Inspection on 27/05/09 for Belle Green Court Care Home

This is the latest available inspection report for this service, carried out on 27th May 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Belle Green Court Care Home 03/01/06

Belle Green Court Care Home 03/06/05

Belle Green Court Care Home 01/03/05

Belle Green Court Care Home 02/07/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Belle Green Court Care Home Off Belle Green Lane Cudworth Barnsley South Yorkshire S72 8LU     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: Jayne White     Date: 2 7 0 5 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 32 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 32 Information about the care home Name of care home: Address: Belle Green Court Care Home Off Belle Green Lane Cudworth Barnsley South Yorkshire S72 8LU 01226718178 F/P01226718178 none 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) : Mr Diwan Chand care home 40 Number of places (if applicable): Under 65 Over 65 40 old age, not falling within any other category Additional conditions: 0 One specified service user under the age of 60 years may reside at the home. Persons accommodated shall be aged 60 years and above There are 20 beds registered for nursing (N) only, and 20 beds registered for personal care (PC) only. Date of last inspection Brief description of the care home Belle Green Court is a care home that provides nursing and/or personal care and accommodation for 40 older people. Mr Diwan Chand owns the home. The home occupies a central position in the village of Cudworth in Barnsley, central to all local amenities. It is a purpose built two storey building with an accessible garden area. There is a Care Homes for Older People Page 4 of 32 Brief description of the care home passenger lift. All bedrooms are single with en-suite facilities. There are car-parking facilities at the front of the building. Written information about the home is kept in the office. This includes the statement of purpose and the service user guide that includes the range of fees and a sample contract/terms and conditions. The most recent inspection report from CQC was on display in the entrance hall. The manager provided information to CQC with reference to the fees charged. This was £361.77, with extra charges for hairdressing and chiropody (if the community chiropodist wasnt used). Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection conducted by Jayne White, inspector. We visited without giving the service any notice. Mrs Sylvia Forster, the manager was present during the visit. The manager completed an Annual Quality Assurance Assessment (AQAA) before the site visit. This gives the service the opportunity to tell the Care Quality Commission (CQC) how well they think they are meeting the needs of people using the service, what the home was doing well, what had improved since the last inspection on 26 June 2007 and any plans for improving the service in the next 12 months. Various aspects of the service were then checked during the site visit including inspection of parts of the environment, records relating to the running of the home, observing care practices Care Homes for Older People Page 6 of 32 and inspecting a sample of policies and procedures. We sent 10 surveys to people living at the home, asking them about their experiences of living there, 4 to health and social care professionals, asking them about their experiences of working with the home and 5 to staff, about their experience of working at the home. Three surveys were returned by people that lived there, two from health care professionals and three from members of staff. The majority of people living at the home were seen throughout the visit and several were spoken with about the care they received. The care provided for three people was checked against their records to determine if their individual needs identified in their plan of care were being met. We also spoke with staff and the manager about their knowledge, skills and experiences of working at the home. We checked all the key standards and previous requirements. All this information and peoples and staffs opinions and comments were considered for inclusion in this report. The manager was provided with initial feedback from the inspection during and at the end of the visit. The Care Quality Commission (CQC) wishes to thank people living at the home, the staff and the manager for their assistance and co-operation during the visit. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: The acting manager had the qualifications and experience required of the person in day to day control of the delivery of care. People could be confident the care home could support them. This was because there had been an assessment of their needs, which told the home about them and the health and care support they needed. People commented, daughter wanted me looked after, I looked round, I liked it as soon as I came in, visited brother here, looked round a few places. Chose this because theres room to move about, daughter looked round and was thrilled to bits. Im happy, once I get used to my surroundings and Sylvia, owner came to see me, shes a lovely person. People were receiving the health and personal care they needed and medication practices supported people in a safe way. Health care professionals commented, ensures high standards of personalised care at all times, staff courteous and have a good knowledge of individual service users and relevant paperbased information is usually up to date and reviewed regularly. Other professionals are alerted and involved as needed to ensure residents needs are met. Staff attitude and approach to care was based on respect for people, which promoted peoples rights and dignity. Each person was treated as an individual. They were as independent as they could be, lead their chosen lifestyle and were given the opportunity to make the most of their abilities. The care home supported people in following personal interests and activities. People said, watch TV, read paper, dont bother with activities, do nothing, but happy doing nothing, play bingo, I like my TV and talking books, everything right on, I like peace and quiet, theres nothing to do and Monday and Wednesdays bingo. People were able to keep in touch with family, friends and representatives. They had meals that were good quality and on the whole met peoples expectations. A complaints procedure was in place and people and their representatives could feel confident that any concerns they had would be listened to. Policies and procedures were in place to protect people from abuse. There was a well maintained living environment that was clean, tidy and a comfortable environment for people to live and enjoy. People received support and care from a well trained staff team, where sufficient staff were on duty. People spoke highly of staff and said, very nice, no fault - cant wish for anything better, staff alright, all lot of them - no swearing, shouting, carers are different in their approach. One or two I wouldnt live with. Some will do anything. Theyre respectful, courteous, never use bad language and very, very good - no swearing and shouting. Where the service held monies on behalf of people it was managed in a way that Care Homes for Older People Page 8 of 32 protected them. The health, safety and welfare of people and staff were protected. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Older People Page 9 of 32 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 32 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 11 of 32 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 could be confident the care home could support them. This was because there had been an assessment of their needs, that they or their representative had been involved in. This told the home about them and the health and care support they needed. Evidence: When we looked at peoples surveys it told us people had received enough information about the home before they moved in so they could decide if the place was right for them. When we spoke to people they said themselves or their representatives had visited the home prior to their admission, to assess the quality, facilities and suitability of the home. Their comments included, daughter wanted me looked after, I looked round, I liked it as soon as I came in, visited brother here, looked round a few places. Care Homes for Older People Page 12 of 32 Evidence: Chose this because theres room to move about, daughter looked round and was thrilled to bits. Im happy, once I get used to my surroundings and Sylvia, owner came to see me, shes a lovely person. The two health care professional surveys that were returned stated the service usually assessed arrangements to ensure that accurate information was gathered and the right service was planned for people. We looked at three peoples files to check that pre admission assessments had been undertaken. This told us that prior to the admission taking place, staff from the home carried out an assessment of peoples needs. This confirmed that the service was appropriate for the person and provided staff with information to formulate an individual plan of care. However, care must be taken that these assessments are dated and signed. They could also contain more comprehensive information. We saw in one of the files, the service had received the assessment for someone referred through care management arrangements. The service should do this for everyone. Care Homes for Older People Page 13 of 32 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. Peoples health, personal and social care needs were met. The home had a plan of care that the person or their representative had been involved in making. Medication practices supported people in a safe way. On the whole, peoples right to privacy was respected and the support they got from staff was given in a way that maintained their dignity. Evidence: The AQAA stated a person centred approach to care planning was used, with people supported to make their own decisions. Also that care plans and risk assessments were in place to identify those at risk from pressure damage, nutrition, infection, bed rails and falls. We looked at three care plans to check this. A care plan had been formulated, including any assessments of presenting risks. The care plans included good information about people. Risk assessments were in place for pressure areas, falls, nutrition, infection and moving and handling. The plans were being regularly reviewed Care Homes for Older People Page 14 of 32 Evidence: and the changes in peoples conditions being observed and recorded. Requirements made at the last inspection had been met. The care plans identified that health care professionals did visit people to assist in maintaining their health care needs. Two health care professional surveys were returned. One stated the care service usually sought advice and acted upon it to meet peoples social and health care needs. Both stated peoples social and health care needs were usually properly monitored, reviewed and met by the care service. Their comments included, ensures high standards of personalised care at all times, staff courteous and have a good knowledge of individual service users and relevant paperbased information is usually up to date and reviewed regularly. Other professionals are alerted and involved as needed to ensure residents needs are met. When we looked at peoples surveys two stated they always received the care and support they needed, one usually. All stated they always got the medical care they needed. When we spoke with staff they showed a good knowledge of peoples diagnosis and could verbally describe the health and personal care needs of the people they cared for. In their surveys all staff stated they were given up to date information about the needs of the people they cared for. They commented, maintains a high standard of care and good rapport with clients and relatives and care and welfare of the service users and with entertainment and activities that the service users can participate in as things they thought they did well. We observed staff working to see how staff valued and respected the privacy of people. There was clear and respectful communication between people and staff and staff treated people in a kind manner. Staff spoke clearly and at a steady pace with people. People looked clean, were well dressed and appeared to receive a good level of personal care. This indicated respect and dignity by staff when caring for them. However, lounge chairs continued to have continence protectors on them, which does not promote the privacy and dignity of some people or promote the use of chairs by other people or visitors. When we spoke to people they commented that they were well cared for by helpful and kind staff who treated them well and found them respectful of their privacy. The health care professional surveys that were returned stated the service usually respected peoples privacy and dignity. Medication storage arrangements for medication held by the home identified Care Homes for Older People Page 15 of 32 Evidence: medication was stored securely in locked trolleys within locked rooms. A sample of four peoples medications in stock and medication administration records (MAR)were checked. Medication adminsitration records we checked were completed with staffs signatures. Peoples allergies were recorded on the MAR, which would reduce the risk of the wrong medication being given. The audit included sampling of two controlled drugs. These were satisfactory. Nursing staff were responsible for administering medication. The date and the quantity of medication received from the pharmacy and the signature of the person checking the record was recorded on the MAR. In one instance the medication carried over from the previous month was not recorded on the MAR. This meant an exact identification of current stock could only be made by looking through records since the persons admission. This was also a recommendation not fully met from the last inspection. Both health care professional surveys returned stated the care service usually supported people to administer their own medication or managed it correctly where this was not possible. Care Homes for Older People Page 16 of 32 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. Each person was treated as an individual. They were as independent as they could be, lead their chosen lifestyle and were given the opportunity to make the most of their abilities. The care home supported people in following personal interests and activities. People were able to keep in touch with family, friends and representatives. People had meals that were good quality and on the whole met peoples expectations. Evidence: The AQAA stated religious needs were met through people attending places of worship and members of different religions being invited into home, the Anglican vicar continued to visit, clients attended the methodist chapel weekly and staff support was offered to maintain attendance. It stated they continued to offer a wide range of activities including, shopping visits and feeding birds, local ice-cream van visiting twice weekly, ladies enjoying complentary therapy and manicures and the visiting library continuing to be used and some people visiting the local library. It stated they provided a newsletter with forthcoming events and the home was a member of the National Association of Providers of Activites (NAPA) and quarterly newsletters were received and ideas used. The AQAA told us the activity organiser was to complete a distance learning programme provided by NAPA. It stated an activities diary was Care Homes for Older People Page 17 of 32 Evidence: maintained daily. The AQAA also told us open visiting arrangements were in place and visitors were welcome at any time. It stated the Silver Food Award had been maintained. Two people in their surveys stated there was always activities that they could take part in if they wanted to, one didnt answer. When we spoke to people and their representatives about their daily life they said, watch TV, read paper, dont bother with activities, do nothing, but happy doing nothing, play bingo, I like my TV and talking books, everything right on, I like peace and quiet, theres nothing to do and Monday and Wednesdays bingo. Both health care professional surveys that were returned stated the service usually supported people to live the life they chose. We saw that daily routines within the home were flexible. People said they could spend the day as they wished and described within reason how they got up and retired to bed as they wished. They described that it was their choice what they did during the day. An activities co-ordinator was employed. The activities record for May identified activities such as a Chronicle morning, exercise, manicures, bingo, jigsaws, dominoes, snakes and ladders, music videos and taking a resident to shop. This meant people were encouraged to keep in touch with local news and community. When we spoke to people it told us their representatives were able to visit the home at any time and were made to feel very welcome. We saw that everyone coming into the home was offered hospitality and staff took time to make sure friends and family were made to feel comfortable whilst visiting. One person in their surveys stated they always liked the meals, two usually. When we spoke to people about the meals that were served it told us that generally people liked them. They felt that generally a good choice of menu was offered. The dining rooms were comfortable and provided a pleasant environment for people to dine in. The tables were nicely set. A choice of meals was identified on the menu board for people. The meal time was a positive and pleasant event. There was no rush to the mealtime and people were given sufficient time to eat. Staff were patient and helpful and allowed people time to finish their meal. Care staff were sensitive to those people who found it difficult to eat their meal themselves and needed assistance. They helped the person at their pace, making them feel comfortable and unhurried. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 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. A complaints procedure was in place and people and their representatives could feel confident that any concerns they had would be listened to. Policies and procedures were in place to protect people from abuse. Evidence: The AQAA stated the complaints procedure was available in reception and each persons bedroom. We saw what the AQAA had told us and informed the manager information about the Commission, within the complaints procedure now needs updating. The AQAA told us 1 complaint had been received in the last 12 months that had been resolved within 28 days. Surveys returned by people told us there was someone they could speak to if they werent happy. Two knew how to make a formal complaint, 1 didnt answer. When we spoke to people this was echoed. They told us they were satisfied with the care provided and had no complaints or grumbles. One health care professional survey told us the service always responded appropriately if they or the person using the service had concerns about their care, the other stated usually. Care Homes for Older People Page 20 of 32 Evidence: The surveys returned by staff told us they knew what to do if the person or their representative had concerns about the service. Similar information was received when we spoke with them, including reporting any allegations, although they said they had no concerns about any care practices. The AQAA told us there were policies/procedures/codes of practice in place to protect people from harm and abuse, that had been reviewed in September 2008. The service had the local adult safeguarding policy and procedure, which was readily available for guidance if an incident took place. The manager had received adult safeguarding training and was aware of the multi agency procedures to be followed in the event of any allegation being made. On the whole, when we looked at staff training records they had received adult safeguarding training. When we spoke with them, they were able to describe how they would protect people living there from abuse. The service had been part of an adult safeguarding investigation, that was not upheld. However, the owner had not acted appropriately and followed adult safeguarding protocols. As a consequence, as part of the agreed action from the referral, it was recommended he attend adult safeguarding training. The manager said he had attended this in July 2008. Care Homes for Older People Page 21 of 32 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. There was a well maintained living environment that was clean, tidy and a comfortable environment for people to live and enjoy. Evidence: The AQAA stated sun awnings had been fitted to either side of the building in patio areas to assist in sun protection when enjoying the garden facility, theyd redecorated eight bedrooms, replaced all extractor fans, purchased a further profiling bed and high risk mattress, purchased two alternating mattresses and six pumps and shelving had been fitted in some bedrooms at request of people to put their ornaments, pictures etc. It stated they were planning to replace carpets in communal areas and corridors by the end of May, redecorate upstairs corridors and a grab rail was to be installed near the toilet in the downstairs bathroom. Everyones surveys told us they thought the home was always fresh and clean. When we spoke to people they were satisfied with their living environment and people were happy with their rooms, that most of them had personalised with pieces of their own furniture and possessions. When we looked round the home, the environment was suitable for the needs of people that lived there. The communal lounges and dining area were generally well Care Homes for Older People Page 22 of 32 Evidence: decorated and were a comfortable environment for people to live. The areas offered sufficient space for the number of people that used them. Furniture and fittings were of a good standard and presented a homely environment for people. Access around the home was good. There were sufficient bathrooms and toilets for people that were appropriately located and easily accessible. The toilets had been adapted to assist people with their independence when going to the toilet. All the bedrooms had en-suite toilets and wash hand basins. A handyman was employed and a routine programme of maintenance was in place. On the whole, the garden area was well maintained with a pleasant patio area, however, care must still be taken that the surrounding verge areas seen from some peoples bedrooms is also always kept tidy. The manhole cover to the front of the building had been replaced, so that the grounds were safe for people and visitors. Laundry facilities were sited away from food preparation areas and areas used by people that lived there, making sure the laundry process did not impose on the life of people and that good infection control measures were in place. A health care professional in their survey commented, the home is very pleasant. I have always found it to be clean. Care Homes for Older People Page 23 of 32 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. People received support as there were enough staff on duty. People could not have full confidence in the staff, because all the required checks had not always been done to make sure they were suitable to care for them. Peoples needs were met and they were cared for by staff who received relevant training and support from their managers. Evidence: Two people in their surveys stated staff were always available when they needed them, one usually. One stated staff always listened and acted on what they said, one that they usually did and one didnt answer. When we spoke to people about staff they said, very nice, no fault - cant wish for anything better, staff alright, all lot of them - no swearing, shouting, carers are different in their approach. One or two I wouldnt live with. Some will do anything. Theyre respectful, courteous, never use bad language and very, very good - no swearing and shouting. Two staff in their surveys told us there was enough staff available to meet peoples needs, one didnt answer. One commented, I enjoy my work at the home and feel comfortable in my role. Care Homes for Older People Page 24 of 32 Evidence: When we observed staff on duty, they worked hard, were patient and showed empathy to people. There was mutual respect between people and staff and their conversations were relaxed and friendly. The AQAA stated the service continued with the learning process, for example, the use of the Mental Capacity Act, including Deprivation of Liberty Standards and restraint and implemented this in training sessions. It stated the home ensured staff operated in a manner which promoted peoples liberty. It told us six staff were currently enrolled on NVQ level 3 in Health and Social Care and 62 of care staff held NVQ level 2 in Care. It stated the manager attends bi-monthly meetings organised by the McMillan Nurse to continue increasing the standard of care to terminally ill people and their relatvies. It stated the manager also acted as wound care link for nursing homes and attended GP meetings. It told us infection control training was ongoing resulting in raised awareness in preventing cross infection and that 26 staff had received training in prevention and control of infection. It stated all staff received induction and regular updates and supervision. Thirty staff had received training in malnutrition care and assistance with eating and four catering and 26 care staff were trained in safe food handling. Two care staff were booked to attend a venepuncture course. Two staff in their surveys stated their induction covered everything they need to know to do the job when they started very well, one mostly. Two stated they had been given training relevant to their role, helped them understand and meet the needs of people, kept them up to date with new ways of working and gave them enough knowledge about healthcare and medication, one didnt answer. Two stated they felt they had enough support, experience and knowledge to meet the needs of people, one that they usually did. We looked at three staff files for their training records to confirm information in the AQAA and what staff had told us when we spoke with them. There was evidence that training took place including, moving and handling, NVQ level 2, NVQ Level 3, health and safety, food hygiene, fire, adult safeguarding, induction, emergency first aid, principles of care and infection control. One member of staff said, the managers obsessed with training. One of the health care professional surveys that were returned stated managers and staff always had the right skills and experience to support peoples social and health care needs, one usually. They commented, staff are approachable and friendly. All staff surveys that were returned stated the service carried out employment checks such as a criminal record bureau (CRB) check and references before they started work. Care Homes for Older People Page 25 of 32 Evidence: The AQAA stated all staff have appropriate recruitment checks. However, when we looked at three personnel records to check this, two of them did not have full employment histories, which meant the recruitment procedure was not sufficiently robust enough to protect people. This was a previous requirement, so we have asked the manager to write to us to tell us why it hasnt been addressed and what they are doing to make sure it is in future. Once this has been received we will decide if further action is necessary. Care Homes for Older People Page 26 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People had confidence in the care home because it was led and managed appropriately. Where the service held monies on behalf of people it was managed in a way that protected them. The environment was safe for people and staff because appropriate health and safety practices were carried out. Evidence: The manager was registered with the CQC. The AQAA stated the manager had sixteen years experience and held the Diploma in Management and Management Certificate in Health and Social Care. She held an assessor and teaching qualification. It stated she had maintained the ethos of the home which remained open and transparent. When we spoke with the manager she had a good knowledge of the needs of people and she was committed to providing a good quality service. There was a relaxed and friendly atmosphere within the home. When we spoke with staff they said they enjoyed working there. Care Homes for Older People Page 27 of 32 Evidence: One health care professional in their surveys commented, I feel this is one of the best care homes in our area. One of the surveys for people completed on their behalf by a relative stated, I think the home is excellent and would say my mother couldnt be in a better place. All of the staff surveys told us the manager met with them regularly to provide support and discuss how they were working. Two stated the way information was shared about people they cared for, with other carers and the manager always worked well, one didnt answer. One staff member commented, managers approachable, can go with a problem. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. It provided good information of the current situation within the service, what they had improved in the last 12 months and what they could do better, to identify a plan for improving the quality of life for people. The AQAA indicated systems were in place to check the quality of the service provided, for example, visits by the provider of the service, infection control audits completed to reduce risk of infection occuring and annual satisfaction questionnaires that were used to monitor the service. The AQAA stated a procedure was in place for the management of peoples money, valuables and financial affairs and that the home provided a safe place for people to keep valuables and money. The manager stated that finances were only dealt with by the home for one person. We looked at this and it told us money tallied with the records. We noted whilst looking at care plans the service had not acted on a previous recommendation to keep separate care plans for people, or at least put dividers in the files they used, to facilitate ease of finding information and for people to take and keep their plan should they wish to do so. The AQAA stated maintenance of equipment was in place for premises electrical circuits, portable electrical equipment, lifts, hoists, fire detection and alarms, fire fighting equipment, emergency lighting, emergency call equipment, heating and gas appliances. It also stated a contract was in place for soiled waste disposal. Fire exits had been kept clear, which should make it easy for people and staff to leave the building in the event of a fire. When we looked at a sample of staff files for training records and spoke with staff it told us staff received fire training. Staff also said Care Homes for Older People Page 28 of 32 Evidence: regular fire drills were held and they could describe what they would do in the event of a fire. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 29 19Schedule 2 Where there are gaps in 10/07/2007 employment, a written explanation of those gaps must be demonstrated. This is so that the service can demonstrate people living at the home are sufficiently safeguarded from the risk of abuse. Care Homes for Older People Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 To enable an efficient and correct record of current stock and efficient auditing of medication, medication carried forward from one month to another should be recorded on the medication administration record. So peoples dignity is not compromised, continence protectors should not be placed on lounge chairs. So that records can be easily identified or kept by people if they wish, separate files or dividers should be used for peoples plans of care. 2 3 10 37 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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