Inspection on 08/04/09 for Elm Lodge Care Home

This is the latest available inspection report for this service, carried out on 8th April 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elm Lodge Care Home 10/04/06

Elm Lodge Care Home 18/01/06

Elm Lodge Care Home 19/08/05

Elm Lodge Care Home 16/03/05

Elm Lodge Care Home 21/07/04

Elm Lodge Care Home 25/03/04

Similar services:

Cheaney Court Care Home

Chater Lodge

Conifer Lodge

Egerton Lodge Care Home

Edenhurst Care Home

Ernehale Lodge Care Home

Ecton Brook House

Cherry Trees @ Hazel Hill

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Elm Lodge Care Home Stand Road Newbold Chesterfield Derbyshire S41 8SJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Richards     Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Elm Lodge Care Home Stand Road Newbold Chesterfield Derbyshire S41 8SJ 01246456755 01246456755 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Amocura Limited care home 40 Number of places (if applicable): Under 65 Over 65 40 dementia Additional conditions: Date of last inspection Brief description of the care home 0 Elm Lodge is a purpose built care home located in a quiet close in a residential area of Chesterfield. Services are provided for forty older persons with primary care needs related to dementia. Accommodation is provided over two floors and all rooms are single and some with en suite facility. The Home is provides assisted bathing and toilet facilities, including large walk in showers. Smaller group living is promoted with a choice of lounge and dining room facilities to each floor. Environmental aids and adaptations are provided to assist those with mobility problems, including a shaft lift, corridor hand rails and grab rails in toilets, hoists and an ermegency call system fitted throughout the home. Level access is provided to a front car park and also to gardens with seating areas to the front and rear of the building. People are provided with personal care and support from a team of care and hotel services staff, including a part time activites coordinator and led by the registered manager. Up to date information as to fees charged per week and what they cover was not provided at this inspection. Any queries or request for information about these should Care Homes for Older People Page 4 of 33 Brief description of the care home directed to the home in order to ascertain these. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. For the purposes of this inspection we have taken account of all the information we hold about this service. This includes our annual quality assurance assessment questionnaire (AQAA), which we ask the home to complete on an annual basis in order to provide us with key information about the service. We also received some survey returns from advocates of people who use the service and staff. At this inspection there were thirty three people accommodated. We used case tracking in our methodology, where we looked more closely at the care and services that three Care Homes for Older People Page 6 of 33 people receive. Due to their given mental capacities, it was difficult to obtain meaningful verbal feedback. Where possible we spoke with their advocates and we observed staff interactions with them, looked at their written care plans and associated health and personal care records and also their private and communal accommodation. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records. We also spoke with the acting manager, who has been in post for a number of months. And the responsible individual, who was also present for part of our visit, about the arrangements for the management and administration of the home and we examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian religion and falling under the category of dementia for the purposes of their care. What the care home does well: What has improved since the last inspection? What they could do better: Ensure the service guide tells people the actual range of fees charged, what they cover and the arrangements for their payment. And that this and the statement of purpose tells people about the arrangements for their reviews and for consultation with them, including peoples views of the home. Ensure peoples assessed needs are consistently accounted for within their needs assessment records and that their risk assessed needs are reviewed at least at monthly intervals. Continue to develop the way in which it provides people with information about activities, to ensure this is easily visible and in format suited to their capacities. Continue to develop the way in which it accounts for and promotes peoples individual capacity to exercise personal autonomy and choice in accordance with the principles of Care Homes for Older People Page 8 of 33 the Mental Capacity Act 2005, including by way of staff training. Ensure disabled access for people to the identified ground floor bathroom, by provision of a suitable adaptations or equipment there as specified. Continue to develop the environment so as to optimise assistance for people as benefit their orientation and dementia care needs. Introduce a formal management tool for the determination of staffing levels, which accounts for residents dependency levels and needs. Thereby providing a proactive rather than reactive management approach to determining these. Publish and make available, the results of satisfaction surveys, including action plans that may arise from these, for people who use the service, or who have an interest there, including CQC. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 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 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although there are some gaps in the homes written service information provided, people are reasonably assisted and informed during the admission process. Whilst the home is able to account for many areas of peoples individual needs. Their personal and social profiles and risk assessed needs are not consistently accounted for, including by by way of reguarly recorded reviews for the latter, which may lead to omissions of care. Evidence: At our last key inspection we found that the home ensured a satisfactory admission process for people, including obtaining the information they needed for each person to ensure the home was able to fully meet their needs. In our annual quality assurance questionnaire the home complete they told us that Care Homes for Older People Page 11 of 33 Evidence: they continue to ensure a comprehrensive approach to peoples admission, including ensuring they are provided with the information they need and a full assessment of their needs before they move there. They told us that they now provide key service information in a large print format, but feel they could make further improvements here by including peoples views of the home within their service guide. At this inspection peoples representatives told us that they mostly received the information they needed on behalf of the service user to assist them in choosing the home and also a written contract. We saw that out of a total of thirty three people accommodated, all fall under the care category of DE, dementia and are British white and of Christian based religious beliefs. We looked at a copy of the homes Commitment Booklet, which is given to people on initial enquiry or admission. Whilst this gave a range of key service information, it did not actually specify the current range of fees charged per week, what they cover and arrangements for their payment. Although we could see a pre printed format for this, which the manager told us is completed on an individual basis, once this is agreed. This means that people are not provided with clear information about fees at the point of enquiry. We also saw that some other key information, which must be provided, was not included within this booklet. This includes information as to the arrangements for consulting with people about the operation of the home and the arrangements for the review of their care plans. We looked at the recorded needs assessment information for three people whose care we explored more closely. We saw, that the service had introduced a standardised recording format to promote some consideration as to peoples capacity to make key decisions about their lives. Although this was in the early stages of development and needed further development to ensure these are person centred, rather than a standardised format applying to all. Staff had not received any training or instruction in respect of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards. For one person, who had lived at the home for some time, their personal and social profile was completely blank. Although we found from speaking with staff and that persons advocate that staff did have some knowledge as to information that could be recorded here. The needs assessment information recorded for that person merely stated that their Care Homes for Older People Page 12 of 33 Evidence: communication capacity caused barriers. However, it did not specify as to how or in what way, or what this means for that person in terms of potential personal impact. Again speaking with staff told us that they were aware of these factors, although they were not clearly recorded. We also found that reviews as to peoples assessed needs were not consistently recorded, particularly concerning areas of identified risk. Although when we spoke with staff we found that they were mostly conversant with peoples needs. And the home told had told us in our annual quality assurance questionnaire under the Healthcare section there, of their aim to review the format and use of their risk assessments in the coming months. Care Homes for Older People Page 13 of 33 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. Overall, peoples health care needs are met from staff that usually treat them with respect and promote their dignity, including for their medicines. Evidence: At our last key inspection we found peoples written care plans effectively promoted peoples general physical and emotional health, but felt that people may benefit from a more developed assessment and planning of their social care needs. In our annual quality assurance questionnaire completed by the home, they told us that they working to provide person centred care planning and care based on recognised approaches to their needs asssessment and care interventions, with care plans that are regularly reviewed. That they enable peoples access to outside health care professionals in accordance with their assessed needs. And that they ensure suitable arrangements for their medicines and promote peoples dignity and privacy at all times. Care Homes for Older People Page 14 of 33 Evidence: They told us about some of the improvements they have made in their care delivery arrangements by way of staff training and updates in dementia, challenging behaviours and safeguarding people. And they told us about improvements they aim to make over the coming months, which include developing staff training in relation to care of the dying person. To review the recorded risk assessment formats they use to ensure these are effective and to further develop the standard of written written care plans. At this inspection peoples advocates told us that usually staff listen and act on what they say and that their relatives receive the medical support they need. And that staff is usually respectful in their approaches with people and promote their dignity and privacy. One relative told us. The staff are very good, my mums face always lights up and she smiles when they approach her, which I think is a good sign. Another relative plaudit said, We are always confident our mother was happy at the home as well as safe. At our visit we observed staff to be sensitive and respectful in their approaches with people. And that they were calm and always explained to service users what was happening or what they were going to do in terms of any care interventions, such as assisting them in their mobility and with eating and drinking. Although we did observe where one service user said repeatedly, they had no idea what time it was and pointed to their watch, which had stopped and was not showing the correct time. Staff present did not act on this to assist that person. The inspector also observed that one service user sitting in a specialist chair, who was not able to communicate or mobilise independently and who had dried food on her shoes, atlhough this appeared to be an isolated incident. We saw from looking at peoples written care plans, that to some extent these were developing in a person centred manner. Although staffs application of this was inconsistent in some areas, such as their risk assessed needs, daily living routines and peoples mental capacity. This means that written care plans would benefit from further development to ensure they are truly person centred and clearly reflect intended outcomes or goals for people. However, we saw from looking at the quality assurance and monitoring systems in place, as referred to under the Management section of this report. That there are action plans for the ongoing auditing and development of these, which tells us that Care Homes for Older People Page 15 of 33 Evidence: home knows what it needs to do here. We also noted that care plans did not consistently have reviews recorded at monthly intervals. Overall, peoples care records also accounted reasonably well for inputs they receive from outside healthcare professionals. Although for one person we case tracked there was no record as to any follow through or outcome relating to action to be carried out following a recent care review with their placing authority. This action related to the need for GP referral relating to their weight loss and district nurse referral for assessment of that persons need to be provided with pressure relieiving equipment. However, discussions with that persons relative and staff indicated that these had in fact been acted on satisfactorily on behalf of the service user. Also, one of the people we case tracked had been permanently admitted for just over one week following a period of respite care at the home. However, their care records were not translated into the homes format used for permanent admissions to the home, but remained as a briefer record in the homes respite care planning format used. The manager advised that she would take the necessary action in respect of these. When we looked at the arrangements for peoples medicines in the home, we were assisted by the deputy manager, who advised she has designated overall responsibility for the management and handling of these supported by named senior care staff, who have received relevant medicines training, including recent arrangements for updates of this training. Records that we saw in individual staff files confirmed this. Overall, we found the arrangements for the ordering, receipt, storage, administration and disposal of peoples medicines to be satisfactory and mostly in accordance with recognised guidance and practise concerned with these. However, we did find some areas where these were not, but could see what the home was doing to improve these. These were as follows. During the course of our visit, we observed an open cupboard cited in a toilet, containing prescribed medicines, which should not be stored there. These were creams labelled for a named service user and out of date. The Inspector pointed these out to the manager, who arranged for these to be removed. For one person case tracked there were four areas of omission in recording on their current medicines administration record sheet, where staff had not signed to indicate their medicines were given as instructed, or used the correct coded reason to indicate the reason why these were not given. However, when we looked at other peoples Care Homes for Older People Page 16 of 33 Evidence: medicines administration records, we saw that these were well recorded, with no omissions. And we saw that regular management audits of MAR sheets are undertaken to monitor the completion of these. We also saw a report of the most recent visit from the pharmacist supplier for medicines in the home in March 2009. This recommended that consent to medicines forms be provided for each service user and for the home to provide clear account of individuals mental capacity to ask for as required medicines. The inspector saw that some work had recently commenced with the aim of addressing these, including for the introduction of written care plan protocols for each service user. Although this is not yet fully completed, this tells us that the home is taking the necessary action in respect of these. Care Homes for Older People Page 17 of 33 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. Progress made to date in providing meaningful activities for people and further developments aimed for are in peoples best interests. People are provided with a nutritious and balanced diet, in accordance with their assessed needs and known preferences from staff that assist them with sensitivity. Evidence: At our last key inspection we found some success in developing a lifestyle for people that promoted their independence and preserved family and community contacts based on individual preferences. Together with a review of menus which enhanced the range and balance of meals provided at the home. However, we found that the establishment of a purposeful range of recreational and developmental activities remained problemmatic. This meant that previous requirements made. That the home establish a programme of activities for people, were not complied with. In our annual quality assurance questionnaire completed by the home, they told us Care Homes for Older People Page 18 of 33 Evidence: they obtain individual needs information concerned with peoples preferrred daily living routines and their social history and interests. That they support people to maintain their personal relationships and to meet their religious and cultural needs. And provide people with a healthy, balanced diet in accordance with their assessed needs, choices and preferences. They also said that they consult with people and their families about the arrangements for their finances and promote access to advocacy for people. They told us about some of the improvements they have made since our last inspection. These include improving environmental orientation for people, providing a structured activities programme, re establishing service user and relative meetings and providing a quarterly newsletter for people. And that they have again reviewed menu provision and provide a daily menu board to inform people. However, they still feel they could improve further by developing better access to activities outside the home for people, including providing information about these any any forthcoming events. Which they aim to achieve over the coming months. At this inspection people told us there are usually activities arranged and some people told us they thought they usually enjoyed their meals. Some people felt that teas could be improved to provide more variety. An example was given relating to a choice of either sandwiches or teacackes for tea. One person felt latter was felt not to be substantial. However, we were advised that people could have drinks and snacks at any time and that a warm alternative is always available. We saw that written information is provided for people within the homes key service information booklet about activities arrangements, together some local support and advocacy networks, including the Alzheimers Society. And that the home provides people with communal TVs, a quiet lounge area, music system and a loop system to the first floor lounge. People can also bring in their own TV, furnishings and music systems, which we saw in peoples own rooms. Activities regularly offered, include reminiscence therapy, card and board games, bingo, music, singing, videos, crafts, dancing quizes and gentle excercise and soft ball games. A prayer service is also held each week and there are occasional outings. Seasonal activities are organised such as the Summer Fayre, Easter bonnets, firework displays and birthdate and Christmas parties. And outside entertainers visit the home, which were booked for the Easter holiday period. People gave very positive feedback about the activities coordinator and her approaches with people. However, all felt arrangements for activities could be improved by providing more hours. The activities coordinator currently works part time usually Care Homes for Older People Page 19 of 33 Evidence: during the afternoon covering four sessions per week. One service user stated on a number of occasions during the morning, that she wanted to do something but had nothing to do. Staff reassured her that the activities coordinator would be organising some activities during the afternoon. The activities board displayed was not updated from the previous day, although other information was provided in one area about weekly activities provision. We also saw that in the ground floor dining room, topics for reminiscence discussion were posted entirely across one large wall, providing lots of very busy information. Staff felt that this format was not best meaningful for people accommodated. We also saw that an orientation board was in place in the ground floor lounge, giving people information about the time, date and weather. Although there are no large faced clocks provided. The activities coordinator was present during the afternoon and organised the choice for residents to sit out and enjoy the sunshine, socialising and singing. We saw that staff were sensitive in ensuring people were suitably dressed for this and with the correct footwear. The hairdresser who visits the home on a weekly basis was also present and a number of people enjoyed having their hair done. We saw that one person we case tracked had a scrapbook containing photos of her family and past life in her own room, along with a music centre and favourite music she liked to listen to. Her advocate told us that staff often spend time with her talking about these pictures, which she enjoys. We saw that people were provided with lunch from a choice of two dining rooms and with a few people who chose to remain in quieter areas. Staff assisted people in a sensitive and unhurried manner and tables were attractively set with aids and equipment provided for people as necessary. Food served was well presented and appealing and although staff ask people each morning their choice of lunch and tea, people were also offered an alternative at the time of serving each course of their meal. Written menus provided indicate a balanced and nutritious diet. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that any concerns or complaints they raise will be listened to and acted on by the home and that residents will be protected from harm and abuse. Evidence: At our last key inspectionn we found the home had a structured and organised approach in dealing with complaints and any protection issues, so that peoples safety was satisfactorily promoted. Since that inspection the home has told us about an allegation of abuse and the action they took in respect of this. The information we are provided with tells us that the home acted in accordance with recognised joint agency safeguarding procedures concerned with safeguarding people from harm and ensured the protection of that person and other people in the home. In our annual quality assurance questionnaire completed by the home, they told us that they ensure people know how to complain, that they take all complaints seriously, act on them and respond to any complaints made with twenty eight days. That they maintain effective records of these, including outcomes and action taken. And that they promote peoples protection from harm and abuse, by way of effective recruitment and staff training so that staff are conversant with the homes policies and procedures concerned with complaints and safeguarding people. Care Homes for Older People Page 21 of 33 Evidence: They have told us they aim to improve by providing their complaints procedure in a range of alternative formats. By reestablishing service users and relative meetings and by providing a suggestion box in the reception area. And we saw at this inspection that the complaints procedure was provided in a large print format, with provisional meetings planned. The homes complaints records told us that they have received two complaints in the last twelve months and also the allegation detailed above. Peoples advocates said they knew who to speak with if they had any concerns or complaints, but that concerns they raised were usually dealt with without having to make a formal complaint. Staff that we spoke with were conversant with their roles and responsibilities concerned with handling complaints and concerns and safeguarding people from harm and abuse. Care Homes for Older People Page 22 of 33 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. Overall, the home is clean, safe and well maintained and for the most part suits peoples needs. Although with some areas, where further development may benefit people who live there. Evidence: At our last key inspection we found the home to be well maintained with a safe and comfortable environment that suited peoples needs. In our annual quality assurance questionnaire completed by the home, they gave us detailed information that tells us this remains so. At this inspection people told us the home is usually fresh and clean, although we did receive some comments about there being stale odours in some areas. We mostly observed the home to be fresh and clean. However, there were some areas of the home with a stale urine odour. We saw that some environmental aids are provided to assist in orientating people, including an orientation board, use signs in some areas and also colour schemes that may assist. Although these could be developed further to assist people. Care Homes for Older People Page 23 of 33 Evidence: Areas of the home that we saw were well furnished and maintained, safe and mostly suitably equipped and clean. And were comfortable and overall suited peoples needs. Although we observed the window closure to the first floor dining room window to be broken and in need of repair or replacement . The home is organised to promote smaller group living, with a choice of lounge and dining rooms provided. Peoples own rooms were also personalised and we saw that the separate laundry facility is suitably equipped and was very tidy, clean and well organised. And there are suitable hand washing and waste disposal facilities and equipment located throughout the home. The acting manager told us about their aim to improve bathrooms to make them more inviting and relaxing and to provide sensory stimulation and we saw that work had commenced in this area. However, we were advised that one bathroom located on the ground floor close to six peoples own rooms, is not used due to their being no fixed hoist there and which does not enable use of a moveable hoist for people who may have mobility problems. People accommodated in those bedrooms were able to access a bath and shower room on the next corridor. We also saw that a privacy curtain was provided behind the entrance door to the large walk in shower room, although these are not provided in large bathrooms where they may benefit and promote peoples privacy. Care Homes for Older People Page 24 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported from staff that is effectively recruited and inducted and for the most part, trained and deployed. Evidence: At our last key inspection we found, although there we some difficulties in maintaining continuity of staff, that peoples interests were generally enhanced through the homes organised approach to staff recruitment and development. In our annual quality assurance questionnaire completed by the home, they told us that the home is adequately staffed in accordance with people assessed needs and that staff is effectively recruited, inducted and mostly trained. They also gave us information about the development plan for ongoing staff training, which tells us they know which areas they need to source over the coming months. At this inspection peoples advocates told us that staff listen and act on what they say, that they are usually available when needed. However, feedback from staff told us that until very recently, they felt staffing levels during the day had not been sufficient. We found that a staff meeting was held the week before our inspection visit, where staff had opportunity to formally express their views about staffing levels and following Care Homes for Older People Page 25 of 33 Evidence: which staffing numbers were increased during the day. Most staff told us that these are now sufficient to enable them to perform their role safely and to ensure people get the care they need. We saw from speaking with people and by looking at staff rotas, that up until this recent staffing level change there had been only four care staff on duty during the day for up to thirty two residents, with management and activities hours additional to that. And that there was no clear management system used for determining staffing levels at the home, that accounted for peoples dependency needs. All staff described satisfactory arrangements for their recruitment and induction and particularly said that access to and provision of training is very good and ongoing. And associated records that we examined reflected these. We also saw that a revised induction process was being introduced which accords with Skills for Care National Induction standards. Although discussions with staff told us that they are not conversant with the principles of the Mental Capacity Act 2005, including Deprivation of Liberty guidance. This important legislation impacts on and has particular implications for the client group they care for in respect of effectively accounting for peoples individual capacity to make key decisions about their lives and to consent to their care and treatment. However, we were informed, that the manager and deputy manager were booked to undertake training in this area during May 2009. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run and peoples health, safety and welfare is effectively promoted and protected Evidence: At our last key inspection we found that an overall systemmatic and thorough approach to the running of the home was maintained to satisfactorily promote the interests, safety and general welfare of people who live there. In our annual quality assurance questionnaire completed by the home, they told us that the home is well managed and run by their acting manager who has achieved the Registered Managers Award. That they operate an effective quality assurance and monitoring system. Regularly consult with people who use the service, or who have an interest there and ensure peoples health, safety and welfare. They also gave us some other information that we asked for, including the homes policies and procedures and their arrangements for the maintenance and servicing of systems and equipment Care Homes for Older People Page 27 of 33 Evidence: there. They told us about some improvements they have made, including the introduction of regular formal one to one staff supervision sessions, reestablishing relatives meetings and in developing their quality assurance auditing systems via outside management arrangements. At this inspection most staff described satisfactory arrangements for their supervision and support and related records that we examined supported those views. We saw that their quality assurance and monitoring systems are developing well, with regular systems audits and action plans in place, that link into an annual development plan for the home. And with regular visits and reports of those visits provided, from a representative of the registered provider for the purposes of determining the quality of care provided at the home. Satisfaction surveys were last undertaken with residents advocates in September 2008 in order to obtain their views as to the quality of some of the services the home seeks to provide. These covered the environment, privacy and dignity, care and activities. Out of a total of twenty seven sent out at that time, twenty one were returned. We saw that these indicated peoples overall satisfaction with the service. Suggestions for improvement, included ensuring a hair dressing service be reestablished, which was achieved. And ensuring better availability of drinking water for people and access to local community. There was however, no record as to any action taken in respect of those suggestions and the results of these were not published for people to access. The homes policy is that they only handles personal monies on peoples behalf by way of safekeeping for these. We found the arrangements for these to be satisfactory. Staff described effective arrangements in respect promoting safe working practises, including the provision of equipment and training for these. And during the course of our visit we observed the environment to be generally safe and free from hazards. A suitable system is in operation for the reporting and recording of accidents and incidents in the home staff spoken with were conversant with their role and responsibilities in respect of these. Care Homes for Older People Page 28 of 33 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 33 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 1 5A Clear information as to the range of fees charged per week, what they cover and their arrangements for payment must be provided within the homes service guide information for people. So as to provide people with the information they need to assist them in choosing the home. 31/07/2009 2 1 4 The homes statement of purpose and service guide must contain all information in accordance with Schedule 1 of the Care Homes Regulations 2001. In this instance, the arrangements for indvidual care plan reviews and for consulting with people about the operation of the home. 31/07/2009 Care Homes for Older People Page 30 of 33 So as to provide people with the information they need to assist them in choosing to live at the home. 3 8 13 Staff must always sign the 30/06/2009 medicines administration record sheet for each service user, for any medicines administered by them to that service user in accordance with the written instruction for these. Or enter the recognised coded reason where these are not administered as prescribed. So as to ensure that people are administered their medicines as prescribed. 4 30 18 Staff must receive training 31/07/2009 and instruction in the Mental Capacity Act 2005 and its implications for Care Homes in accordance with the Department of Health guidance. So that staff is conversant with the principles of the Mental Capacity Act 2005 and it implications for those people who live at the home. To ensure that the principles of this act are applied consistently and effectively. So as to promote the best interests of people accommodated. Care Homes for Older People Page 31 of 33 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 3 Peoples personal and social care needs should be consistently accounted for by way of ensuring these are clearly and consistently recorded. Peoples risk assessed needs should be reviewed at monthly intervals. Where care review outcomes determine the need for consultation with specified outside health care professionals. The action taken and outcomes should be clearly recorded within peoples individual care planning records. Care plans should be further developed to ensure these are truly person centred and reflect expected outcomes and goals for people and should be regularly reviewed. Recommended at monthly intervals. The service should continue to develop the way it provides people with information about activities, to ensure that is easily visible to people in a format suited to their capacities. The service should continue to develop the way it accounts for and promotes peoples capacity to exercise personal autonomy and choice and in accordance with the principles of the Mental Capacity Act 2005. The ground floor bathroom, which is not accessible to people whose rooms are located nearby, due to their mobility needs, should be made accessible to them by providing a suitable hoist. The home should continue to develop the environment to further assist people in their orientation and relating to their dementia care needs. The premises should be kept free from offensive odours at all times. A formal management tool should be used to determine staffing levels in the home, which accounts for residents dependency levels and needs. The results of satisfaction surveys conducted by the home, should be published and made available to people who use the service and who have an interest there and other interested parties, including CQC. 2 3 3 8 4 9 5 12 6 14 7 21 8 22 9 10 26 27 11 33 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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