographs of meals. We cross referenced the written menu with the food record kept by staff and found that in the main meals were served in line with the published menu. We found that people were satisfied with the food and drink served at Peel Moat. People told us that there was plenty of variety and choice. They said: I like it really- the cooks not bad he comes and asks me what Id like- hes very kind.; I have a salad every day for lunch and a bacon sandwich for breakfast- when they bring a drink they always bring a biscuit. The staff understand that I want weak tea. The staff are very obliging and helpful. And a relative commented: She enjoyed the meal today- theyre good, they try to give a variety. We observed that the cook asked each person about the menu choice and provided what was requested. We found that every one who returned CQC surveys confirmed that the meals served at Peel Moat was varied and met their needs. Care Homes for Older People Page 20 of 34 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 involved with Peel Moat have their complaints taken seriously and the homes adult protection policies and procedures promotes the safety of people living there. Evidence: We looked at the complaints procedure a copy of which was in the entrance of the home. We assessed that this provided sufficient information about how to make a complaint and described how complaints would be dealt with. People were also informed about how they could take their complaint or concern further if they were dissatisfied with the way it was handled by the home. We found that everyone who returned CQC surveys knew how to make an official complaint. People we talked to illustrated that they were clear about the actions they should take to make a complaint and they were confident that any issues would be resolved. Comments made to us included: I cant say I have any complaints- I did complain about the breakfast when the cook was off and Matron talked to me and it was seen to. If I have a complaint she talks to me and it is seen to- we discuss it. And Care Homes for Older People Page 21 of 34 Evidence: I have made a complaint and this was responded to. We looked at the protection of vulnerable Adults (POVA) policy and guidelines used at Peel Moat and these are in keeping with the POVA policy introduced by Stockport Metropolitan Borough Council (SMBC). The manager confirmed that one POVA investigations have taken place. This had been dealt with openly and involved the SMBC safeguarding team, and the outcome was that the allegation was unfounded. We found that Protection of Vulnerable Adult training is included in the induction training, staff also receive training at Peel Moat through use of a training video and they have access to a rolling programme of training provided by the Stockport Training partnership. We found that staff interviewed were keen to confirm that they would take action to prevent or stop abuse or deal with complaints. They told us: If I saw something I didnt like I would go to the Matron or the deputy- we have to be careful how we speak to people, such as, we can sound abrupt when its not meant, like if we speak loudly.; If someone made a complaint I would tell the matron and put in the records. And If I would see someone is getting abused I would take action- like if it was someone above me I would report it to the Commission- if my level I would report it to the manager but would also jump in and say Sorry you cant do that.. We discussed the implementation of the Deprivation Of Liberty Safeguards (DoLS) with the manager. She confirmed that she and senior staff had attended this training. We discussed the need to ensure that if there is risk of peoples liberties been restricted then the policy should be followed. We were told by the manager that she would look at peoples needs in relation to this policy and make the necessary referrals. Care Homes for Older People Page 22 of 34 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. Peel Moat provides accommodation that meets peoples physical and social needs but more work is needed to ensure that all areas are hygienically clean and free from offencive odours. Evidence: We visited Peel Moat and entered a number of bedrooms and all of the communal areas. We noted that there was a heavy scent of urine as we entered the home. We discussed this issue with the manager who concluded it was because the carpets were old and worn and so became difficult to clean. We assess that the carpets in the hallway and corridors should be replaced so that these areas are clean and free from unpleasant odours. We found that the lounge and dining areas were clean and the furniture was clean and pleasant to use. We found that, in the main, bedrooms were clean although the carpet and beds in two of the rooms entered should be cleaned or replaced because they looked dirty. We found that all the rooms entered had been personalised to meet individual taste. And people confirmed that they were able to bring their furniture, pictures and other items to make their rooms more homely. Care Homes for Older People Page 23 of 34 Evidence: We entered a number of shared rooms and saw that each had a privacy screen that staff used to promote peoples privacy and dignity when needed. We observed that people made use of the different lounge and sitting areas throughout the home. We noted that although some of the furniture had been replaced the process of refurbishment needs to continue. We observed that people could mobilise around the home safely using handrails, walking frames or walking sticks and other aids and adaptations that had been provided. The manager informed us that there were sufficient toilets and baths to meet the needs of the residents. And we saw on the day of the inspection that a new adapted bath had recently been installed. The manager reported that people loved this particular piece of equipment. We saw that the laundry at Peel Moat was clean and well organised. The equipment, fixtures and fittings meets the required hygiene standards in that all the surfaces were washable and there is a washing machine with a sluice facility. People told us: I have brought my own bed, chair and bureau from home. and Yes Im happy- I like to be here. Care Homes for Older People Page 24 of 34 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. Staff are provided in sufficient number and with appropriate skills to meet the health needs of people living in the home. Evidence: We found, on the day of inspection, that there were 30 people living at Peel Moat and the staffing included, the manager, the deputy manager and four care staff. Other workers at the home on that day included a domestic, the full-time laundry worker and the chef. We noted, through looking at the duty roster, that this was the usual level of staffing. The manager said in the information returned to us that they rarely had to use agency staff. We found that since the last key inspection and Annual Service Review the deployment of staff has been evaluated and changes made. For example staff do not have breaks all at the same time, and a part-time activities coordinator has been employed although she was on planned leave on the day of the inspection. We looked at a number of staff files including that for the most recent recruits. We saw that up-to-date Criminal Record Bureau (CRB) checks and POVA firsts had been completed. The files also contained the original application form, proof of identity, two references and photographs. And all staff who returned surveys confirmed that the recruitment and selection had been robust and that POVA firsts and references had Care Homes for Older People Page 25 of 34 Evidence: been taken up before they started to work at the home and they did not undertake personal care until the CRBs were returned. All the people living at Peel Moat who returned surveys said that they felt that there was always enough staff on duty to meet their needs. The majority of staff who returned rosters felt that there was usually enough staff to meet peoples needs. We observed staff interaction and saw that this was calm and time was taken to meet peoples needs. And we noted that there was sufficient staff on duty to ensure that people received one to one personal support in respect of diet and personal care. We saw that when people required assistance this was provided quickly. We asked people about the staff and they told us: The girls are very kind.; Yes there does seem to be enough of them around. And staff were enthusiastic about working at Peel Moat, comments included: I love working here. We found that staff at Peel Moat have receive ample opportunities to receive training. Courses provided since the previous inspection includes:-Medication administration and management levels 1 and 2; Infection control; Health and safety; Care planning; Appointed First Aider; food hygiene; Fire safety; Moving and handling; Dementia care; National Vocational Qualification (NVQ) level 2 and 3 in care; NVQ level 4 in management; Registered Managers Award; protection of vulnerable adults training and dealing with challenging behaviour. We saw that the induction training is in keeping with Skills for Care Common induction protocol and covered the following topics:-the principles of care; safety; communication; abuse and neglect; care in practise and self development. We were informed by the manager in the information she returned to us that well over 50 of care-staff have achieved NVQ level 2 in care or above. We talked to members of staff and they were knowledgeable about the work they did and how to apply the new learning they had received. People enjoyed working at Peel Moat and they identified that the residents benefited from staff who worked as a team. Comments about the staffing included: We all work well together people do a good Care Homes for Older People Page 26 of 34 Evidence: job and if they dont they get told. and I feel we have some good staff that make the residents feel at home, good communication skills. Care Homes for Older People Page 27 of 34 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. People at Peel Moat benefit from a home manager who has the skills, training and experience to take effective action to ensure that the home runs smoothly and peoples wellbeing is promoted. Evidence: We found that the manager continues to update herself with relevant training and by attending professional meetings. Courses she has attended since the previous inspection includes:- Mental Capacity Act Training,; Deprivation of Liberty Safeguard Training and Health Care for the Elderly. On the day of inspection she was also attending a course and update concerning Infection control and Swine Flu. We noted that magazines, leaflets and other publications confirmed that she provided staff with current information and chances to increase their knowledge both formally and informally. The manager confirmed in the returned CQC Annual Quality Assurance Care Homes for Older People Page 28 of 34 Evidence: Assessment(AQAA) that the quality assurance process at Peel Moat gives relatives and others the opportunity to comment and make suggestions about improvements and how the home is run. We looked at the forms completed by people and discussed the action taken by the management team in light of comments made. From the forms read we found that the homes quality assurance process encouraged people to comment the environment; privacy and dignity; independence; wellbeing; catering and food; activities; laundry and housekeeping. There continues to be some dissatisfaction with activities and so the manager stated that an internal improvement plan had been made in relation to trying to increase the number of outings offered to the residents. We found that the quality assurance process is still incomplete as the information has not been analysed or published so that people involved have an official acknowledgement that their opinions have been taken into consideration in relation to developing the service. We found that peoples money is accounted for. We looked the accounts of five people and found that the amounts tallied with the records kept. A receipt book is used to record all expenditures and funds passed over to relatives are signed for. We found that peoples health and safety is protected by the steps taken by the manager. We were informed by the manager that all fire safety, manual handling and services were maintained and inspected in line with the manufacturers or regulating bodys recommendations. We noted through certificates and the testimony of staff that health and safety and moving and handling training was provided and updated. We concluded that moving and handling practises observed on the day of inspection were satisfactory. We noted that staff complied with moving and handling instructions that are detailed in individual care-plans. We were informed that staff are due to have their infection control training updated. We noted that hand washing posters were in place and staff were aware of how to prevent the spread of germs and infection, and knew that correct hand washing was the most important action to take in respect of infection control. We also saw that they used gloves and aprons correctly. We looked at the fire safety records and these confirmed that fire drills took place at Care Homes for Older People Page 29 of 34 Evidence: different times so that all shifts knew what to do. We found that a Food Safety inspection had been completed by Stockport Metropolitan Borough Council under the Better Food Better Business protocol. We found that people were complimentary about the management style in the home the approach of the management team. And people said The matron is very good- shes number 1. Care Homes for Older People Page 30 of 34 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 34 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 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 7 The registered person should ensure that all staff know when to report a decrease in peoples weight so that this can be more closely monitored to make sure that the effect of any intervention can be measured and so prevent people from having weight loss if at all possible. The registered person should make sure that all staff always adhere to the Peel Moat policy and guidelines in relation to the administration, storage and recording of the medication they handle this is so that they can always be certain that medication is provided to the correct person, at the correct time and in the correct dose and by this promote peoples comfort and wellbeing. The registered person should ensure that they are able to check whether the room where medication is stored is kept between the temperatures recommended by the the pharmaceutical society. The registered person should make sure that the storage and recording of medication that needs special consideration is secure and accurate. This will protect against discrepancies and make sure that the medication is always available for the person it has been prescribed for. Page 32 of 34 2 9 3 9 4 9 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 5 12 The registered person should ensure that equipment used for activities is age appropriate and fully meets the different physical needs of people living at Peel Moat, this is so that people can participate to the best of their ability and also demonstrate that staff understand that peoples interests are sophisticated and adult, including trips out. The registered person should ensure that staff and people concerned with the home understand the workings of the Deprivation of Liberty Safeguards so that people do not have their rights infringed. The registered person should make sure that all areas of the home are clean and free from unpleasant odours, this will show that the home is as hygienically clean as possible and make the environment pleasant to live in. 6 18 7 26 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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