Inspection on 27/11/09 for Edgemont House

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

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Edgemont House 20 West Street Oldland Common Bristol Avon BS30 9QS     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: Odette Coveney     Date: 2 7 1 1 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 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) 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 32 Information about the care home Name of care home: Address: Edgemont House 20 West Street Oldland Common Bristol Avon BS30 9QS Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Ruth Cecilia Mary Taylor Type of registration: Number of places registered: care home 13 Edgemont House Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 13. The registered person may provide the following category of serivce only - Care Home only Code (PC) to service users of either gender whose primary care needs on admission to the home are withinthe following category - Old Age not falling within any other category Code (OP) Date of last inspection Brief description of the care home Edgemont House provides accommodation and personal care for up to 13 men and women who are aged 65 or over. Edgemont House is located in a residential area on the main road between Warmley Care Homes for Older People Page 4 of 32 Over 65 13 0 Brief description of the care home and Oldland Common. Shops are within easy reach of the home. There is a bus service to Kingswood and Bristol city centre. The Home consists of a large detached house with parking to the front and a garden to the rear of the property. Accommodation is on two floors. There is a passenger lift; all rooms are single occupancy and three rooms have en-suite facilities. The home recently won a Best Care Home Garden in the local garden in bloom competition run by the local council. Fees charged are dependent upon the assessed needs of the individual. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection took place over 7.5 hours and was completed in one day. The manager was present during the inspection and participated in the process. Evidence was gained from a whole range of different sources, including: Information provided by the manager in the Annual Quality Assurance Assessment questionnaire, completed prior to our visiting the service, from our directly speaking with people who live and work at the home, a review of individuals care records, a tour of the home, an examination of some of the homes records and observation of staff practices and their interactions with the people who live at Edgemont House. The purpose of the visit was to establish if the home is meeting the National Minimum Standards and the requirements of the Care Standards Act 2000 and to review the quality of the care provision for the individuals living in the home. Care Homes for Older People Page 6 of 32 Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Edgemont House provides a caring, supportive environment for those who live at the home. There are some areas for the home to address and these are as follows; The criminal record disclosure discussion between a staff member and the manager should be recorded in order to evidence that all areas of risk and support for the staff member have been fully considered. Medication is well managed in the home and people are supported in this area, one person is maintaining their independence and is managing their own medication. We saw that the home had in place some information about this, however, this should be more detailed and outline areas of potential risk and how these are to be avoided. This risk assessment will provide an opportunity to fully evaluate the situation and evidence that all areas of safety have been considered and (where possible) eliminated. Manual Handling risk assessments should be developed and these must record the level of risk and support that is required by residents. This will ensure that people are supported in line with their assessed needs. A full manual handling risk assessment will also provide information about any equipment and staff support needed in this area. Care Homes for Older People Page 8 of 32 Staff should undertake training in Mental Capacity Act legislation in order to ensure they are aware of the rights of those living at the home and to be aware of their responsibilities in this area. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 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 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes assessment processes and the information available about the home ensures that placement is offered to those people whose needs they can meet. Evidence: Edgemont House is a care home registered with the Care Quality Commission to provide personal care and accommodation for up to 13 persons, male or female. At the time of our visit there was one person who was staying at the home for long term respite, there was one vacancy at the time of our visit. The home has a comprehensive Statement of Purpose in place at the home, at the time of the site visit this document was under review and was being amended slightly, this was to ensure that full information was contained about the skills, qualifications and qualities of the manager. On the whole we found that the information within this document was comprehensive and contained clear information for residents and their Care Homes for Older People Page 11 of 32 Evidence: relatives about the services and facilities provided at the home and furthermore contained information about the staff arrangements at the home, information about the admissions process for going into the home and how to raise issues of concern and how these would be responded to. There is a clear process to ensure that the service is able to meet the assessed care needs of prospective people moving to the home. There is an admission procedure, which is included in the Statement of Purpose and full assessments of needs were undertaken prior to people moving into the home. For those people living at the home who are funded by the local authority we saw that the home had in place a comprehensive care management assessment in order to make a decision on whether the home and the skills of the staff team are able to meet the individuals needs. For those people living at the home who are privately funded we saw that the home had developed comprehensive care plans, these were based on the homes initial preadmission assessment and also from information obtained by the home through observations and their discussions with the individual since their admission into the home. We saw letters in individuals files formally offering them a place in the home, once a placement had been accepted we saw that the home work diligently to produce a care plan. Care plans for new residents were seen to be well written and sufficiently detailed in order to inform and guide staff practice. We spoke to the deputy manager who fully demonstrated to us a clear understanding of the admission process for individuals to the home. We were told about the admission process for the most recently admitted person into the home and it was noted that the whole process was tailored to the needs of the individual and that consideration was given of the views and needs of others who live at the home. We saw in records that the home holds a review after one months placement at the home, at this meeting the resident and their representatives are present and make their views known, these are recorded and appropriate action is taken. We reviewed the terms and conditions of the placement and saw that all have contracts in place, we saw that the information contained within these was correct and clear . Intermediate care is not provided at this home. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals personal and health care needs are being met. Individuals Living at Edgemont House are protected by the homes medication practices and procedures. Evidence: Individuals care records were reviewed at this visit and it was found that the plans in place had been generated from either a care management assessment or the homes own assessment. Information contained within care records included: An individuals admission record which contained information about the reason for admission, health care support services involved, next of kin, family contact details and medical history. Each person also had risk assessments, records of health professionals visiting, daily records of individuals routines, medication information and a care plan. The care plan identified the areas in which the individual required support and detailed how staff intervention and support would be provided, the support and the situation is evaluated and dated. When examining the care plans it was evident that the home had spent time with individuals discussing their wishes and choices and it was seen that, where able, individuals had signed their care plan confirming the validity of its contents. We also saw that the home reviews individuals care plans at least on a monthly basis, Care Homes for Older People Page 13 of 32 Evidence: and sooner should a need be identified, for example, we saw that due to one person having an increase in the number of falls they had experienced the home have reviewed and updated the care plan on a weekly basis with the home responding promptly to the changing needs of the individual and providing an effective and responsive service. It was very evident from talking with staff and the individuals living in the home that people living at Edgemont House can choose when to get up and retire to bed. During our visit one person was being supported with bed rest in their room, when we visited them in their room they looked comfortable, they told us that they felt tired and wanted a day in bed, they told us that staff were attentive and caring and that nothing is too much trouble, staff are kindness itself. Within this persons notes we saw that staff were checking upon them regularly and ensuring that they were receiving the care and support needed as outlined within their plan of care. People living in the home are registered with a local doctors practice. Medicines are supplied to the home using a weekly blister pack system. All the medicines used in the home are given by staff. We checked the medication systems used to make sure that they meet the required standards. The home uses a local pharmacy for their medications and gets support from them. Good practice guidelines are followed such as having a photograph of the person needing the medication on their chart. The pharmacy provides printed medicine administration record sheets for staff to complete when they give medicines. These are kept with each persons medicines, along with a copy of the homes medicine policy. This means that staff can be clear about how to give medicines safely. Medicines were given from the labelled packs provided by the pharmacy. Staff signed the administration record as they gave the medicines. We checked a sample of medicines and these indicated that they had been given as prescribed by the doctor. The records of administration had been completed fully. There is an individual who lives at the home who is being supported to manage their own medication, this is going well and the person is able to retain their independence and control over this area of their life. We saw that the home had in place some information about this, however, this should be more detailed and outline areas of potential risk and how these are to be avoided. This risk assessment will provide an opportunity to fully evaluate the situation and evidence that all areas of safety have been considered and (where possible) eliminated. Care Homes for Older People Page 14 of 32 Evidence: We saw that the home has a medicines disposal book to record how unwanted medicines are disposed of. All individuals spoken with said they like living at the home, and that they feel well cared for, that staff listen and treat them well and knew that they have a care plan in place. All knew who to speak with if they had any concerns. Staff were aware of their responsibility in respect of confidentiality and respecting individuals right and privacy, these are under pinned by the homes policies and procedures in this area. We discussed with the manager the sensitive area of supporting people at the end of their life. Mrs Taylor explained to us the process the home has in place and how this issue is raised with people, Mrs Taylor was fully aware of the rights of individuals and told us about how people have been supported, evidencing a caring and supportive approach. We saw that peoples wishes in respect of their end of life had been recorded. Care Homes for Older People Page 15 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. Those living at Edgemont House are enabled to maintain contact with families, friends and local communities. Choices are provided to people in respect of meals and mealtimes. The home provides those who live there with structured and meaningful activities and they are able to choose whether they wish to participate or not. Evidence: Due to the good staffing levels at the home the routines of daily living and activities are flexible and varied to suit the expectations, preferences and abilities of individuals. people who live at the home told us that staff knew what help and support they needed and that staff are very kind, they also told us that staff responded quickly to their requests for assistance Individuals are encouraged to continue with any activities outside of the home. Those that are able to, can go out as they wish and there are no restrictions made on their movements. There is one individual who lives at the home who is supported by an external agency for one and a half hours per week to participate in activities of their choice outside of the home. We saw that within individuals care plans the home had Care Homes for Older People Page 16 of 32 Evidence: spoken to people in order to ascertain information about their social interests, hobbies, religious and cultural needs and had responded to these appropriately, for example one person used to enjoy playing the piano, the manager contacted this persons family and arranged for them to bring in a keyboard in order for them to continue playing music they had enjoyed so much. People we spoke with at Edgemont House, told us that they enjoyed the entertainment provided at the home and in particular enjoyed it when entertainers visited and sing-alongs were held. People living at the home confirmed they are able to participate, or not, in activities as per their choice. Within activity records we saw that some group activities such as bingo and quizzes are arranged and outings out such as a planned trip in December to the garden centre and a trip earlier in the year to the zoo. Individuals are also supported on a one to one basis, we saw for example that when people are in their private rooms they are still asked if they wish to participate and are supported with an activity in their room if they so wish. People living at the home were seen listening to music of their choice, reading, watching television and enjoying conversations with each other. Local clergy visit the home and provide a religious service for those who wish to participate. We saw that people living at the home are consulted about the services provided at Edgemont House, this is because the manager is readily available to the residents and also because meetings are held with the residents. At these meetings people are encouraged to speak out and give an opinion. We saw that the last meeting that was held at the home took place in September, areas of discussion included the redecoration of the home, staff uniforms and outings, events and social activities that the residents would like to participate with. Areas discussed have been acted upon, such as meal requests, these have influenced menu changes. People told us that Ruth (the manager) always takes time out to speak with us, nothing is too much trouble. We were told that the home has a relaxed policy related to people seeing their friends or family at the home. Individuals are able to see their visitors in private and are able to choose whom they wish to see and not see. The visitors book evidenced that there are many people who visit the home and visitors were seen by us during our time at the home. People living at the home told us that staff make their visitors welcome and always offer a cup of tea. Care Homes for Older People Page 17 of 32 Evidence: There is a comfortable dining area for individuals to have their meals in. The Home operates a rotating menu. During our visit the menu choices were looked at to see if people living at the home are being offered a well-balanced and varied diet. All the choices seen were well balanced, traditional and varied with fresh fruit and vegetables available. People who live at the home told us they enjoyed the meals and that There is always plenty and always a choice. 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. There are sound and robust complaints and adult protection protocols in place at the home. Individuals can be assured that any complaints they have will be listened to and acted upon and that they will be safeguarded from harm. Evidence: There is a copy of the South Gloucestershire Council policy on The Protection of Vulnerable Adults from Abuse at the Home to ensure that the Home is aware of the protocol to be followed if incidences of abuse occur. The complaints policy and procedure shows a clear timeline and action to be taken in event of a complaint. It also directs the complainant to the Care Quality Commission and South Gloucestershire Social Services. A copy is made available to residents and relatives should they request it. The Commission have received no complaints since the last site visit to the home. We asked people if they knew who to speak with if they were unhappy or unsure about something, all of the people we spoke to were able to tell us who they would speak with and some residents told us names of the manager and individual staff they would talk to. No complaints or concerns were raised to us during our visit, people were very complementary about the service they receive and the assistance and support they receive from staff. Care Homes for Older People Page 19 of 32 Evidence: The home has in place a complaints logbook and it was seen that issues have been dealt with effectively and fairly. Records of recently employed staff members were viewed and contained personal information and record of identity. Other information seen included, record of previous employment, and satisfactory Criminal Records Bureau disclosures. Minor accidents and incidents were recorded and more serious accidents and incidents affecting the well-being of people who live at the home had been reported to the Commission. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Those who live at Edgemont House live in a home that is safe and the quality of furnishings are of a high standard and suitable for those who live there. Evidence: Edgemont House is located within the pleasant, semi rural area of Oldland Common. It is wheelchair accessible. There are gardens to the rear of the house these were seen to be well tended and the home are to be commended for achieving first prize in the best care home Garden in Bloom category from Bitton Parish Council. There is parking available at the front of the house. In walking around the home it was evident that the home is well maintained and provides a safe environment for both the residents and staff. New fencing and gates have been fitted in order to make the garden area more secure and safe for residents use. There is a communal lounge, dining area and a quiet area that overlooks the garden, all were comfortable areas for residents use, since our last visit the home have invested in new furniture, soft furnishings and a music system. The home have also purchased a new television for residents to enjoy after being given a donation from a relative. Care Homes for Older People Page 21 of 32 Evidence: Whilst we were at the home we were able to spend time with some people in their private rooms, people told us that they were happy in the home and that they were comfortable there. Since our last visit to the home eight bedrooms have been refurbished (another was being re decorated at the time of our visit). Rooms were seem to be well furnished with fittings of a high standard, people had personalised their rooms with photographs of family members, plants, pictures and soft furnishings. All rooms are single occupancy. There are adaptations in place throughout the Home and specialist equipment including hoists, bathing aids, mobility aids, sensory aids and handrails. All equipment is serviced and checked for safety as required in order that it is fit for use. New railings have been fitted since our last inspection and the ramp leading to the rear garden has been significantly repaired this is to enable those who live at the home to access the rear garden safely. Toilets are situated in readily accessible parts of the Home near to communal areas and bedrooms. The bathrooms and toilets were clean, and were well stocked with hand towels and soap to help minimize risk from cross infection in the Home. Since our last visit the home had re-furbished a ground floor toilet area, making this more pleasant for residents use. The Home looked clean and tidy in all areas that were viewed. 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. Individuals are cared for by sufficient numbers of competent staff that are provided with training to fulfill their roles and responsibilities. Safe vetting and recruitment procedures are in place. Evidence: A strength of Edgemont House is that there is a good history of retaining staff with a well-established staffing group. There were sufficient numbers of staff on duty at the time of our visit, staff were observed by us to be friendly, polite and responded promptly to requests from the people who live at the home. Each individual has a key worker to support them with the manager being involved with the overall monitoring of individual care. It was clear that staff have developed relationships with individuals and have worked together with them and others in order to identify the needs of residents and then support the person appropriately. There was information in individual care plans that provided information to guide staff to the appropriate level of support that individuals require. Regular staff meetings are held at the home and appropriate subjects are covered in respect of the service provided at the home and in line with the needs of those living at the home. The training records of staff were reviewed and staff are well supported in this area. Records seen by us evidenced that staff have undertaken training in the following Care Homes for Older People Page 23 of 32 Evidence: areas: First aid, fire safety, manual handling, food hygiene, health and safety, diabetes and also death and dying. The manager confirmed to us that all staff would be undertaking dementia care training and also refresher training in medication practices. Medication training will be provided by the pharmacist who supports the home, all staff have completed protection of vulnerable adults training, as this was some time ago refresher training in this area will also be provided. The achievement of a National Vocational Qualification (NVQ) is well promoted within the home, all staff with the exception of one (newly appointed) person, have obtained an NVQ in care practice at level two, a further five staff have achieved this award at level three. The home are to be commended for the level of qualified staff in this area. There are people who live at the home who have a diagnosis of a dementia, we spoke to the manager about the rights and choices that people make and spoke in length about the Mental Capacity Act, Mrs Taylor was able to demonstrate a good understanding in this area. We discussed training that is provided by the local authority in this area and recommend that staff should undertake training in Mental Capacity Act legislation in order to ensure they are aware of the rights of those living at the home and to be aware of their responsibilities in this area. At this inspection the staff records for three staff members were fully reviewed and two staff members were spoken with as part of the inspection process. Through examination of staff records we found that the manager operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of residents. We saw that each staff member had a job description which outlined the job purpose and the qualities and skills required for the position. Written references, protection of vulnerable adults checks and criminal record bureau checks had been undertaken for staff prior to their commencement at work. We did note that one person had criminal disclosures, these do not affect their ability to care and support the people living at the home. We found that the manager had discussed the disclosures with the staff member and felt that residents were not at risk. It is recommended that this discussion be recorded in order to evidence that all areas of risk and support for the staff member have been fully considered. When starting employment at the home staff complete an induction, we saw that the homes induction covers areas such as role and responsibilities, policies and procedures, health & safety, responding to concerns complaints and protection. We saw that the most recently employed members of staff to the home had commenced their induction. Whilst it is in place the current induction programme is not robust enough. It is recommended that the manager should obtain a copy of the Skills for Care induction programme and implement this in order to ensure that staff are being Care Homes for Older People Page 24 of 32 Evidence: trained in line with current good practice guidance. We saw that when staff have completed their induction training they receive ongoing training in order to fully undertake their role effectively. Staff told us that they felt well supported by the new manager, that they enjoyed their work and supporting the people in their care. Care Homes for Older People Page 25 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 Home benefits from good leadership and management, its practices have offered protection to the health and safety of residents. However, some improvements are needed to ensure that manual handling assessments are in place. The home is run in the best interests of the residents. The home is well managed ensuring that individuals interests and rights are promoted and protected by a committed staff team Evidence: Throughout the inspection Mrs Taylor demonstrated a commitment to the provision of good quality individualised care packages in the home. We observed many occasions when Mrs Taylor spent time with the residents, she was supporting and reassuring. Mrs Taylor has high visibility in the home and gives strong leadership and direction. She encourages openness and discussion and is regarded as someone who is respected and who listens. Care Homes for Older People Page 26 of 32 Evidence: The home have a number of methods in which to monitor and review the quality of service provided at the home and to also establish the levels of satisfaction for the people who live at the home, these include residents, relatives and staff meetings, care planning reviews, staff supervision and training. The home have also established a formal process which involves surveying the views of people in the home in areas such as the quality of care, the support they receive from staff, the quality of food and determining whether people have any areas of complaint or concern about their care. The home had surveyed the views of people in the home in September this year, we reviewed the results and those seen by us indicated high levels of satisfaction, additional comments recorded, made by the people who live in the home included; staff are very polite, staff are very good. Prior to our visiting the service the manager had completed an Annual Quality Assurance Assessment about the service, this was well completed and sufficiently detailed, within the section of What the service does well ?, the manager had written; We provide a safe, homely home with excellent, competent caring staff which has a lovely atmosphere. Policies and procedures are in place at the home and all are of the standard expected for a care home, we saw that staff are familiarised with these as part of their induction programme with a more in depth approach to such policies as the whistle blowing procedure and adult protection. The home are completing the appropriate checks on the fire equipment and recording of training and testing of equipment were satisfactory. Staff have attended fire drills to ensure that they have clear knowledge of action to be taken in the event of fire emergency. The home has a fire risk assessment in place, this was reviewed by the manager in September 2009, no areas of concern were identified. At this visit we found that manual handling risk assessments were not in place, these should be developed in order to provide an opportunity to evaluate any risk factors in this area, in particular for people who are prone to falling or who require support in bed. Risk assessments should outline the areas which would require support, the ability of the resident and record any equipment needs. Staff supervision was reviewed. Evidence from the records viewed showed that staff have received supervision. All staff are issued with a supervision contract. Formal, recorded supervision provides staff with the opportunity to express their opinion about the services provided at the home and to discuss areas of concern in relation to individuals care and to also discuss staff personal development and performance. Care Homes for Older People Page 27 of 32 Evidence: We reviewed accidents and incidents which had occurred at the home, those seen by us were situations that could be expected to occur. Accident reports had been well written and showed what had happened, what injuries had been sustained and what the home had done to support the person involved and recorded the measures that had been taken in order to try to prevent recurrence. We did note however, that reports had been written on loose leaf paper which were not numbered. It is recommended that the manager should obtain a recognised accident book. In order to be able to provide a clear audit and evidence the sequence of accidents that have occurred at the home. 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 1 9 13 The Registered Person shall 28/12/2009 ensure that any activities in which service users participate are so far as reasonably practicable free from avoidable risks. A risk assessment for self management of medication will provide an opportunity to fully evaluate the situation and evidence that all areas of safety have been considered and (where possible) eliminated. The Registered Person shall 14/01/2010 make arrangements to provide a safe system for moving and handling service users. Manual Handling risk assessments should be developed and record the level of risk and support required by residents. 2 38 13 Care Homes for Older People Page 30 of 32 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 29 Criminal records disclosure discussion with a staff member should be recorded in order evidence that all areas of risk and support for the staff member have been fully considered. Staff should undertake training in Mental Capacity Act legislation in order to ensure they are aware of the rights of those living at the home and to be aware of their responsibilties in this area. The Manager should obtain a copy of the Skills for Care induction programme and implement this in order to ensure that staff are being trained in line with good practice guidance. The manager should obtain a recognised accident book. In order to be able to clear audit and evidence the sequence of accidents that have occurred at the home. 2 30 3 30 4 38 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. 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