Inspection on 02/04/09 for Alandale

Also see our care home review for Alandale for more information

Summary
Extracts
Full report

This is the latest available inspection report for this service, carried out on 2nd April 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Alandale 9 The Drove Whitfield Dover Kent CT16 3JB The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mark Hemmings Date: 0 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Alandale 9 The Drove Whitfield Dover Kent CT16 3JB 01304824904 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : alandaleresidentialhome@ntlworld.com Mr Paul Maple care home 32 Number of places (if applicable): Under 65 Over 65 32 old age, not falling within any other category Additional conditions: 0 One service user in the LD category may be accommodated within the home. The maximum number of service users to be accommodated is 32. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP). Date of last inspection Brief description of the care home Up to 32 older people can make their home in Alandale (the Service). The property is a detached original house, to which extensions have been added. The accommodation is on the ground and the first floor. There is a passenger lift and two stair lifts that give step-free access around the place. Everyone has their own bedroom. Each bedroom has got a private wash hand basin and seven of them also have their own toilet. There are two bathrooms and two shower rooms. There are seven separate toilets. Theres a call bell system. This has call points in each of the bathrooms and toilets. There are call points in the lounge and in other public areas. Also, there are call points in each of Care Homes for Older People Page 4 of 34 Brief description of the care home the bedrooms and in their private bathrooms. This means that people can ring for assistance. The Service is in a quiet residential street in Whitfield. This is a village that joins onto Dover. At the back there is a garden that has a circular patio area around a central pond and fountain. There are four seating areas with a back drop of flowerbeds and shrubs. There is off street car parking for eight cars. The Service has its own car. Alandale is not part of a group of homes. Its a privately run family business. The Registered Provider is currently also the Registered Manager. However, hes assisted in the day to day running of the Service by a Manager of Care. If you want to find out more about the Service and about the fees charged, you can telephone the Service and speak with the Registered Provider or with the Manager. Information is also available on the website and by email. The web address is www.alandaleresidentialhome.co.uk If you want to fax the Service, the number to use is the same as the telephone number that weve listed above. 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: The quality rating for this Service is 2 Star. This means that the people who use this Service experience good quality outcomes. Since 1 April 2006, we have developed the way we do our inspection of care services. This inspection of the Service was Key Inspection. We arrived at the Service at about eight oclock in the morning and we were there for about seven and a half hours. It was a thorough look at how well things are going. We took into account information provided by the Registered Provider in his self assessment. This is called the Annual Quality Assurance Assessment (the Assessment). Further, we considered any information that we have received about the Service since the last inspection. During the inspection, we spoke with five of the people who live in the Service. We also spoke Care Homes for Older People Page 6 of 34 with the Registered Provider, the Manager, with three of the care workers and with the cook. We walked around parts of the accommodation and we looked at a selection of key records and documents. Before we called to the Service, we asked ten of the people who live there and 10 members of staff to fill out a questionnaire for us. We wanted them to tell us what they think of Alandale. Eight of the people who live in the Service and three members of staff kindly filled them in and sent them back to us. Later on in our report, well tell you what people are saying in these questionnaires. The Registered Provider has done his own questionnaires. These have asked the people who live in the Service what they think about different aspects of how things are going. Seventeen people responded to most of the questions. Well tell you what theyre saying in their answers as we go through our report. What the care home does well: What has improved since the last inspection? What they could do better: The system used to organise the monthly review of the individual plans of care needs to be more organised. This is necessary to make sure that the reviews take place as regularly as is intended. The arrangements used to store refrigerated medication need to be strengthened. This is so that the medicines can be stored securely when theyre not in use. The system used to ensure that some medicines stay within their use by date needs to be strengthened. This is necessary to make sure that some medicines arent used when they are out of date. One part of the recruitment system needs to be strengthened. This is so that the Registered Provider can be sure that he has completed all of the necessary security checks. The quality assurance system doesnt fully involve all of the people who live in the Service. This is important because theyre the experts on what it is like to live in Alandale. They need to have a direct say in how things are going. Also, they need to be told what is going to be done to respond to any improvements they may come up with. Care Homes for Older People Page 8 of 34 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 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 who are thinking of moving in are asked about what support they need and how they want this to be done. People who want to stay for shorter periods are helped to go back home. Evidence: The Manager asks people who are thinking of moving in about what support they need and want. This is done so that everyone can be confident that moving in to Alandale is the right thing for them. She also talks with family members, care managers (social workers) and with medical staff. All of this information is collected so that the Manager can build up a really good picture of how the persons needs can best be met. After shes got all of this information, she can then decide if the Service can support the person in a way thats right for them. We looked at the information that has been collected for one person who has recently Care Homes for Older People Page 11 of 34 Evidence: moved into the Service. We wanted to see what sorts of things are being considered. There is lots of useful information. This includes things such as the way they need to be helped to manage their continence at night. There is also information about how they like to be helped to get about. The Manager says that when she gets the information she shares it with the care workers. This is done so that they know in advance about what support they will need to provide. We asked two care workers about how all of this works out in practice. They say that they are indeed told about people who are about to move in. They say that as a team they discuss how best to help the person in the first few days, while they get to know them better. The Manager recognises that moving into a residential setting is a big step for anyone to take. She says that she wants to do everything possible to put the persons mind at rest. We agree that this is really important. She says that as part of the introduction process, people are invited whenever possible to visit Alandale. This is so that they can see what the place is like first hand. During these visits, people can ask any questions they want. There are also some written documents that say about the Service in quite a lot of detail. These are called the Service Users Guide and the Statement of Purpose. People can ask to see these if they want. The Manager is quite happy for them to take away a copy if they want to have a look at them at their leisure. In our questionnaire we ask people who live in the Service, did you receive enough information about this home before you moved in so you could decide if it was the right place for you? Everyone says that yes they did. One person adds, visited and could see for myself. We asked one person about this when we were in the Service. They say, its a real shock to move in to a home and even if you come to have a look around first which I did, you do have to get used to it. Still I have my own things around me and the staff are so kind. Id rather be at home of course, but if I was Id be lonely and they really do take care of me so well here. Most of the people who move into the Service do so with the intention of making it their longer term home. However, there is provision for people to stay for shorter periods. This might be so that someone who cares for them at home can have some time to themselves. Or, someone might move in because they been in hospital and arent quite ready to go home yet. When someone moves into a residential setting theres always the risk that their stay might become longer than is necessary. The Manager is aware of this. She says that people are helped to make any arrangements that are necessary for them to leave as planned. This has recently been done for one person who moved into the Service after they werent managing too well at home. The Manager has liaised with the persons care manager and with members of their family. Care Homes for Older People Page 12 of 34 Evidence: This has been done so that the person can be supported when they go home. Care Homes for Older People Page 13 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 are provided with the personal and health care they need. Some of the ways medicines are managed need to be strengthened. People are treated with kindness and respect. Evidence: The people who live in the Service say that the care workers offer them all the assistance they need. There is a written individual plan of personal support for each person. These are important because they are one of the ways that people can say what assistance they want to have and how they want it to be done. Also, the plans give information to care workers so that they know what to do. We looked at three of these plans. They give a clear account of who needs to do what and why. For example, there is useful information about things such as health care, helping people in the bathroom and about keeping people safe. In more detail, one person needs to be helped to keep their skin in a healthy condition. Someone else needs special help to manage their continence. Care Homes for Older People Page 14 of 34 Evidence: We asked three care workers about some of these things. We wanted to know what all of this written information means in practice. They know all about it. In our questionnaire for people who live in the Service we ask, do you receive the care and support you need? Six people say that they always do and two people answer that they usually do. The latter people dont say any more about their answers. One of the former people adds, I have been very pleased and grateful for the high level of care and support. The Registered Providers questionnaire asks about the adequacy of the level of care provided in the Service. Eight people say that its excellent and nine people say that its good. The care plans are kept up to date so that they are accurate. This involves care workers making daily notes about how things are going. There are then monthly reviews. This is when the Manager and the care workers check out with the person concerned and with their family how things are going and what might need to be changed. There is a system to record the completion of these reviews. We looked at two sets of these records and one of them is not up to date. However, in our questionnaire for people who live in the Service we ask, do staff listen and act on what you say? Everyone says that yes they do. Sensible steps are taken to ensure that people do not have any avoidable accidents. For example, some people are a bit unsteady on their feet. They are accompanied by a care worker so that they dont lose their balance. There are special rails fitted to some of the beds. This has been done so that people dont have to worry about rolling out of bed. The Manager says that she has carefully checked the use of these bed rails. This has been done to make sure that theyre the most helpful thing to use for each of the people concerned. People are helped to keep healthy. Care workers keep a tactful eye open so that a doctor can be called if someone is becoming unwell. Since our last inspection, people have seen their doctors as and when necessary. There have also been contacts with specialist hospital based medical staff. We looked at some of the records about how quickly doctors are being called after the need for medical attention is first noted. Its being done straightaway. In our questionnaire for people who live in the Service we ask, do you receive the medical support you need? Six people say that they always do and two people answer usually. The Registered Providers questionnaire asks about the availability of doctors. Seven people say that its excellent and seven say that its good. At the moment, two of the people who live in the Service manage their own medication. There are supported in doing this. Care workers check out with them every now and then how things are going. The other people have asked the Service to Care Homes for Older People Page 15 of 34 Evidence: manage their medication for them. There is a system to check that the correct medicines are received from the chemist. Once in the Service, most of them are being stored securely. However, when we checked the fridge where things like eye drops are kept it wasnt locked as it should be. The Manager has assured us that she will put this right without delay. There is a system that should make sure that things like eye drops dont go beyond their use by date. However, this isnt working right. When we checked two of them, there was no record to show when they had been opened. This means that the Manager cant be sure that theyre still within their use by date. Again, the Manager has assured us that this oversight will now be put right. There is a procedure for administering medicines. This is designed to double check that the right medicines are given to the right people at the right time. There is a record kept each time a medicine is given out. We examined two sets of these records for a period of several recent days. They are being correctly completed each time a medicine is given. We looked at two medicines in more detail. This was done to see if the remaining stock matches what should be there. Again, we found things to be in order. People say that the care workers are courteous and attentive. When we were in the Service we talked with people a lot about this. They are very positive about the care workers. Several people summarise the general mood in their comments to us. One says, the carers really are good and kind. You can have a laugh with them and theyre not serious. We have jokes about who supports which football team and they are always there to have a chat with. I like them all and I know that theyll help me if I need it. Another person says, I like to spend time in my bedroom but the girls are always around and they often pop in to see how I am and I never really get lonely. I can hear them up and down the corridor then a face pops up and asks me how I am and I like it here. I get well taken care of. The Registered Providers questionnaire asks about the helpfulness of members of staff. Eight people say that its excellent and eight people say that its good. The care workers are relaxed and informal in how they are. Things are orderly without being too much so. Peoples privacy is respected. If they need help in the bathroom the door is closed first. Members of staff knock and wait before going into peoples bedrooms. People are helped to wear neat and clean clothes so that they can present themselves how they want. They are given their post promptly. Also, they are helped to deal with it if something is difficult for them. People can use the telephone whenever they want. Care Homes for Older People Page 16 of 34 Care Homes for Older People Page 17 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. There are some interesting things for people to do. People are free to receive visitors and to spend the day as they wish. Good quality meals are served. Evidence: The Manager says that the plan is that there is an organised social thing that people can do on most days. She says that each week someone comes in to lead gentle exercises and that another person comes to take an arts and crafts session. There are also outside entertainers who come in to play music and to give talks. In addition to this, the care workers organise things like bingo sessions. We looked at the record of the events that have taken place during the course of a recent week or so. There were two bingo sessions, an arts and crafts activity, an exercise session, a musical entertainer and a trip out. In our questionnaire for people who live in the Service we ask, are there activities arranged by the home that you can take part in? Five people say that there always are, two people answer usually and one person says sometimes. One of the former people says, very good efforts are made to provide entertainment and motivation to those able and wishing to participate. Excellent craft lady. The Registered Providers questionnaire also asks about social activities. Three people say that theyre excellent, eight people say that theyre good, four people Care Homes for Older People Page 18 of 34 Evidence: think theyre fair and one person says that theyre poor. The Assessment says that the range of social activities will be kept under active review. This is so that new and additional things can be offered in the future. When we were in the Service we kept our eyes open to see what people were doing. Some were enjoying the privacy of their bedrooms. However, most were sitting in the main lounge or in the conservatory. There they were doing things such as reading, watching the television and chatting. There was quite a lively atmosphere. Later in the afternoon, eleven people sat with three care workers having quite a hotly contested game of bingo. We asked people about the sorts of social things that they can do. People are generally positive. One person summarises the general mood when they say, I do the bingo but would like to win more than I do. Still its good fun and like it. Theres always someone to chat to around the place and I like to sit in the lounge and see people going by. I never get lonely or bored theres always something to do. Another person says, we have lots to do like the musical man. We chat to each other and we all get on. If people dont want to do things its up to them. People are helped to keep in touch with members of their families, if this is necessary and if this is what they want. Family members and friends are welcome to call to the Service at any reasonable time. The Manager keeps in touch with family members so that they know how things are going. For example, if someone is not well or if they are admitted to hospital. The Registered Provider doesnt get involved in handling peoples financial affairs. For example, running bank accounts or signing for things in someones name. Its a good idea not to get involved in this way. This is because it avoids conflicts of interests. Instead, most people get help from members of their family. People are encouraged to make their bedrooms their own private space. They are asked to bring in things for their own homes so that they can have personal items around them. We saw lots of examples of this. For example, people have their own photographs and ornaments so that their bedrooms feel more like being home. People say that they receive good quality meals and that they have enough to eat. They consider meal times to be a relaxed and pleasant affair. Some people choose to dine in the privacy of their bedrooms. One of the questions we ask in our questionnaire for people who live in the Service is, do you like the meals? Five people say that they always do and three people answer usually. The Registered Providers questionnaire asks about the meals too. Eight people say that theyre excellent, six say that theyre good and one person says that theyre fair. When we were in the Service people chatted with us about the catering arrangements and they were very complimentary. Care Homes for Older People Page 19 of 34 Evidence: One person says, oh yes, we always have enough food and I think that its very tasty actually. Ive got no complaints at all about the catering and theres a good choice of things too. The main meal of the day is lunch. This is normally a set meal. However, if someone doesnt want it the cook will prepare an alternative. There is a cooked option at tea time and other things in addition to this such as assorted sandwiches. We looked at the records of the meals provided over a two day period. We wanted to see if different people are actually having different things. They are. We also looked at the variety of meals provided over a period of two or three days. There is a reasonable balance. The lunch time dishes include things like roast chicken, beef and mushroom pie and liver and bacon casserole. Care workers say that people can have drinks and snacks throughout the night. This is important. Otherwise, it can be a long time for some people between the late evening milky drink and breakfast the next day. 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. There is a complaints procedure. There are arrangements to make sure that complaints are dealt with properly. There are arrangements in place to safeguard people. Evidence: There is a written complaints procedure. This explains how to go about making a complaint or raising a concern about something. The Registered Provider has received four complaints since our last inspection. We looked at two of these recorded items. One involved a complaint from a senior member of staff about an incident when three care workers were a bit high spirited and flicked things like cream at each other. The incident didnt involve any of the people who live in the Service. Nevertheless, the Registered Provider looked into it. He has reminded the care workers concerned that Alandale is other peoples home and that it must be respected as such. The other complaint was more serious and it involved some money being stolen from one of the people who live in the Service. The records show that the Registered Provider responded promptly to this matter. He determined what had happened. This then lead to a member of staffs contract of employment being ended. The Registered Provider has kept in touch with ourselves and with other relevant agencies to keep us informed about the matter. In our questionnaire for people who live in the Service we ask, do you know how to Care Homes for Older People Page 21 of 34 Evidence: make a complaint? Everyone says that yes they do. We asked several people about making complaints. They say and show by their relaxed manner they would feel quite okay about raising a complaint should they need to. Its very important that people are confident that theyre safe from being taken advantage of. The Assessment commits the Registered Provider to guarding against this. We asked some of the care workers about this matter. They know what to look out for. One person says, the residents absolutely come first here and Ive never even had the slightest concern about anyones wellbeing. It just wouldnt be tolerated here. This is a really caring family type home. We also asked people who live in the Service about this general subject. None of them have any concerns about how things are going. One of them says, I feel quite safe here and I like to know that staff are around in case I need them. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The accommodation is comfortable and pleasant. There is a modern fire safety system. The kitchen is well equipped. There is a suitable laundry. Evidence: The building is well maintained on the outside. The patio garden is neat and quite attractive. On the inside, the accommodation is well decorated and furnished. There are lots of little touches that make the place feel lived such as interesting pictures. In our questionnaire we ask people who live in the Service, is the home fresh and clean? Everyone says that it always is. One person adds, always very clean. The Registered Providers questionnaire asks about the standard of the housekeeping. Seven people say that its excellent, nine people think that its good and one person says that its fair. The building is fitted with an automatic fire detection system. This provides a high level of fire safety protection. We understand that the fire brigade people say that the system meets the national standard. The Registered Provider has a system of doing regular fire safety risk assessments. This is where he goes around the place to check out that everything is still working in the right way. We looked at the record of the most recent one and it says that everything is still okay with the system. The Registered Provider is now going to send a copy of the assessment to the fire brigade Care Homes for Older People Page 23 of 34 Evidence: people. This is so that they can then check that its detailed enough. Hes going to do this by 1 June 2009. The people from the local Department of Environmental Health called to look at the kitchen earlier this year. Their report gives the Service a Clean Food Award. It says that the kitchen is clean and well presented. We looked in the kitchen too. Its well equipped, clean and very well organised. The cook does sensible things to ensure good food hygiene. She makes sure that the fridges and freezers are cold enough to store food safely. She also makes sure that hot foods are cooked through thoroughly. Theres a stock management system. This means that individual foods dont go beyond their use by date. People who need it are helped to get about. The baths are fitted with a special hoist. These swivel so you can sit on them outside the bath and then be lifted over and into the bath. The showers are special walk in ones where you dont have to step in to them. There is one mobile hoist. This can be used in the lounges and in the bedrooms. It might be needed if someone cant manage to stand at all and needs to be lifted. There is also a special stand aid hoist. This is useful for people who can bear some of their own weight but who find it difficult to stand without being supported. At key places, there are assistance poles. These are fitted to the wall and they are there for people to hold onto for extra support. There are frames near to the toilets. People find these very helpful when they are getting down and getting back up again. There are other less obvious things to help people get about. For example, there are special belts that can be used to give people that extra bit of help they might need when getting up from a chair. Also, there are special sheets that can be used to help people change position in bed. When someone moves into the Service, the Manager makes a special note of what assistance they need to get about. She looks at things such as the help someone needs in the bedroom and in the bathroom. We asked care workers about this. They know what theyre doing. We saw one person being helped to walk using a frame. They didnt rush the person who was helped to go safely at their own speed. We asked people how warm the accommodation is kept. They say that they are always comfortable even during the coldest weather. When we arrived in the Service the central heating was on and it was on when we left. Most of the radiators are fitted with guards. This has been done to reduce the chance that someone will be burnt if they fall against them. Most of the hot water taps that are used by the people who live in the Service are temperature controlled. This means that they wont get hot enough to scald someone. We tested a few taps and the temperature seems alright to us. The Care Homes for Older People Page 24 of 34 Evidence: Registered Provider says that he intends to fit guards and temperature control valves to all of the remaining radiators and hot water taps. While this is being done hes going to consider if any interim arrangements need to be made to help prevent the occurrence of any accidents. Hes going to do this by 1 June 2009. The laundry has two commercial grade washing machines. These have an extra cycle for items that need an especially hot wash. There is a large tumble drier. We looked in the laundry. Its well organised and clean. The Manager says that everyones clothes are marked so that theres less chance of them getting lost or mixed up with other peoples things. This is very important because its a really basic thing to wear only your own clothes. We checked this out for two garments. We found each of them to be marked with the name of the owner. We asked people about this. They say that they do nearly always get their own clothes back from the laundry. Care Homes for Older People Page 25 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. There are enough care workers around. A part of the recruitment arrangements needs to be strengthened. Care workers know what theyre doing and they are given relevant training. Evidence: During the day and the evening, there are always at least three care workers on duty and sometimes there are four. At night, there are two waking care workers on duty and there are special security arrangements. During the day, there are other members of staff on duty. They variously work in the kitchen or do most of the housekeeping. The Manager says that all of the shifts are being reliably filled. We looked at the written roster. It confirms what the Manager is saying. In our questionnaire we ask people who live in the Service, are the staff available when you need them? Three people say that there always are and five people say usually. The Registered Providers questionnaire also asks about staffing levels. Five people say that theyre excellent and 11 people say that theyre good. In our questionnaire for members of staff we ask, are there enough staff to meet the individual needs of all the people who use the Service? Two people reply always and one person says usually. When we were in the Service we asked members of staff about this. One person sums up the tone of what was said when they observe, I think Care Homes for Older People Page 26 of 34 Evidence: that this place is quite well staffed actually. We have enough staff around to do the job and not to have to rush. I think that the residents get quality time with us and things are how they should be. When we were in the Service we kept a look out for things that might give us a clue about how well the place is being staffed. We noticed that two people who asked to be helped to use the toilet were assisted straight away. Another thing we looked at was the time taken to answer the call bells. We looked at two occasions when it went off. On both times it was answered in about a minute. Its very important that only honest and trustworthy people are employed as care workers. With this in mind, the Registered Provider completes a number of security checks on new care workers. These include things such as confirming their identity, taking up references and doing a police check. We looked at the records for two recently appointed care workers. Most of the checks that we need to see have been done. However, neither of the references for one of them has been received back. The Registered Provider is now going to chase these up. More generally, the Manager is going to check the personnel files for all care workers appointed in the past year. Shes going to do this to make sure that the Registered Provider has got all of the references he needs to have in place. This exercise is going to be completed by 1 July 2009. The Manager says that new care workers have introductory training before they work on their own. In our questionnaire we ask about this. We say to members of staff, did your introductory training cover everything you needed to know to do the job when you started? Two people say that the training met their needs very well and one person says that it mostly did. Theres a checklist of the subjects that new care workers are told about. We looked at one of these checklists that has recently been completed. It shows that important things are being covered. For example, they are told about the individual support plans that we spoke about earlier. They are also shown how to help people get about safely. We asked care workers about this when we were in the Service. One person says, the initial training is very good actually. You get shown around and gradually introduced to the residents. Theres a lot to learn and you have to do it slowly. I was told about things such as bathing, personal care and health care things. The Manager says that this initial training is just to get care workers started. After that, care workers are expected to do further training. These courses include how to safely support people move about, basic first aid, food hygiene, keeping people safe and infection control. In our questionnaire for members of staff we ask, are you being given training which helps you understand and meet the individual needs of service Care Homes for Older People Page 27 of 34 Evidence: users and that keeps you up to date with new ways of working? Everyone says that yes they are. We spoke with care workers about this matter when we were in the Service. One person sums up the general mood when they say, we do get a lot of training here. Ive done courses about infection control, food handling and how to move people in the right way. I think that (the Manager) takes training seriously and I think that we get good support. We looked at the records of who has done what courses so far. In general, they show that quite a lot of training is being done on a regular basis. Theres a total of 23 care workers employed in the Service. Seven of them have completed a National Vocational Qualification (NVQ) at Level 2 or 3 in health and personal care and three more are currently studying for the award. This qualification is a very good idea. This is because it helps care workers to deliver high quality residential care services. The Manager says that all new care workers will be encouraged to study for the award. We spoke with three care workers to find out what they know about particular bits of the support they will need to give people. As we have said earlier in this Report, they know a lot about how each of the people who live in the Service likes to be supported. More generally, they know about things such as how to help people to express themselves. They know about how to help people take care of their skin. They also know about how to respectfully help people who need assistance to manage their continence. Care Homes for Older People Page 28 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. Things are well managed. People are asked what they think, but this needs to be a bit more organised. People are helped to buy what they want. There are reliable health and safety arrangements. Evidence: The Manager in general has a good knowledge of how things are going. She has both of the formal qualifications that are recommended by the Standards for managers. These qualifications are important. This is because theyre designed to help managers ensure that high quality residential support is reliably provided. The Registered Provider has asked us to register the Manager in her post. This will give us a chance to speak with her in some detail about how she intends to ensure the reliable running of the Service. The care workers say that there is good team work between them. There are handover meetings at the beginning and end of each shift. These are held so that care workers Care Homes for Older People Page 29 of 34 Evidence: can be kept up to date with developments. In our questionnaire for members of staff we ask, are you given up to date information about the needs of the people you support or care for? Everyone answers always. One person adds that, information about the clients and their needs is always available. We asked people about team working when we were in the Service and we got positive replies. One person says, theres good team work here and we all get on well together. Theres a plan for each shift so that we know what each others doing. We are updated about how things have gone over the last shift so that we can take this account. For example if someones not well they might be having a lie down and so well just go and check on how they are a bit later on. There are team meetings about every few months or so. We looked at the records of the sorts of things that were discussed at the last one. Theyre practical and relevant. For example, care workers talked about how to make time for the handover sessions weve just mentioned. They also discussed some training courses that are being planned. In our questionnaire we ask members of staff, do the ways you pass information about people who use the Service between staff (including the manager) work well? Everyone says that yes they do. Its really important that the people who live in the Service have a direct say on how things are going. Theyre the experts because they live there. The Assessment says that people who live in the Service are regularly asked what they think about their home as part of everyday life. As we have already noted, each year the Registered Provider also asks the people who live in the Service to fill in the questionnaires that we have quoted from. In general, we think that this is a very useful thing to do. However, there are some further improvements that can be made. Not everyone is completing the questionnaires. Those who choose not to do so may prefer to be asked what they think in another way. Although there is a Newsletter, this doesnt really mention the results of the questionnaire exercise. Theres no organised system to tell people who live in the Service whats been said in the questionnaires and about what is going to be done to respond to any improvements that may have been suggested. The Registered Provider is going to look into this further to see what can be done. There is a system to help people buy goods and services without having to handle too much money. This involves the Registered Provider paying for things such as seeing the hairdresser and the chiropodist. The sums spent are then invoiced to the person who can then settle the bill as part of their ongoing monthly payment for living in the Service. We looked in some detail at some of the various transactions involved. We found everything to be in order. What is being charged on the invoices is supported by a receipt that shows the Registered Provider has indeed spent the money in question. Care Homes for Older People Page 30 of 34 Evidence: The Registered Provider is required to do regular checks to make sure that the fire safety equipment remains in good working order. We looked at the records and the checks are up to date. There are regular fire drills. There is also a programme of fire training that plans to give instruction to every member of staff twice year. There are up to date reports from engineers about the gas appliances, the electrical wiring installation, the mobile hoists and the passenger lift. They say that everything is in good working order. We looked at the record of accidents that have occurred in the Service over the past few months. There hasnt been that many. Most have been minor bumps and bruises. The Manager keeps an eye on who has had an accident and what has happened. This is done so that she can do something if there is a particular problem thats causing the accidents. We dont think that theres anything obvious that needs to be sorted out at the moment. The Registered Provider and the Manager regularly check things to do with the building and with the equipment. This is done so that if something is broken it can be repaired quickly. Theyre also looking for hazards that might result in someone having an accident. They havent found any. We kept our eyes open when we were walking around. We didnt notice any particular hazards either. Care Homes for Older People Page 31 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 32 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 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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