Inspection on 10/08/09 for Doddlespool Hall Care Home

This is the latest available inspection report for this service, carried out on 10th August 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.

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: Doddlespool Hall Care Home Main Road Betley Crewe Cheshire CW3 9AE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Peter Dawson     Date: 1 0 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Doddlespool Hall Care Home Main Road Betley Crewe Cheshire CW3 9AE 0000 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Doddlespool Hall Care Home Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 27 The registered person may provide the following category of service only Care Home Only Code PC To service users of the following gender Both Whose primary care needs on admission to the home are within the following Categories Older person OP Dementia DE Date of last inspection Brief description of the care home Doddlespool Hall is a private residential care home, without nursing, registered to provide personal care for up to 27 older people. Registration includes providing a service for people with dementia care needs. Whilst providing essentially long-term Care Homes for Older People Page 4 of 31 Over 65 0 27 27 0 Brief description of the care home care the home also provides short stay/respite care for people if vacancies exist. Doddlespool Hall is located on the outskirts of the village of Betley, 6 miles from Nantwich, 4 miles from Crewe and 10 miles from the Potteries towns. The home is on a bus route with a stop outisde the home. This impressive country house of character provides spacious accommodation on two floors with a shaft lift to the upper floor. There are two lounge areas on the ground floor and pleasant galleried area on the first floor overlooking the driveway and grounds. There are views of the landscaped gardens and surrounding countryside from most rooms. With the exception of one room, all bedrooms have ensuite facilities including a bath. The grounds are spacious extending to around 3 acres including courtyard and patio area overlooking the garden area. Details of fees charge for care at Doddlespool Hall can be obtained directly from the home. Care Homes for Older People Page 5 of 31 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 is a well-established home that has been operating for several years. Ownership changed on 2nd March 2009. The service therefore becomes a new service and following registration has to be inspected within 6 months. This is therefore the first unannounced key inspection of the new service. This inspection was carried out by one inspector on one day from 8.30 a.m - 6.00 pm The Acting Manager has made application to us for registration as the Registered Manager of the service and the application is still being processed. The service completed an AQAA (Annual Quality Assurance Assessment) and this was sent to us prior to the inspection within the required timescale. The AQAA is a legally required self-assessment document, containing information about what the service think they do well, what progress they have made over the past year, what they think Care Homes for Older People Page 6 of 31 they could do better and their plans for improving the service over the next year. The AQAA gave us the information we required and some information is included in this report. There were 18 people in residence at the time of the inspection, including one in hospital. Most were seen and many spoken with together and separately in the lounge and dining areas, some were seen and spoken with in their bedrooms throughout the day. Four visiting relatives were seen and spoken with and we had conversations with staff on duty. All expressed their views about the quality of the service, the environment, staffing and their life at Doddlespool Hall. All expressed positive views about the service, there were no complaints or concerns expressed and there was evidence of positive outcomes for the people living there. We inspected all the communal areas of the home and a sample of bedrooms were seen. Records inspected included: Care plans, risk assessments, daily notes, medication records, staffing rotas and staffing record as well as other documents relevant to the inspection process. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? Doddlespool Hall is classed as a new service from the date of change of ownership on 2/03/09. The changes made from that date are as follows: A new electric hoist has been purchased, this means that there is now a hoist on each of the two floors of the home. Two new wheelchairs have been purchased, providing reliable transport for people needing to be transported within and outside the home. Four adjustable foot stools have been purchased, in response to a request from people using the service. This means that people can rest or elevate their legs safely and comfortably. New bedlinen has been purchased throughout, improving stocks and quality. Care Homes for Older People Page 8 of 31 The carpet and furniture has all been replaced in the dining room, improving the presentation of this area considerably. Four bedrooms have been completely refurbished with new carpets, furniture and soft furnishings and the rooms redecorated. The home see this as the way they would wish to continue to upgrade many bedrooms. The carpet in the hall has been replaced in part with matching carpet from another area. The splits and threadbare parts of the carpet are now secure. A new large plasma TV has been purchased for the lounge area. Previously the small TV was difficult for some people to see in a large lounge area. Gas, heating and electrical installations have been serviced and repaired to ensure safety for people. Work to remedy problems of damp in part of the building has taken place and resolved those problems. What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 31 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 31 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 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More detailed information will assist people in making a decision about admission, but pre admission procedures ensure successful placements. Evidence: The statement of purpose and service users guide have been provided for the new service commencing 2nd March 2009. Some further information is needed to give people details of the services provided. This includes the range of activities provided, whether nursing is provided and the service provided by the District Nursing Service, how the needs of people with dementia and physical disabilities are to be met. The staffing chart shows two General Managers which is confusing. Contracts should be provided for all people. We saw a contract dated 6/8/09 for a person admitted in November 2008 and there was no contract for a person admitted recently for respite care. The Manager confirmed that new contracts for people having short term care were in process. All people currently at the home are self-funding and Care Homes for Older People Page 12 of 31 Evidence: must have contracts with the home. The recent change of ownership means that the majority of people have contracts with the former owners and these need to be changed. Pre admission procedures and documentation are good. This is summarised in the AQAA We give prospective service users the option to come for the day or short stay to see if they like it here before coming in permanently. They may have several short stays before this happens. We carry out pre-admission assessments to ensure that we can meet the needs of prospective service users. Where a clear-cut decision cannot be made the senior staff discuss this together and arrive at a decision. We saw pre-admission assessments for three people. These gave adequate information about their needs. As all people are self-funding this generally means that there is no multi-agency assessment provided by the Social Worker, the information in the homes assessment is therefore critical. People are not informed in writing, following assessment, that the home can meet their needs. The Acting Manager will provide this in future. People spoken with said that they had visited the home prior to admission, had been well received by staff and supported well during the initial settling-in period. Care Homes for Older People Page 13 of 31 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 and personal care needs are known and met. Improved recording of aspects of medication will ensure a safer system is in place to protect people. Evidence: We saw a sample of 4 care plans for people recently admitted and some having longer-term care. Health care information was generally good. There were details of diagnosed conditions and ongoing care plans updated for people whose healthcare needs were changing. Risk assessments were in place for moving and handling and other daily activity. A person admitted to hospital following a fall two days prior to this inspection had a detailed risk assessment relating to falls. The person had falls prior to admission and this had been recorded on the pre-admission assessment. We looked at instances of actual or potential pressure damage. A person with a sore bottom had been referred swiftly to the nursing service and pressure relieving mattress and cushion provided - she was seen in the lounge with the cushion in place. This person had been admitted with a fluid balance chart and prescribed nutritional supplements. She had made good progress over 6 months with a significant weight gain. Care Homes for Older People Page 14 of 31 Evidence: The plan of a more dependent person was seen. There were details of health care needs including regular hospital appointments with Consultant, requiring blood tests at specific intervals prior to the appointments. Records in the homes diary and persons care plan recorded dates for referrals to District Nurse for tests and hospital appointments. There was a care plan for moving and handling, although the hoist was reported to be used occasionally, this was not recorded in the risk assessment. The person has long-term use of a catheter, 12 weekly changes by the nursing service recorded in the care plan. The catheter drain bag is changed by staff. Records showed the day bag changed weekly and night one nightly by staff, although there was no record of this. A care plan needs to be established for catheter care with ongoing recording. The person had developed small skin breaks on his bottom, referred to the nursing service and a good body map outlining the pressure area, but this was not dated. Each aspect of care plans seen had been reviewed on a regular monthly basis, with a detailed recording of the review. We saw that people had signed care plans in some instances. Some information was not contained within the care planning information such as doctors visits and daily notes. The information was available but in different places. The Acting Manager intends to review the care planning format and it was suggested that some dated information could be archived but other information streamlined together for easy reference. Care plans should be working documents giving current information to staff to facilitate care. We observed staff speaking to people in a respectful way and the privacy and dignity of people being observed when providing personal care for them . We looked at the medication system in the home. This is supplied in tablets/bottles and not in monitored dose form. This means that all MAR (Medication Administration Records) have to be handwritten by staff, that is time-consuming and open to possible error. The Acting Manager is considering moving to a monitored dose system. All staff adminstering medication have had training in the safety of medicines and their competency assessed There is some self-medication and risk assessments were in place where this happens. There is no count of medication on MAR sheets, meaning it is not possible to audit the system. A MAR sheet of a person self-medicating anti-Parkinson medication showed box given - the number of tablets not recorded. Staff rely upon the person telling Care Homes for Older People Page 15 of 31 Evidence: them when the tablets need re-ordering. Another person self-medicates analgesics. All medication received must be quantified on the MAR sheet with stock medication added. This is the only way of auditing the system at any point in time and also when prescriptions should be re-ordered. It was clear that not all prescribed creams and sprays were recorded. These must be recorded on MAR sheets and signed when applied - or if more convenient a separate sheet in bedrooms that can be signed by carers when creams are applied. There must be a record of all prescribed treatments and this includes creams. Returns to the pharmacy are listed, signed by staff and countersigned by the pharmacy, ensuring accuracy in disposals of medication. Care Homes for Older People Page 16 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure their chosen lifestyles are met. A wider choice of activities will provide greater choice and quality of life for people. Evidence: There is a limited range of activities. An activities programme on the notice board listed activities only on 3 days for 1 hour or a Film Afternoon. There are no other indoor activities and nothing at weekends. Events are arranged and the notice board showed: Clothes Party, Summertime Express (Theatre group) and a Violinist. People using the service did say that there had been a Summer Strawberry Fair and Bar B Qs. Activities need to be developed to provide a range of activities to meet the diverse leisure and social activity needs of people. Activities are not presently recorded and no-one seems to take specific responsibility for ensuring they take place. People should be consulted about the programme of activities. Many activities are based upon the known previous hobbies and interests of people, but we saw little information in care plans giving social histories upon which to extend and build further interests. The shortfalls in activities are summed up in the AQAA - We need to have a regular Care Homes for Older People Page 17 of 31 Evidence: planned programme of activities that we can offer to service users. We need to look at more outside entertainment to be provided throughout the year and need to recruit or have one person responsible for activities within the home. We need to hold more frequent service user meetings to find out what they would like to do. Clergy visit the home regularly and provide a service open to all. The AQAA states We would do our best to meet any specific cultural needs if they were identified Visitors are positively encouraged to visit at any time and take their relatives out for the day or a short time if they wish. We saw 2 visitors who were, in fact, visiting two relatives/friends in the home. They said that they were made very welcome. One said she has been a volunteer visitor in other settings and There was nothing to match the care given here. Another visitor spoken with said that her mother received excellent care and remarked about the noticeable changes being made since the new owners took over. At the start of the inspection at 8.30 am only one person came to the dining room for breakfast, all others had breakfast trays served in their bedrooms from choice, allowing a leisurely, no-pressure time to rise and eat. Later virtually all came to the dining room for lunch, in advance of the meal time and it was clearly an enjoyable social occasion that people looked forward to The external grounds are extensive with well-kept gardens, lawns and trees resembling a Country House Hotel. There are sitting areas to the side and rear of the building in the courtyard overlooking the garden and the patio areas with good, comfortable seating. Some people said that they like to walk around the building/garden, but clearly some need staff support to do so. Most rooms have panoramic views of the garden. Several people were seen and spoken with in their bedroom throughout the day. The confirmed they like to spend time there as they wish, at the same time enjoying the social contacts in the lounge and dining areas during the day as they wished. The mid-day meal was served in the impressive dining area that has been refurbished, has well-laid tables and extensive views of the impressive grounds - resembling a good restaurant. There are choices of dish at all mealtimes - 4 meals per day plus additional drinks and snacks. All people spoken with said that the food was excellent or marvellous. The food was sampled and included cakes and pastries all home made resembling those seen in the quality patisseries. Special diets are catered for, presently only soft-food and diabetic diets. The home would cater for any cultural food Care Homes for Older People Page 18 of 31 Evidence: needs if they were identified. Care Homes for Older People Page 19 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure their concerns are taken seriously and addressed and staff training and awareness of Safeguarding procedures, ensure they are protected. Evidence: There is a complaints procedure available in the reception area of the home, available to people using the service and visitors It was suggested that the procedure could be made more user friendly rather than what at first seemed to be a set of rules for making complaints. The Acting Manager will review this. No complaints have been received by the home or by us since the new registration. A comments book is kept to record domestic type concerns, two had been recorded and related to issues like clearing the grounds for easier access. Training records showed that all staff have had recent training in Safeguarding vulnerable adults. The Acting Manager is to attend a further course in September entitled: Safeguarding for Registered Managers. One safeguarding referral has been made since the new registration. This related to monies left by a former user of the service. The referral was appropriate and handled well. Care Homes for Older People Page 20 of 31 Evidence: In discussions, staff demonstrated an understanding of forms of abuse and the procedures to follow if abuse is seen or suspected. Care Homes for Older People Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a good standard environment that is being enhanced by the new owners to provide a higher standard of comfort and safety for them. Evidence: Doddlespool Hall is a grand and imposing characterful building, set in extensive well kept gardens where most rooms have views of the surrounding countryside. Whilst well presented some areas have needed some upgrading, redecoration and replacements. Since the new registration in March this year the new owners have made many improvements these include: New furniture and carpets provided in the dining room. New bed-linen and towels provided throughout. Two new wheelchairs purchased and 4 adjustable foot-stools following suggestions by people in the home. The carpet has been replaced in the hallway. A new hoist purchased for the first floor there is now one on each floor. New large plasma TV for the lounge. Long needed building work to the external part of the building has been carried out to resolve the damp problems. Needed gas, water and heating servicing and maintenance has been carried out. Four bedrooms completely refurbished including new furniture, carpets and soft furnishings. This work has all been completed in the 5 months since the new registration. There are plans to continue with a programme of replacements, one considered urgent is provision of a shower room on the first floor - there is presently no shower facility. Care Homes for Older People Page 22 of 31 Evidence: Some bedroom areas have restricted access with steps and a draw-bridge to bridge the landing for access from 2 bedrooms to the galleried area where people sit and enjoy the extensive views of the garden or received visitors. The Acting Manager is considering options to improve this. Many bedrooms are large (previously double rooms). Two seen were large enough to have a bedroom and lounge area. The two people seen in these rooms said that they enjoy the space and regularly receive visitors there. There are high standards of hygiene throughout the home - two housekeepers working on the day of the inspection. Visitors commented upon the standards of cleanliness and said they never pick up any bad odours within the home and we like that, it is very important. There is an improvement plan in place for the next year when continued upgrading, already seen in many areas, will continue. Discussions with people using the service and the Acting Manager revealed that there were 2 external doors that were not alarmed. Two people have used them for access to the garden, one with full mobility and vulnerable if allowed to leave un-noticed. It is important that all external doors are alarmed to alert staff when people leave the building. Care Homes for Older People Page 23 of 31 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 can be sure that their needs will be met by the numbers and skill mix of staff. Evidence: On the day of this inspection there were 18 people in residence including one in hospital. There was a Senior Carer and 2 Care Assistants on duty. Support staff included 2 catering staff and 2 housekeepers. The Acting Manager was present and is additional to the normal care staffing as stated above. There are few staff changes and many staff have worked at Doddlespool Hall for several years. There has only been one new appointment to the care staff since the change of ownership, this was a bank carer appointed to cover where required. The Acting Manager would like to use this person where additional staffing hours are needed and example was to take people out or simply walk around the grounds, as many wish to and some need a staff presence. There has been a necessary increase in staff training since March. All staff have had training in Safeguarding, some completed a dementia awareness course, three have completed fire training. The Acting Manager is an approved Moving & Handling trainer and trains all staff. Kitchen staff have had Food Hygiene training and on the evening of this inspection training was being provided for all staff in Infection Control. Care Homes for Older People Page 24 of 31 Evidence: Training courses booked include: Fire Marshall Course, Record keeping course for Seniors and courses on Parkinsons Disease, tissue viability, Risk Assessments, Key worker responsibilities and Nutrition in the Elderly. The cook and a senior carer are to complete training in Peg Feeding. Not all staff are completing all non-statutory training but the objective is to provide a mixed skills staff group. The AQAA states: We will provide further training for staff to promoted equality and diversity NVQ training continues with 50 of Care Staff trained to NVQ standard when the last person completes the course in the next few weeks. All Senior Carers have NVQ qualifications. Staff said that a new incentive scheme has been introduced providing gift vouchers and pay increase for people completing NVQ training. NVQ training has been provided for housekeeping staff (a trainer arrived on the day of this unannounced inspection). Catering staff are also involved in NVQ in Cookery. A sample of staff files were seen. A recently appointed bank carer had a CRB (Police) check prior to employment, one written reference had been obtained following employment. A second written reference had not been obtained. The Acting Manager said that several people employed prior to the change of ownership had not had CRB checks and will take steps to rectify this. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people who live there. The improvements made and planned will further improve quality of life. Evidence: The Acting Manager has worked as a Deputy Manager in another home of the same ownership. The AQAA states: The Acting Manager has sent her application form to the Care Quality Commission and is awaiting her interview date. This is correct and the application is in process. The Manager has enrolled on the Leadership and Management Course, Level 4 NVQ with the local college to commence in September and is to attend another 5 day Management Course in the near future. The Acting Manager shows total commitment and enthusiasm in the changes that Care Homes for Older People Page 26 of 31 Evidence: have already taken place and keen to continue to improve all aspects of care and the environment. The importance of ensuring the safety of people is reflected in the training taking place. Additionally the home have contracted with a specialist company to assess and advise on staffing and safety in the home. There is a relaxed atmosphere in the home with noted good engagement between people using the service, staff and managers. Visitors and people using the service have told us about the changes being made and also those planned. There is evidence of changes made as a result of listening to people - and example in process - is to change the dining and lounge areas, providing more room for the dining area and the lounge area will be smaller, more homely and conducive with easier communication and social interaction. This arose from a meeting with people in the home. Quality assurance at the moment is limited to meetings with staff and people using the service and from contacts with visitors. This needs to be extended to include written questionnaires/feedback from people using the service, relatives and other visitors including GPs, District Nurses and other health care professionals as well as Social Workers and other stakeholders. Relatives meetings may be another option. Good progress has been made in the past 5 months and the indications are that this will continue. The stated philosophy of the service is People are at home - not in a home and we will deliver the best possible care to our service users, ensuring a happy and secure environment. Care Homes for Older People Page 27 of 31 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 28 of 31 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 1 More information in the Statement of Purpose and Service Users Guide will help people make a judgment about the suitability of the home for them. All people using the service should be provided with a contract at the point of moving into the home. This will clarify the rights and obligations of people if there is a breach of contract. A count of all medication must be kept to enable an audit of the system. This will give added protection to people in the use of their medication. All treatments, including creams and sprays should be recorded. This will ensure people have the necessary treatment prescribed for their health and wellbeing. In consultation with people using the service a wider range of leisure and social activities should be developed to meet the diverse needs of people using the service. All external doors should be alarmed, so that staff are aware when people leave the building and may be at risk. Two written references must be obtained for all new staff Page 29 of 31 2 2 3 9 4 9 5 12 6 7 19 29 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations prior to employment. This will ensure people are protected. 8 29 Police (CRB) checks should be obtained for staff employed by the previous owners. This will ensue that people are protected. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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