Key inspection report
Care homes for older people
Name: Address: East Croft Grange Scaw Road High Harrington Workington Cumbria CA14 4LY The quality rating for this care home is:
three star excellent 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: Nancy Saich
Date: 1 0 0 3 2 0 1 0 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 32 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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: East Croft Grange Scaw Road High Harrington Workington Cumbria CA14 4LY 01946832754 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Brancaster Care Homes Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only Code PCT To service users of the following gender: Either Whose primary care needs on admission to the home are in the following categories: Old age, not falling within any other category (OP) Maximum number of places:21 Dementia over 65 years of age (DE)(E)) maximum number of places:10 Date of last inspection Brief description of the care home Eastcroft is situated in a residential area of Harrington and is near to transport links and the village amenities and is set in its own very well tended grounds. It is a short drive into the centre of Workington. 0 0 Over 65 10 21 Care Homes for Older People Page 4 of 32 Brief description of the care home The home is divided into two separate areas. The main house is for older adults and has single bedrooms and four shared areas where people can spend time together. The `Garden Unit is for older adults who have dementia. This specialist unit also has single bedrooms and two shared areas. The unit is secure so that people with dementia will not wander out into any danger. They have space to walk and access to a very nice secluded garden. The home has a new manager who is applying to be registered with the Care Quality Commission. The charges range from £398 to £470 per week depending on the needs of the individual. Further information about charges can be obtained from the company or the manager. 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: three star excellent 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 the main or Key inspection of this service for this year. It is the first visit to the service for three years. Some weeks before the visit we sent out an Annual Quality Assurance Assessment (the AQAA). This document asks for information about how the service has been running in the previous year and plans for the future. We also ask for some statistics about residents, resources and staffing. This was completed very thoroughly and in a lot of detail by the Operations Manager who was managing the home along with the deputy managers until a new manager came in to post. After this we sent out postal surveys to residents and relatives. We received 100 returns of these. Generally these surveys were extremely positive and any comments made give us a good picture of life in the home and also gave some suggestions about ways people would like things to improve. We gave feedback from these to the new Care Homes for Older People
Page 6 of 32 manager after the inspection. We also received staff surveys and these had a general theme of improvement within the comments. We quote from a variety of surveys in this summary. We then made an unannounced visit to the home on the above date. We arrived at around 7.30 in the morning so that we could meet some of the night staff and we stayed until late afternoon. The lead inspector, Nancy Saich, spoke to a number of people who live in the home, to visitors, the new manager and staff on duty. She also shared a very pleasant meal with residents and was around during the mornings activities. We read a wide range of documents that backed up what was observed and what was said on the day and in the returned surveys. Care Homes for Older People Page 7 of 32 What the care home does well: This home is very good at giving people information and the opportunity to visit the home before they decide on a placement. They are very careful only to take people once they know that they can give them the right level of care and services. I was given time to think about coming here and had a look around before I made my choice. Every person in the home now has an up-to-date care plan that gives details of their life story, their background and their personal preferences. These written plans also give staff good directions for delivering care appropriately. We met well groomed, well nourished, interesting and interested older people who were all very confident that the care and attention they received was of the very best. The home provides very good care for its residents. All are treated with respect and dignity. Residents always look very well-dressed and groomed and look happy. Meals are varied and nutritional and effort has always made to cater for individual needs. Emotional and physical well being are supported extremely well. (Relative) We have been extremely happy with the care and support given to my relative. She looks relaxed and happy always looks very well groomed and of smart appearance. People feel confident in this service that their medical needs are attended to properly and that staff are keen to prevent ill-health and work closely with people like district nurses to make sure people get the best care. The home gives excellent care to our relative and are always informing us of any problems regarding health. The staff are always welcoming and friendly and it is a pleasure to visit the home. I can get a doctor or nurse when I am not well. Staff are good if you are under the weather. I enjoy my food and have put on weight since I came in. We met with both night and day staff and we found them to be polite, caring and respectful. People told us on the day and in surveys that the staff team worked well together and maintained very high standards. Generally East Croft is a fine, caring place. I refer to the day staff as angels without wings. The staff are always welcoming and friendly and it is a pleasure to visit the home. There are regular outings and entertainments and daily activities. Several people said in surveys that activities were done well. Pleased with the entertainment for the residents and including the residents from the unit as my relative loves a good singsong and a little dance. Well done all the staff. East Croft is back to a happy well-run home. Care Homes for Older People
Page 8 of 32 People in the home told us that their complaints were listened to and they were not afraid to approach any member of staff and would, if necessary, talk to a representative of the company. They also told us that there was nothing abusive going on in the home and felt confident that the company had a good track record of dealing with anything of this nature. I have no complaints but I am not afraid to speak up if I had to.The bosses have been in to sort some things out. Eastcroft Grange has been tastefully and appropriately adapted and extended to meet the needs of both frail older people and people with dementia. Every area of the home that we visited on the day was clean, fresh and very well decorated and furnished. People told us that they really liked being in the home and were extremely satisfied with their individual rooms. East Croft is a lovely residential home, the carers look after the residents very well they are kept clean and tidy, the rooms are very clean and if there are any problems staff are very approachable. Staff are suitably qualified and have received good training from the company over the years. A new training plan was being developed on the day. We judged there were sufficient staff numbers to deliver the care and services in the home. This company has good management systems in place, these have allowed them to identify problems in this service and they have been able to deal with these and put things right because they have robust systems and staff who have the welfare of older people at the heart of everything they do. What has improved since the last inspection? In the past year there have been some management difficulties in this service. However we saw an improving picture in all areas. Every care plan in the building had been updated and residents had been consulted again about their needs and wishes. Medication management had been audited and reviewed. We learned of plans to develop activities and therapeutic approaches in the dementia care unit. The new manager had only been in post for just over three weeks and already she had looked at some of the general risk assessments, had started to look at a new training strategy for staff, was beginning to get to know the needs of her residents and had developed a simple interim plan for how she wanted the home to progress. One staff member told us in a survey: All the staff work well as a team and have continued to do so with the conditions we have had to work in, in the last few months. We want to continue to improve and hopefully the new manager will help us to do this. There had been continual, ongoing maintenance, repair and decorative work in the home in the three years since we last visited. We saw thoughtful and tasteful replacement fixtures and fittings that allow people to have a safe and comfortable environment to live in. Care Homes for Older People
Page 9 of 32 Some matters of adult protection had not been appropriately handled in 2009 but the company, once they were made aware, had taken steps to deal with these issues. The new manager had done this on her first day of employment with support from the company. The company had strengthened the management team after a number of problems in 2009. The home now has two dedicated, qualified and well-trained deputy managers who have their own units to look after. In 2009 the home had used some agency staff but recruitment had taken place with further plans to improve the deployment, training and development of the team. Some matters of quality management and use of systems had been noted by the company and again these things had been dealt with correctly. The new management team and the company were in the process of reviewing and checking how everything was working in the home. They were also taking the opportunity to look at even more ways to improve how the home runs. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 10 of 32 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 11 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 12 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. This service makes sure they only admit people after giving and gaining all the information needed to make the choice of coming into Eastcroft Grange the right one for the individual . Evidence: On the day of the inspection we were given an updated and detailed Statement of Purpose, a Service User Guide and a brochure of the Home. These were easy to read and very informative. The new manager had updated these to reflect the changes in the way the home is managed. We met a number of people who had only recently been admitted to the service. We observed staff working with them and helping them to settle in. We saw that staff asked about and followed through some of the small things that are important to people. We had a brief discussion with the people involved and they were satisfied with the care and services given to them so far.
Care Homes for Older People Page 13 of 32 Evidence: We read the relevant files and discovered that one person had come to the home independently and we saw the assessment had been completed and a suitable contract was in place. In other files we also found suitable assessments, hospital discharge notes and social work assessments. Surveys and speaking to visitors showed us that people are supported and assisted to make the right choice. We also saw from notes that people were normally only admitted once the staff team were sure they could give them the right levels of care and services. Care Homes for Older People Page 14 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this service received high standards of care delivery for their physical, emotional and psychological well-being because the staff team are committed to respectful and dignified care. Evidence: We read a good range of the written plans of care in this home. We noted that all of the care plans had been updated by the new deputy managers and all the information contained in them was relevant and up-to-date. Many of the plans were extremely detailed and gave all the important information -- both great and small -- that allows people to have the kind of care and lifestyle they want and need. One of the senior carers said to us The care plans are always a work in progress. This means peoples care is constantly under review. We judged that this team are eager to continue to improve care planning and are open to learn and develop this skill. Residents told us that they had been fully consulted about their needs and wishes. Some plans showed evidence of families being heavily involved when the person was unable to contribute fully. Care Homes for Older People Page 15 of 32 Evidence: We read daily notes and care plans and these showed that people received suitable medical intervention. Local GPs and district nurses visit regularly and give both treatment and advice. For example one person had some problems with their skin and the staff team worked really hard with the local district nurse to overcome this problem. This person was well cared for and comfortable despite extreme frailty. We also saw that staff were asking for help and support for people with dementia who had complex problems. The new manager had taken the lead on this and was beginning to develop relationships with the community psychiatric team. We observed people in the service and we could see that they were well groomed, well nourished and that their clothes and possessions were well cared for by the staff team. People we spoke to told us that they had put on weight, had health problems dealt with and medicines managed correctly. We checked on the medicines being administered on the day and these were being given out to people correctly and signed for appropriately. We looked at the records for ordering, administration and returns. These were now being done appropriately. We did however discover that the last manager had made some errors in relation to the recording of some drugs. This was part of a general problem seen with records and this is discussed further in the management section. Medication in this home is regularly audited by staff from one of the companys other services. There had been no other errors in administration of medicines noted by this person. The company are in the process of dealing with the recording error. This home works with the local pharmacy to make sure that people have their medications correctly. We spent some time just simply observing residents and staff together. We saw some very sensitive and kind interactions. We judged that staff at all levels understood older peoples need for privacy, dignity and respect. In the last year this company have trained all their staff in the core values needed for care delivery. They have also dealt with staff when their approach has been unacceptable. People who live in the service told us that the staff team were kind, considerate and thoughtful. We watched staff help people with their meals and with moving around their home. This was done with patience, cheerfulness and in a professional manner 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. People in this service have that kind of lifestyles that they want and need and the staff team are keen to make life for people with dementia even more fulfilling than it is at the moment. Evidence: The inspection started just a little after 7:30 in the morning and we met with some members of the night staff team. They told us that when people were naturally early risers they would help them to wash and dress and give them breakfast. Most people were still in bed when the inspection started and they were helped to get up and start the day when they wished. People told us that they could choose the way they spent their time and some people who enjoy their own company spent most of the day in their own rooms, even having meals there. Other people told us they enjoyed socialising and spent their time in one of the lounges and enjoyed eating meals in the dining room. We were told that there were no rules or regulations and the staff respected their preferences. We learn from surveys, the visitors book and people we met on the day that families and friends are made very welcome in the home. During the year prior to our visit we had evidence to show that this company had made sure that visitors opinions were
Care Homes for Older People Page 17 of 32 Evidence: listened to and acted on. The new manager had arranged a cheese and wine party for relatives and friends and was planning to use this social occasion to get to know families and listen to their opinions. We met some visitors on the day and they told us that they felt relaxed about coming to the home and were always made welcome. The activities coordinator told us that they encouraged families and friends to help with outings and activities and the local community groups, including churches of all denominations, were always made welcome in the service. One person who had not lived in the service very long explained how she had been helped and supported to get the right kind of spiritual support from a local church. On the day of our visit the activities coordinator and a group of people were doing exercises to music and she was keen to tell us that she was going on a course the next day to help improve the way she did these. We also learned about other activities on offer. People told us that they were going to do some planting of containers for the garden, that they enjoyed music sessions, craft work, quizzes and board games. People who live in the service have the opportunity every Thursday to go on an outing. The company hire a local minibus and a member of staff drives this and residents go to places of local interest, shopping or to a local hotel that has afternoon tea dances. Some people told us that they didnt mind what they did but they just enjoyed the interaction. We had several discussions with the new manager and the newly promoted deputy manager for the dementia care unit. We were interested to hear their ideas about developing special activities for people with dementia. We were pleased to see that each person in the building had a life story book that they had developed with the staff team. The manager is keen to develop more of this reminiscence and person focused work. We also spoke to the company who are keen to look at innovation and developments in specialist dementia care. We make a good practice recommendation that activities and therapeutic approaches with people with dementia continue to be developed. People told us during lunchtime (and in surveys) that they were very happy with the quality, quantity and presentation of their food. We looked around a well-stocked kitchen that has a five star rating from environmental health. We spoke to a very new and very enthusiastic cook and we sampled some of the food on offer. We judge the catering operation to be excellent in this service. Care Homes for Older People Page 18 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. People who live in this service are listen to and protected from harm and this will be reinforced once staff receive updates to their training in adult protection. Evidence: This service had received some complaints in the last year. The company have kept the Care Quality Commission fully informed of these complaints and have taken swift and decisive action to rectify any problems. The company directors and operations manager have become involved with individual complainants and we have been informed that complaints have been managed extremely well with one person telling us they appreciated the personal touch from company directors. Staff have received training in managing complaints and a number of staff spoken to on the day explained how they would do this. We also ask staff about how they would support people where abuse or neglect was suspected. We were told by staff that they would have no hesitation to report any matters of safeguarding to the manager or a company representative or to ourselves. We have some evidence to show that the previous manager - who is no longer in the companys employ - should have dealt with one matter as an adult safeguarding referral. This was not done but different information was received by the company and the first task of the new manager was to deal with this issue and this was done swiftly and correctly. We discovered that in the previous year some members of staff had not received
Care Homes for Older People Page 19 of 32 Evidence: enough training or supervision relating to matters of adult safeguarding. We now want this company to make sure that everyone has updates to safeguarding. There is a new management team in this home and they are eager to make sure that they do everything they can to keep people safe. We spoke to a number of residents about how well protected they felt in the home. We were told that they had not heard of anything abusive going on but that if they were concerned about anything they had already started to trust the new manager and had a lot of faith in the staff team. They also told us that they regularly saw people from the company and would feel comfortable to talk to them. We saw an example of one resident disclosing a concern and the follow-up action taken that stopped this escalating. We judge that this is a company that takes these responsibilities very seriously and we now want them to reinforce the good practice of staff by revisiting training in safeguarding. Care Homes for Older People Page 20 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. East Croft Grange is a well appointed, well maintained and tranquil house where people feel at home in their surroundings. Evidence: Eascroft Grange is a period property that has been thoughtfully and tastefully adapted and extended to provide comfortable accomodation for older people and people with dementia. The home is situated in a residential area of Harrington and is a short distance from the centre of Workington. There is a local bus service and the local railway station is on the other side of the village. The home has suitable car parking facilities. The home is an adapted and extended period property and a number of the period features have been retained. The office, lounge areas, dining room and some bedrooms are within the original house. The shared areas are of a very high standard and are tastefully and restfully decorated.Further bedrooms are located on the first floor. This is accessed by a passenger lift. The dementia care wing - The Garden Wing is a secure, purpose-built and self contained ground floor unit with a secluded garden. Staff talked about plans to improve this garden in the summer. This unit is designed so that people can move around safely and freely. It has its own lounge and dining room, ensuite bedrooms
Care Homes for Older People Page 21 of 32 Evidence: and toilet and bathing facilities. The company have improved the flooring in the circular corridor and the dining area. This is both hygienic and very attractive and is suitable for people who may have visual disturbances and problems of perception related to dementia or poor vision. The manager is looking at ways to improve the environment so it becomes even more restful and continues to reduce any disorientation. She is going to have new signs put up in the unit so people can easily find their own room. Doors in the unit (and in the main house) have special locks so that the door may be locked from outside but people can open it from inside without a key. All of the door locks in the home have been updated and replaced. We arrived quite early in the morning and even at this hour the entire building was clean, orderly and odour free. We looked at all areas of the home during the day and found that shared areas, individual bedrooms, bathrooms, the main kitchen and laundry were spotlessly clean, well decorated and maintained. The furniture and fittings are of a very good standard and that was plenty of evidence to show that the building is kept hazard free and that good standards of infection control are in place. There is a handyman who works full time in the home and he deals with most of the maintenance and repair work and some of the internal decoration. Two empty bedrooms were being decorated on the day of our visit. Bedrooms are normally redecorated before a new person moves in and sometimes new carpets and furniture are provided. Residents may choose to bring their own furniture into the home and all of the bedrooms we saw were freshly decorated and personalised. Residents told us on the day and in surveys that staff looked after their home very well and they were very satisfied with the work of the housekeeping staff. People also told us that they were happy with the way their clothing is cared for. We checked on beds and bedding and found that all household linens were clean and fresh and of good quality. That was a plentiful supply of protective clothing for staff and they told us that they had good stocks of cleaning materials and enough time to keep the house as clean as possible. This home has extensive grounds and is set somewhat back from the main road and has pleasant views over the fields. It has a rural feel but is near to local amenities. Residents told us that they enjoyed sitting out when the weather was fine. There is a sheltered smoking area in the grounds that people do not mind using. Care Homes for Older People Page 22 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. This home is in the process of reviewing and updating all the things needed to continue to have a well trained and dedicated team. Evidence: On the day of our visit we were given copies of the last four weeks worth of rosters. We also spoke to staff. There had been some discussions and negotiations with the previous manager in relation to the rostered hours. The staff in the home now work 12 hour shifts and some people prefer this. Staff who work in the dementia care unit thought that it was less confusing for the residents. Other people preferred shorter shifts. They said they had started to talk to the new manager about their shift patterns and felt that she was listening to their concerns. The manager said that it was one of the things she planned to look at to make sure that the way staff were deployed was in the best interests of the residents. Currently staff work in both parts of the home but there is a plan to bring in a key worker system again so that staff may, in future, work in specific teams who deal with the different needs of individuals. We look forward to hearing about how these changes are developed. Generally we judged the home to have sufficient staff numbers and the new manager was looking at recruitment needs.The home no longer uses agency staff. Staff in the service are encouraged to complete National Vocational Qualifications in care. Currently there are 15 people with this at levels 2 or 3. Senior staff have the
Care Homes for Older People Page 23 of 32 Evidence: qualification at level 4. This exceeds the minimum standards. We looked at staff files in relation to recruitment and we found that people had suitable references and checks on their background. Staff told us that they thought they had been fairly recruited. The new manager understood the need to check on new starters before they had access to vulnerable people. The new manager has an interest in training and was doing what is called a training needs analysis so she could find out what training individuals and teams need and what kind of training and development people want to do and where their interests lie. She was hampered in this because training records had been allowed to fall into disarray. She was in the process of talking to her staff, getting them to think about their training needs and all the information was being properly collated. She had a basic training plan in mind. The company had started to put in training for the whole team for one full day per month in all of the core values and in the practical skills needed. There is a training manager for the company who is working with the new management team. This blanket approach was beginning to deal with the problems related to poor co-ordination of training. We also heard a lot about staff learning on the job from committed and experienced carers who, despite problems with training, had continued to deliver good standards of care and services. The company are investing in training and plan to have an annual award ceremony for staff to celebrate the learning and dedication of staff members. Care Homes for Older People Page 24 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. The registered person has recognised and dealt with some management failings and the team in the home are busy putting these things right so that people can continue to receive good standards of care and services. Evidence: This company owns a number of other care and nursing homes for older adults in different parts of the country. They pride themselves on having excellent outcomes in all their services. They work with the Care Quality Commission in an open and responsive way. The home currently has a new manager who had been in post for a little under four weeks when we did this inspection. During the last 12 months the registered manager retired and another manager came in to post. This manager was not registered with us and is no longer employed by the company. Residents and staff spoke to us very openly about their experiences in the past year when the management arrangements had been somewhat unsettled. We learned from this that some things have not gone as smoothly as they might have but we also had
Care Homes for Older People Page 25 of 32 Evidence: evidence that staff and residents alike believe that this company and its directors have been very committed to dealing with these management issues. Residents told us that people from the company visited frequently and listened to what they have to say. Residents were quite impressed with the new manager and were beginning to get to know her. One of the residents in the dementia care unit was able to talk about a lengthy discussion he had had with her and he felt that she had plenty of time for him. Another person was given immediate assistance by the manager. The new manager said that she enjoyed being hands on but also said that she had a number of years of experience in residential care and had been registered manager in another part of the country. Staff said that she was approachable and supportive. Surveys and people we spoke to on the day told us that morale in the home had improved tremendously since the beginning of the year and more since a new manager started in post. We received a first draft of her development plan for the service on the day of our visit. The company have now strengthened the management team by creating two deputy posts in the home. One person is responsible for the general unit and the other takes the lead in the dementia care unit. One of the deputies is trained as a homes manager and has been registered with CQC at another home.We were pleased to see that both of these members of staff had updated all of the care plans since their very recent appointments and were working on how staff are deployed and the care and services provided for residents. We spoke to one of these deputies on the day and she was very enthusiastic and keen to move the dementia care unit on. This company has a specific quality monitoring process and they use a number of ways to check that systems are being operated correctly. Some of these quality systems had not been used appropriately within this service in 2009. A number of management systems had gaps in their upkeep. However since the start of this year we could see that systems were being operated again appropriately.The company also look at quality by using staff from other homes and quality matters had been found lacking through just such an audit and they had made all the necessary changes to put the deficits right. They, quite correctly, did not try to cover up these problems but kept us fully informed of the problems and of their subsequent actions. We judged that this company are keen to operate in this open and responsive way because they want the very best for residents. We looked at the way staff are supervised and we saw that last year this had really not been taking place to the kind of standard required. However again we saw that this had been spotted through quality checking by their operations manager. The two deputys had started to supervise staff appropriately once they came in to post and every member of staff had received one recent supervision session. A number of Care Homes for Older People Page 26 of 32 Evidence: people told us that last year they did not receive this kind of supervision or mentoring.They said they felt they had always had informal supervision from senior carers and several people said they had worked as best they could as a team to keep things running smoothly. When we checked on the recording systems again we found some serious gaps had arisen last year. The current recording processes were functioning quite well but the new manager was very open about having difficulty finding some old records that are vital to the way a home operates. We accept that this underperformance only happened for a short period of time in 2009. We are aware that the company knew about this and dealt with this in a proactive way. We now recommend that the company continue to monitor all the systems that were underfunctioning and make sure that these continue to be robust enough to protect people and support staff. We could see that already they had started to do this. Medicines had been audited, a number of staff disciplinary matters had been dealt with correctly, the care planning system had been audited and the new manager has dates set for meeting with residents, relatives and staff.Residents and families had received confidential questionnaires from the company in January 2010 and action had been taken on some concerns highlighted. We also recommend that the company produce for the people who live in the home and for staff and visitors, a plan that shows where they want to take the home in the next year or so. There are suitable systems in place to ensure that peoples financial affairs are managed appropriately. The company audit this themselves and the accounts were balanced correctly on the day. One or two people have solicitors who deal with this or are assisted by Social Services. One person on the day had an appointment with a solicitor who was coming to the home to help with this. We looked at the arrangements for assessing risks in manual handling and we found that these were on file and were up to date. A number of the care plans we looked at had good manual handling plans and we saw staff move people appropriately throughout the day. When we checked the training records we found that either staff had not received training or the training had not been recorded appropriately. Manual handling updates were being arranged and several people had already had this deficit put right. We also checked on the fire log book and we could see that the handyman checked all the fire systems and equipment on a systematic, regular basis. He recorded this correctly. There was an fire risk assessment that new manager had reviewed. We saw Care Homes for Older People Page 27 of 32 Evidence: that some staff members had received extremely good fire training, drills and instructions. However we again found gaps in some of this fire training from 2009 and we were told by various sources that the last manager had promised to update people on fire drill and instruction but they had never received this from her. Again the company had started to deal with this and we want them to make sure that all matters of fire safety and fire training are up-to-date. Care Homes for Older People Page 28 of 32 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 29 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 It is recommended that a full audit of medications given in 2009 is completed as a former member of the team may have made some errors. It is recommended that the company and the new manager work together with other professionals to look at training for staff who work with people with dementia and activities for people in the dementia care unit so they can deliver care that reflects up to date practice for people with dementia. It is recommended that all staff receive updates to their understanding of their role in adult safeguarding. It is recommended that the company continue to check on the systems in place to make sure that they continue to operate smoothly and that people are happy with the way the home is now managed. We would like to see any development plan that is written after this. It is recommended that the company ensure that any gaps in fire training or instruction continue to be put right. It is recommended that the company continue to update manual handling training for staff whose training was
Page 30 of 32 2 12 3 4 18 32 5 6 38 38 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 ommitted in the last few months of 2009. Care Homes for Older People Page 31 of 32 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
