Care Home: Windmill Court

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What the care home does well Windmill Court provides nursing, personal care and support for a maximum of 34 people. On the day of the inspection residents looked well cared for and those spoken to said they were happy living in the home. Staff were observed working with people in a positive manner which resulted in individualised care and support. The expert by experience noted that ‘I observed many of the staff and was very impressed with their attitude to the residents and to each other; they came across as a happy team who enjoyed their work’. Pre admission assessments are always carried out to ensure that the home can manage the needs of the person. Ongoing training means that staff are up to date and have the skills to look after the current residents.Windmill CourtDS0000067809.V376272.R01.S.docVersion 5.2Documentation and records seen were well organised, up to date and stored as required. People are given choices about how they spend their time, they told us that they like to make use of the garden and enjoy going out on trips. The expert by experience wrote that ‘The home is surrounded by grounds that are beautifully maintained with numerous shrubs, trees and flowers, bird feeders with an assortment of food to attract different birds have been sited throughout the grounds and outside of resident’s windows for the pleasure of the residents and I have been told that they are filled every day. Pottery, paintings and poetry that have been done by the residents are placed around the home along with collages of photographs taken during the workshops’. What has improved since the last inspection? There are 2 domestic washing machines to use if the main sluice cycle washing machine breaks down. The new area manager from the Maria Mallaband Care Group who visits the home regularly (and produces a regulation 26 report about her findings following each visit which is available for CQC to look at) has worked with carers on the floor to find out how they feel about their jobs and what the work entails. The manager said that she is very approachable and constructive and supportive. Some help was given to the maintenance man/gardener following the last inspection to get the garden into shape and make it easier to manage in the future. What the care home could do better: Nine of the ten completed staff surveys said commented that staffing levels are of concern with four indicating that there are ‘never’ enough staff, two that there are ‘sometimes’ enough and three that there are ‘usually’ enough. The manager is aware of the issues and is implementing some changes that will increase the amount of time care staff can spend with residents. Radiator covers need to be installed throughout the home. A risk assessment of each radiator needs to be in place until such time as it is covered. Key inspection report CARE HOMES FOR OLDER PEOPLE Windmill Court St Minver Wadebridge Cornwall PL27 6RD Lead Inspector Mandy Norton Key Unannounced Inspection 2nd July 2009 10:00 DS0000067809.V376272.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 2 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 Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Windmill Court Address St Minver Wadebridge Cornwall PL27 6RD Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01208 863831 01208 862890 windmillcourt@gmail.com Thomas Henry Mallaband Limited Manager post vacant Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34), Physical disability over 65 years of age of places (34), Sensory Impairment over 65 years of age (34) Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) named service user under the age of 65 years to be admitted. Date of last inspection 10th July 2008 Brief Description of the Service: Windmill Court is registered to provide personal care with nursing for up to 34 service users in the category of OP (Old age), PD (Physical disability) and SI (Sensory Impairment). The home is set within its own grounds just outside St Minver (approximately 5 miles from Wadebridge). All rooms are all single occupancy and all except one have en-suite facilities, comprising toilet and wash hand-basin. The premises offer modern accommodation and level access throughout. Communal space consists of a lounge, conservatory and a dining room. There are rural views from the rear of the home. The grounds comprise of a variety of garden areas, including an enclosed patios with seating areas in an inner quadrant that is accessible by wheelchair, there is a large garden to the side of the home with paths and seating. The home is owned by the Maria Mallaband Care Group (mariamallaband.co.uk), who own a number of homes on the North of England. The fees range from £733 - 764 per week (correct July 2009). Each person is issued with a contract once a settling in period has been achieved. A copy of the Statement of Purpose and previous inspection report are displayed in the entrance foyer. Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place from 09.45 am to 4 pm on the 2nd July 2009 with one inspector and an expert by experience’ *. The inspection was conducted with the manager. A tour of the home was carried out and people who live at the home and people who work at the home were spoken to and observed formally and informally. A variety of records were also seen during the course of the day. Other evidence gathered since the previous inspection such as notifications received from the home (e.g. regarding any incidents which occurred), the annual quality assurance assessment (AQAA) (a self assessment document that the home completes annually and submits to the Commission) and completed surveys from both care staff and residents was also used to help form the judgements made in the report. *An expert by experience is a person who, because of their shared experience of using services or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The three tasks that an expert by experience can do are to talk to people who use services, staff and management, observe daily life in the service and the interaction between staff and people who use services and look around the premises. What the service does well: Windmill Court provides nursing, personal care and support for a maximum of 34 people. On the day of the inspection residents looked well cared for and those spoken to said they were happy living in the home. Staff were observed working with people in a positive manner which resulted in individualised care and support. The expert by experience noted that ‘I observed many of the staff and was very impressed with their attitude to the residents and to each other; they came across as a happy team who enjoyed their work’. Pre admission assessments are always carried out to ensure that the home can manage the needs of the person. Ongoing training means that staff are up to date and have the skills to look after the current residents. Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 6 Documentation and records seen were well organised, up to date and stored as required. People are given choices about how they spend their time, they told us that they like to make use of the garden and enjoy going out on trips. The expert by experience wrote that ‘The home is surrounded by grounds that are beautifully maintained with numerous shrubs, trees and flowers, bird feeders with an assortment of food to attract different birds have been sited throughout the grounds and outside of resident’s windows for the pleasure of the residents and I have been told that they are filled every day. Pottery, paintings and poetry that have been done by the residents are placed around the home along with collages of photographs taken during the workshops’. 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 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. Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 People using the 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 this service have information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. EVIDENCE: The manager said that the ‘statement of purpose’ and ‘service users guide’ in resident’s rooms is being amended to reflect recent changes in the management structure. She said she takes a copy with her when she carries out a pre admission assessment to give to the prospective resident, there is Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 9 one on display in the main entrance and anybody who requests a copy is sent one. The one seen during the inspection included annual questionnaire results and information about what the service can offer. The manager said that she carries out a pre admission assessment (or one of the trained nurses who is qualified to carry out an assessment will if she is off) before offering someone a room to ensure they can meet their needs. The prospective resident (and/or their representatives) is offered the chance to come and view the home and meet with staff and other residents if they want to (this may also be useful as part of the assessment) and have a chance to ask any questions they may have. The AQAA told us that ‘Our contracts explain resident’s rights & responsibilities, the Home’s responsibilities, room to be occupied, & fee structure. It is reviewed as their needs change. We support & facilitate the use of an Advocate if appropriate, to aid understanding of the document. The resident & the Home, each retaining a copy, sign this document’. The current fee level ranges from £733 to 764 per week (correct July 2009). Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the 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 practice regarding the planning and delivery of care means that people can be sure that their nursing, health and personal care needs will always be met. EVIDENCE: The care plans seen are updated daily and reviewed at least monthly. The nursing and care staff complete daily records about a person’s welfare and detail what care and support has been provided. The care plans examined set out people’s health and personal care needs and contained detailed information about visits made by health care professionals such as GPs, dieticians, opticians and dentists. There was also information about social history and hobbies and interests that the activity organisers use to tailor the activities to suit peoples group and individual needs. Individual risk assessments seen were Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 11 up to date and relevant and included manual handling, skin integrity, nutrition, self medicating, lockable space and personal finances. The AQAA states that ‘we involve resident, &/or their family/advocate, in the care planning process, seeking their views & preferences. Their consent & degree of desired involvement is documented’. A tour of the home showed that equipment to help skin stay in a good condition and for prevention of pressure sores is available and meets people’s current needs this included hoists and electric mattresses and adjustable beds. The manager said that they have enough equipment and any equipment she has asked fro from the company has always been provided. The medicines are stored in a locked trolley, which was clean and well organised. The drugs fridge generally had its temperature taken and recorded daily. The records of administration were clear and a photograph of each resident is kept with the record to aid identification. The procedure for receipt, storage and disposal of unwanted medicines was explained and is in accordance with laid down legislation. Staff were heard and observed interacting with people appropriately and providing care and support in a discreet manner. Staff were heard knocking on doors before entering and doors remained closed whilst personal care was taking place. The expert by experience said in her report ‘I was told by several residents that their privacy is respected and people do knock before entering (their room)’ she added that ‘the staff spend time with the residents and are patient to their needs. I did not observe any patronising or rudeness and the residents that I spoke to had no complaints about the way they were spoken to’. Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A wide range of activities within the home and local community mean that people have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and staff are always available to help make them an enjoyable and social occasion for people. EVIDENCE: People are encouraged to exercise choice in how they spend their time and activities are offered individually or in groups. Three activity organisers spend 3 hours each during the week (at staggered times) usually Tuesday, Wednesday and Thursday offering a variety of activities, these were seen advertised within the home and included poetry readings and quizzes. There are bus trips twice a month, arts and crafts sessions weekly and the manager Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 13 described the visit by the donkey sanctuary that was enjoyed very much and a recent ‘Abba sing-a-long’ that the staff and residents were involved in. There was a bus trip on the afternoon of the inspection to a local garden centre and one of the nurses was asked by the manager to ring a relative to let them know where the trip was going as they might like to meet their relative there for a cup of tea. This was noted as good practice. One comment on a completed service user survey was that it ‘maybe nice to take the residents outside into the garden when the weather is warm for some fresh air’. The expert by experience said in her report that ‘the home is surrounded by grounds that are beautifully maintained with numerous shrubs, trees and flowers, bird feeders with an assortment of food to attract different birds have been sited throughout the grounds and outside of resident’s windows for the pleasure of the residents and I have been told that they are filled every day. Pottery, paintings and poetry that have been done by the residents are placed around the home along with collages of photographs taken during the workshops. There are several bookcases filled with an assortment of books including large print books and armchairs to relax in. An electric organ is available for residents who play and for visiting musicians. I was told that they once had a resident who would play whilst residents were getting ready to eat; this was much enjoyed by all. I looked at the activities folder to see what was on offer and was amazed at the different activities they regularly do. The activities folder contained numerous photographs of some of the past events and a session record sheet is kept showing who participates and how they enjoyed and benefited from the activity, I have yet to see a more organised and impressive activities choice’. The care plans are designed so that information about people’s interests and hobbies is recorded and can be used when trying to develop person centred care. The AQAA states that ‘residents complete an Activities Questionnaire and Getting To Know You booklet on or soon after admission with their named nurse if necessary. Two meal times are offered and residents may choose to eat in their room or with friends in the dining room or with relatives in the conservatory. New residents are introduced to others and encouraged to meet up e.g. through coffee mornings and trips out. Flower arranging and other activities shared. We have a designated hair salon with a hairdresser visiting twice a week. We hold regular religious services’. Visitors are welcomed at anytime and people were seen coming and going freely during the inspection. Most people have their meals in the dining room, Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 14 There is a 4 weekly menu rota, people are asked what they would like for their meal in advance and there is always a choice. Drinks and snacks are available 24 hours a day. A daily menu is displayed on each table in the dining room. Records are kept of what people eat to ensure they are receiving a balanced diet. The mealtime observed showed that staff are available to give people any help or support they may need. The tables were laid very tastefully with place names. The trays laid for people who were choosing to eat in their rooms were also laid out well and would add to the dining experience. One comment on a completed Service User survey was that they would prefer their supper later than 5.45 which they consider a little early, they went on to say that overall they are satisfied with the service provided. Five people indicated on completed surveys that they ‘always’ enjoy the meals at the home and four that they ‘usually’ did. Specialist diets are catered for and the staff are appropriately trained to manage them. A dietician is contacted if necessary and the staff are able to follow any instructions as required as well as monitor weight, condition of the mouth and co-ordination as required. The expert by experience added ‘the residents are given a choice of food at all meals, both main and dessert dishes. I observed during dinner and was very impressed with the choice on offer, the food was well cooked and presented and there were large bowls of assorted fresh fruit which the residents can have at any time of the day. Unfortunately on the day of my visit the head cook went home sick so it was left to the remaining staff to prepare and cook the meal. They were efficient, organised and served a delicious meal with no problems. Residents are taken out regularly. Some of the outings have been to art exhibitions, and historic house and gardens’. During the inspection the manager detailed where she thinks improvements can be made and the AQAA states that she wants ‘More `one to one` activities e.g. massage and other sensory experiences for those residents less able to make choice or who are on bed rest. Some of the garden area is not suitable for wheelchair use, & we need to rectify this as soon as possible’. Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. Staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. EVIDENCE: The complaints procedure was seen displayed in the home and is included in the Service Users Guide. It is comprehensive and gives options about who to contact and timescales for responses to be made. There have been no complaints made to the Commission or the home in the last 12 months. The manager said that people are seen by senior staff daily and hopes that any issues or concerns would be bought up at then. The manager said that they have a good relationship with a number of relatives and liaise with them about the ongoing welfare of their relatives. Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 16 Eight of the ten completed Service User surveys indicated that they knew how to make a formal complaint and nine of the ten completed staff surveys indicated that they knew what to do if someone has concerns about the home. Records show that a number of staff have attended safeguarding training; they also have information about safeguarding when doing National Vocational Qualification (NVQ) training and during induction training. All staff are to receive in house safeguarding training provided by an external trainer and a number of staff will have training on Deprivation of Liberty Safeguards (DOLS) which have been introduced by the Mental Capacity Act. The manager should ensure she and the senior staff are conversant with the local authority safeguarding procedure and she is confident they know how to make an alert if necessary. Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 25 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Ongoing refurbishment, redecoration and maintenance means that people have a comfortable, homely and safe environment in which to live. EVIDENCE: The home is set within its own grounds just outside St Minver (approximately 5 miles from Wadebridge). All rooms are all single occupancy and all except one have en-suite facilities, comprising toilet and wash hand-basin. The premises offer modern accommodation all on one level with level access throughout. Communal space consists of a lounge, conservatory and a dining room. Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 18 A tour of the home showed that people’s rooms are very personalised with furniture and mementos they bought in with them. People spoken to said they were happy with their current accommodation. The expert by experience stated that ‘The rooms are very light, some with amazing countryside views. They are decorated and furnished very tastefully and residents are able to bring in some small pieces of furniture, pictures and ornaments to give a really homely feel’. Comments on completed service user surveys included’ the grounds could be in a better state, the gardener/handyman does his best but has a lot to do’ and ‘we need a good gardener in addition to the maintenance man to keep what were attractive gardens in good order’. The expert by experience reported that ‘The home is surrounded by grounds that are beautifully maintained with numerous shrubs, trees and flowers, bird feeders with an assortment of food to attract different birds have been sited throughout the grounds and outside of resident’s windows for the pleasure of the residents and I have been told that they are filled every day’. The grounds are obviously important to the residents and the gardener/handyman struggles to maintain it as people would like. The garden at the side of the home known as ‘the secret garden’ is an area that the manager would like to develop to its former glory, it has level access for the residents and would be a good place for people to sit and enjoy some fresh air, entertain their visitors and perhaps enjoy a BBQ or a cream tea. The manager said that there is an ongoing programme of routine maintenance and redecoration that is implemented by the handyman. The home complies with the local fire service and environmental health department requirements. There are enough assisted bathrooms, shower rooms and toilets for the people who currently live at the home and all but one of the rooms have en-suite facilities. The bathrooms were functional as well as being bright and modern. On the day of the inspection the home was clean, tidy and hygienic. There are domestic staff on duty seven days a week. Nine of the ten completed residents surveys indicated that the home is always fresh and clean and one that it ‘usually’ is. One comment was that ‘it is spotlessly clean’. Policies and procedures around infection control are up to date and available to staff at all times. Staff files examined showed that training on infection control is routinely offered to staff. The AQAA states that ‘our team of ancillary workers have annual mandatory training that includes infection control & COSHH awareness’. There is sluicing disinfector and the laundry has a washing machine that has the required programming to ensure linen is washed at the right temperature for the right amount of time to thoroughly clean it and reduce the risk of cross infection. . Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 19 Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the 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 staffing levels and skill mix are satisfactory meaning peoples needs are generally being met. The robust recruitment procedure means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. EVIDENCE: On the day of the inspection there were appropriate staff numbers and skills mix available to provide the required nursing care and support for the 29 people living at the home. There is a qualified nurse on duty 24 hours a day. Four of the ten completed staff surveys indicated that there are never enough staff to meet he individual needs of the residents, three that there ‘usually’ are, two that there ‘sometimes’ are and one that there are ‘always’ enough staff. A variety of comments were made including ‘provide adequate care staff in order to maintain to maintain the good standard of care Windmill Court was known for’ and ‘my only concern is that sometimes we do not have enough carers on the shift to carry out the care to the standards Windmill Court Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 21 expect’. Another stated when asked the question what could the home do better? That ‘more staff so we can share special time with our residents, sit and have a chat not just chatting whilst a task is being carried out’. Comments on completed resident surveys when asked what the home could do better included’ someone who would be employed to come in and chat for half an hour about everyday issues’. Staff spoken to say they love working at the home despite the staffing levels pressure and just wish they could have time to meet all of peoples needs. The nursing and care staff are supported by administrative, catering, domestic and maintenance staff. There is a stable staff group and a variety of training opportunities are provided including first aid, moving and handling and food hygiene. The AQAA states that ‘67 of staff hold an NVQ 2 or above’. Upcoming training dates were seen displayed on the staff notice boards in the nurse’s office and in the staff room. The nurses have to be registered with the Nursing and Midwifery Council (NMC) and to remain registered have to complete a number of hours of relevant training each year. Staff files we looked at all had completed application forms, 2 written references, criminal records bureau (CRB) checks, statements of terms and conditions of employment and job descriptions. The AQAA states that ‘references, CRB’s, & POVA clearance are obtained & checked before employment commences. We have a period of supernumerary status for new members of staff for induction purposes’. All completed staff surveys indicated that CRB and reference checks were carried out. Five indicated that their induction covered everything they needed to know to do the job when they started very well’, three that it ‘mostly’ did and two that it ‘partly’ did. The company have a human resources department and have a nominated person that deals directly with Windmill Court to support their staff. All staff have a staff handbook that details employment practices, some policies and procedures and systems inn place to support them. Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 People using the 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 systems and procedures in place are designed to meet the needs of the service as they strive to continually improve the service the home offers to the people that live there. The attitude to health and safety shown by the providers, nursing, care and ancillary staff means that people live in a safe and well maintained environment. EVIDENCE: Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 23 The manager has recently become the manager of Windmill Court. She has worked at the home for sometime as the deputy manager and took on the manager’s role when the previous manager left. She has applied to the Commission to be registered and has a fit person interview in the near future for which she well prepared. Staff report that she has made some positive changes since taking over and is well respected. She said she has good support from the company’s new area manager and meets with other managers from homes in the group on a regular basis. The AQAA states that ‘the management ethos within the home is open, inclusive, & nondiscriminatory’. Evidence collected by the inspector and the ‘expert by experience’ on the day of the inspection by observing and talking to staff and residents would support this statement. The manager was able to demonstrate that the home have appropriate checks in place for various health and safety procedures including portable appliance tests, moving and handling equipment, insurances, environmental health and the maintenance of fire safety. The AQAA states that ‘accidents & incidents are recorded, monitored, & audited by the home & Area Manager. They are reported as H&S legislation requires. We have monthly audits of pressure sore occurrence, falls, & accidents, monitored by the Manager & Area Manager’. The company conducts regular quality assurance surveys using satisfaction surveys given to residents, relatives and members of the multidisciplinary team that work with the home. The results of these surveys are analysed and the results are discussed with staff and added to the Service Users Guide. A number of thank you cards and letters were seen during the inspection and are kept in the entrance area alongside other useful information about the home, the previous inspection report and minutes of meetings held with residents and relatives. The area manager conducts 4 – 6 weekly visits to the home. She speaks to the manager, staff and residents and has a tour of the home. Following the visit she prepares a report that highlights any areas of concerns or where actions need to be taken. These are then kept at the home and are available to the Commission at any time. The homes policies and procedures are up to date and available to staff at all times. The company review a number of them and the manager or appropriate head of department reviews the rest as required. We saw the written records kept of all financial transactions on behalf of the residents, they included income and outgoings and receipts if necessary. The administrator said they do not generally manage resident’s money and demonstrated how any expenditure such as the hairdresser or newspapers are invoiced to the person who pays the bills. Secure facilities are used for storage of money and any valuables. The handyman carries out ongoing routine house and garden maintenance, including decorating of rooms. He also provides ongoing maintenance for the bungalows that are on site. Any faults noted by staff are recorded in the Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 24 handyman’s book that he looks at each day he is on duty and then deals with the issues appropriately. He checks the hot water restriction valves and records the water temperatures regularly. The manager said that they have maintenance contracts in place for all equipment, machinery, electrical & gas installations. Records to support this were seen during the inspection. Supervision of staff is undertaken and appropriately recorded. The AQAA states that ‘each member of staff has regular supervision throughout the year, & an annual appraisal. From this we are able to plan their training needs with them, & formulate an individual training plan’. Six of the completed staff surveys indicated that they get enough support from the manager who meets with them regularly to discuss how they are working ‘regularly’, one indicated they ‘often’ do and three that they ‘sometimes’ do. All of the records seen were well constructed, up to date and stored appropriately. Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 x 3 x 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 3 X 3 Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP25 Regulation 23 (2) (p) Requirement All radiators should be covered or guaranteed low surface temperature. A planned programme of how this is to be achieved must be developed. A risk assessment for all radiators not covered must be in place and regularly reviewed until such time as they are covered. Timescale for action 02/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations Staffing levels should be kept under review to ensure that resident’s needs are being met at all times. The changes that the manager has proposed to improve staffing levels should be monitored to ensure that people’s needs are being met. Windmill Court DS0000067809.V376272.R01.S.doc Version 5.2 Page 27 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: 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. 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