Inspection on 28/01/10 for Ferngrove House Care Centre

This is the latest available inspection report for this service, carried out on 28th January 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ferngrove House Care Centre 25/02/08

Ferngrove House Care Centre 14/12/06

Ferngrove House Care Centre 06/05/05

Ferngrove House Care Centre 22/09/04

Ferngrove House Care Centre 08/06/04

Similar services:

Chirnside House

Emmaus House

East Croft Grange

Craignair

Croston Park Nursing Home

Conifers Nursing Home

Cloisters

Elmsdene Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for older people Name: Address: Ferngrove House Care Centre Blackstone Edge Old Road Littleborough Lancashire OL15 0JG     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: Pat White     Date: 2 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Ferngrove House Care Centre Blackstone Edge Old Road Littleborough Lancashire OL15 0JG 01706378938 01706375356 f.house@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ashbourne Homes Ltd Name of registered manager (if applicable) Paula Finn Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of people who can be accommodated is: 36. The registered person may provide the following category of service only: Care Home only - Code PC, to people of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) Date of last inspection Brief description of the care home Ferngrove House, part of the Southern Cross Group, is a care home providing accommodation and personal care for up to 36 residents suffering from dementia on both a permanent and respite basis. The home is a conversion of two period semi detached houses that have been extended and modernised during 2006 to provide a home on three levels. Local shops and amenities are a short drive away from the home. Care Homes for Older People Page 4 of 29 Over 65 0 36 0 9 0 2 2 0 0 9 Brief description of the care home There is ramped access to the front of the home with adequate parking. Safe enclosed garden areas are available at the rear of the home. The rooms and facilities of the home are spread over three floors with a passenger lift available to all levels. Two of the three floors were in use at the time of this inspection visit. All rooms are single and vary in size they all have ensuite toilets. There are four lounge/dining areas: two lounges on the ground floor, one of which has a bar area, and two smaller lounges on the second and third floors. The toilets and bathrooms on all floors have aids to assist residents. Written information about the home is available to people that covers things such as the facilties and staffing matters. The weekly fees charged for this service are available from the manager and additional charges are made for hairdressing and chiropody. Care Homes for Older People Page 5 of 29 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 previous key inspection for this service was in February 2009 when the service received a One star adequate rating, and according to the commissions inspection methods for an adequate service had to have a further key inspection within 12 months. This was undertaken in January 2010. At the key inspection in 2009 concerns were identified with medication management in the home, and this resulted in an inspection by a commissions pharmacist inspector. A requirement and recommendations were made at this inspection, and the pharmacist inspector returned with the lead inspector for this key inspection in January 2010 to monitor the progress on this. This key inspection included a site visit to the home that was carried out on the 28th January 2010. The purpose of this inspection was to determine again an overall assessment on the quality of the care and services in the home, and to monitor Care Homes for Older People Page 6 of 29 progress on the matters identified for improvement at the previous inspections. This involved assessing important areas of life in the home that should be checked against the National Minimum Standards for Older People. Two inspectors carried out this inspection, one of whom was the pharmacist inspector (see above). The inspection involved looking at all the information received about the service over the last 12 months, talking to residents, touring the premises, observation of life in the home, looking at residents care records and other documents and discussion with the manager of the home and a member of staff. The pharmacist inspector assessed medication management, and checked whether or not the previous issues of concern referred to above had been rectified. In addition we have used written information provided by the management prior to the site visit. This includes detailed information about the home, the staff and the facilities, and is also the homes own assessment about what they need to do to improve and develop. Survey questionnaires from the commission were also sent to some residents and staff before the site visit. All the residents spoken with had varying degrees of confusion and memory loss and not all of them could, or wanted to, give their views about the home. About 2 or 3 gave some views, and 1 relative who was in the home at the time of the visit also spoke to us and gave their views. At the time of writing this report the commission had received completed questionnaires from 10 residents and only 1 member of staff. Some of the views of all these people are included in the report. However at the time this report was written only one member of staff had returned a completed questionnaire. It also needs to be noted that the 10 questionnaires returned from residents had been completed on behalf of residents by one member of staff, and this meant that we could not fully rely on this information when making our judgements. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? Most aspects of medication management had significantly improved and the systems were now safe and well monitored. This should help ensure that residents are kept as healthy as possible. The premises have been recently improved. Parts of the home had been decorated and refurbished, and more improvements were planned. Some management and staffing matters had improved. There was a permanent manager in post who had made some progress and improvements since the previous inspection. These included improvements in medication (see above) and attending to Care Homes for Older People Page 8 of 29 some staffing problems, creating more stability and a better ethos. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. 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 29 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 29 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. The records did not fully demonstrate that the homes admission procedures helped to determine whether or not the home could meet peoples needs and whether people felt it would be a suitable place to live. Evidence: Although the written information about the home (the Statement of Purpose and the Service User Guide) was not viewed for this inspection, the manager told us that the written documents had been reviewed and updated following some changes to the management of the home and the owner organisation Southern Cross. This will ensure that people have accurate information about the home and are kept informed of changes. The manager informed us that as part of the admissions procedure an assessment of needs was normally undertaken before admission for those admissions not classed as an emergency. However the records viewed of a recently admitted resident did not Care Homes for Older People Page 11 of 29 Evidence: have evidence of this. Any assessment visits made to people in their own home or in hospital were not always being written down so there was no written information about these peoples needs until the day of admission when a needs assessment was started. Records were seen of a recent admission described as an emergency. The needs assessment commenced on the day of admission and covered most areas required in the National Minimum Standards. However not all the details about their date of birth and next of kin were accurate and there was insufficient information about the reasons for admission, and about a possible dementia condition, to assist staff to understand and manage any issues arising from this. Detailed written information about residents needs and background is necessary to assist staff understand these needs and from which to develop a comprehensive care plan. Looking at other records showed that even though Ferngrove is registered to provide care to people with dementia there was no specific assessment undertaken by the home relating to this. This is necessary to help staff understand the specific needs relating to dementia and to provide the specialist written guidance to assist them to give the right support. In addition in the records we looked at there was no evidence that residents mental capacity was being assessed under new government legislation and guidance. This needs to be done so that the right support is given to those residents who cannot make their own decisions and so that decisions are made in their best interests. We were told that staff had not yet undertaken training in this matter. Care Homes for Older People Page 12 of 29 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. The care plans needed more details in some matters to instruct and guide staff and to ensure that people received the right care and including the correct management of some risks. Residents health was promoted and medication practices and procedures were safe. Evidence: There was evidence that all residents had a care plan detailing the care and support that people needed. We looked at the records of 4 residents and it was evident that there was a system of developing care plans at an appropriate time after admission. For one person who had been admitted as an emergency, as a short stay, a short term care plan had been developed which gave staff some useful guidance as to the support needed during this period. This, and the other care plans looked at, included information about most health and peronal care matters, some of which, such as nutrition, mobility and pressure area care were supported by an assessment of the risks involved. There was also evidence that the care plans looked at had been reviewed. Care Homes for Older People Page 13 of 29 Evidence: However not all parts of the care plans were as detailed and as accurate as they should be. The care plans did not include information about how dementia related needs were addressed (see previous section). This is necessary so that staff have guidance on the right way of supporting people. One care plan did not include sufficient information about speech impairment to help staff understand how to communicate with that resident, and another care plan did not give sufficient written guidance to staff on how to manage a persons aggression towards other residents. This is necessary to help prevent incidents which could harm other people. Some residents were said to be resistant to having certain aspects of personal care carried out but the care plans did not include sufficient information about how this could be best overcome and managed. Also in a number of bedrooms the emergency call bell lead was not in situ so it was not clear how these residents could summon help. We were told that a number of residents could not use the emergency call bell and that others could use the bell without a lead. However there was no written information on the care plans about this so it was not clear how staff would ensure that these residents would receive the assistance needed. In addition the care plans were not particularly person centred and did not include information about preferences, likes and dislikes and how they would like staff to provide care and support. We were also provided with information from a social services department that agreed with these findings. Though there was no evidence on the day of the site visit to indicate that people were not receiving the care needed because of gaps and inaccuracies in the care plans, detailed and accurate written information is necessary to help ensure staff give the right care and support. These shortfalls were discussed with the manager who agreed to develop the areas identified. She also informed us that a person centred planning approach to care and care planning was being developed according to guidance from Southern Cross. We were subsequently told that all the care plans were being reviewed, developed and updated, including the care plan of concern to social services, and that information about the call bells was being included in them. Looking at records and talking to people showed that the residents health was promoted and that residents had access to all the necessary health care services, including mental health services. There was information in the records about several residents and on going contact with the mental health services. Also a specialist nurse from one of the local hospitals was working with staff in the home on improving their understanding of behaviour related to dementia. As part of the visit a pharmacist inspector checked how medicines were being handled because at out last visit we found some shortfalls. We checked a sample of medicines Care Homes for Older People Page 14 of 29 Evidence: stocks, medicines records and care plans. Overall we found good improvements in the handling of medicines that help protect the health and wellbeing of people who live in the home We found medicines stock to be well organised, records were clearly presented and spare stock was stored securely in clean and tidy rooms. Records of medicines received into the home, given to people and disposed of were usually signed and up to date. Ordering and recording procedures were efficient and all medicines could be easily accounted for. We carried out some detailed checks on the current stocks and records and found that all medicines were being given correctly. However, we found some recent courses of antibiotics and some regular medicines used to prevent stomach ulcers were not given before food as they should have been because staff had not read the medicine label properly. We advised the manager to take immediate action to put this right because giving medicines at the wrong time can stop them working correctly. We looked at a sample of care plans and records to check if medicines were properly reflected in them. Visits from Doctors and other health professionals were usually recorded in detail and we saw some good care plans about how to manage peoples swallowing problems, mental health issues and diabetes. We saw some good information about how when required medicines were to be given such as those used for pain, anxiety and for use on the skin. We gave some further advice about how to keep these plans up to date because having clear written care plans helps make sure peoples health and medical needs are properly met. We looked at how staff were trained to handle medicines. All staff had received certificated medicines training and their competency in handling medicines was formally assessed. The manager and senior care staff carried out regular checks to make sure the correct procedures were being followed and these were recorded in detail. Regular training, efficient audits and formal competency checks on staff help make sure they have the necessary skills to handle medicines safely. Observations on the site visit indicated that residents were being treated with respect and that their dignity was being upheld. Staff were seen treating residents patiently and kindly. Some residents who were spoken with and who were able to give their views said that residents treated them well. One person said that she loves it in Ferngrove and everyone is so good with you. Care Homes for Older People Page 15 of 29 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. Residents had fullfilling activities and sufficient choice in their everyday lives. The meals were varied and appetising and suited most peoples needs and preferences. Evidence: Residents who were able, told us in discussion that routines were flexible enough to suit some of their preferences. These included having a good choice of meals, choice of rising and retiring times, support to go out, and choice of leisure activities (see below). The information supplied by the home for the inspection told us that there was a newly appointed activities organiser working in the home, and that a wide range of leisure activities was being organised. This was confirmed at the site visit through discussions with the residents, talking to the activities organiser and through looking at information in the home. There were special events/celebrations, remeniscence sessions, crafts, painting and games. However there was insufficient information on peoples care plans about their previous hobbies and interests and little information to assist staff to understand peoples spiritual/religious needs. The manager said that an internal inspection process had identified a lack of information about this on the care plans, and about peoples spiritual interests. As a result life histories were being Care Homes for Older People Page 16 of 29 Evidence: developed, to help staff understand peoples past lives and interests, and the manager was forming links with the local churches. Very positive comments were made in the residents questionnaire survey about the activities in the home, but we did not fully rely on this information to make conclusions in the report because of the reasons explained in the Summary. A relative spoken with on the site visit said that visitors were made welcome in the home at any reasonable time and that visits could take place in private. They said that communication between them and the staff in the home was good and that they were notified of all the important events affecting their relative. They had no complaints about any aspect of the home. Residents spoken with, and who were able to give their views, said they felt that they had sufficient choices in their everyday lives and felt that they were listened to. Residents could bring personal items into the home to personalise their bedrooms. However subsequent to the site visit we received some concerns about the lack of choice in some aspects of personal care for a particular resident and which could also mean that the persons dignity was not being upheld. This was discussed with the manager who assured us that she would address these matters with the staff concerned. Menus were according to the Southern Cross corporate guidance on healthy and varied meals, and the menus viewed showed that the food served was wholesome and varied, with a good mix of traditional and contemporary meals. There was a good choice and people could have what they wanted for breakfast including a cooked option. There was a choice of hot and cold dishes at both lunch and tea time. Menus showed that there was always a choice between two main cooked meals at lunch time and 2 desserts, and this was confirmed on the day of the site visit. There were two newly decorated and refurbished dining rooms that provided a pleasant environment where most residents ate their meals. Staff were observed giving residents patient and appropriate asistance and encouragement at the lunch time meal. Some residents spoken with said the food was very good though this view could not be confidently confirmed from the questionnaires for the reason explained above. Care Homes for Older People Page 17 of 29 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. Complaints were treated seriously and investigated properly. The homes policies and procedures and staff training programme should help protect people from abuse. Evidence: There was a suitable complaints procedure in the information supplied to residents and relatives. Two people who were spoken to at the site visit and who could give their views stated that they would speak to the manager if they were not happy with anything in the home, but had no complaints. The relative spoken with knew how to make a complaint under the complaints procedure but also said there had been no reason to use this procedure. Information provided to us by the home before the site visit stated that 3 complaints had been made in the last 12 months. Records showed that these had been taken seriously by the home, investigated fully according to the company policy and the complainants informed of the outcome. This should help to reassure people that their concerns will be dealt with properly. There were policies and procedures to help protect people from abuse (safeguarding), including a whistleblowing procedure. Records showed that staff had undertaken training in the protection of vulnerable adults. A member of staff in discussion confirmed that they had undertaken training in this matter and that she would report any concerns to the manager. These systems should help to protect people from Care Homes for Older People Page 18 of 29 Evidence: abuse and poor practice. There had been a recent safeguarding investigation following an allegation of physical abuse by a member of staff towards a resident. The management of the home had dealt with this according to procedures, and appropriate action taken with the member of staff concerned, including a referral to the protection of vulnerable adults register. There were some other incidents between residents that had been referred to social services but the manager was unclear what action the social services were going to take. She was advised to follow these up to ensure that the correct action was taken to protect people, and that matters are concluded satisfactorily. Care Homes for Older People Page 19 of 29 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. Ferngrove provided comfortable, clean and well - maintained private and communal accommodation that suited residents needs. Evidence: Ferngrove is situated on the main road between Littleborough and Halifax, is in a rural location with good views across the countryside. A tour of the premises showed that the areas viewed were well maintained and decorated. We were told by the manager, and the information provided by the home before the inspection, that the furnishings and decor in many parts of the home had been considerably improved since the previous inspection. The dining areas were attractively furnished and tables set with matching table cloths and serviettes. All the bedrooms were single, and en suite in terms of toilet and handwash basin. The bedrooms seen were decorated and furnished to a good standard and people had some personal possessions that they had brought with them. All the residents spoken with were satisfied with their bedrooms. The homes heating and hot water systems were safe. The radiators were covered and the hot water outlets were regulated, so residents were not at risk from hot surfaces or water that was too hot. Care Homes for Older People Page 20 of 29 Evidence: All areas of the home that were viewed appeared clean, and there were no unpleasant odours in the rooms and areas viewed. There were suitable laundry facilities and most staff had undertaken training in infection control to help prevent the spread of infections in the home. Care Homes for Older People Page 21 of 29 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. Sufficient qualified and trained staff were on duty to ensure that the needs of the residents were mostly met. Staff recruitment procedures however were not thorough enough to ensure that only suitable staff worked in the home. Evidence: At the time of the site visit staffing levels in the home appeared suitable for meeting the needs of the residents. We were told by the manager and a member of staff that there had been problems with staff shortages in the previous year but that this had improved and that extra care hours had also been secured in the evening. Some residents and a relative spoken with at the site visit spoke highly of the staff, and said they were treated with kindness and respect. The survey questionnaires returned to the commission all stated that staff were always available when needed, but as stated above the validity of the responses is dubious because of the way the surveys were completed. Staff were completing relevant qualifications and training and there was a rolling programme of training and courses according to the Southern Cross company training programme. The induction training for new staff was in accordance with Government guidance so new staff should be competent to start work in the home. Information supplied by the home prior to the inspection, and updated on the site visit, indicated that about 69 of care staff were qualified to at least National Vocation Qualification Care Homes for Older People Page 22 of 29 Evidence: level 2. Information from records viewed at the time of the site visit showed that most staff had undertaken training in moving and handling, first aid, food hygiene, fire safety and safeguarding of vulnerable adults. Records also showed that about 56 of staff had undertaken training in dementia care and that less than 50 of staff had undertaken training in challenging behaviour. As Ferngrove is a home registered to provide care to people with dementia, some of whom have behaviour difficulties, this needs to be rectified so that staff have the right knowledge and understanding to help them look after the residents correctly. A member of staff spoken with at the site visit confirmed the training undertaken and the opportunites available, and said that support for staff had improved recently. Only one member of staff completed a questionnaire from the commission, and even though the views expressed were also positive, this meant that we did not have an overall view of staffing matters at this inspection. With respect to staff recruitment, two staff files were looked at. The records for one of these members of staff showed that this person had been working in the home for a number of weeks without a criminal records bureau check, and that there was only one authentic reference that was from a previous employer. These procedures were not according to the care homes regulations and may not help prevent unsuitable people from working in the home. Care Homes for Older People Page 23 of 29 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 new manager was experienced and qualified and was improving standards in the home. The development of the home took into account the views of residents and relatives and the health and safety of the residents and staff were promoted. Evidence: The manager had been in post about 5 months at the time of the site visit was undergoing the registration process with the commission. She had the right qualifications, skills and experience to manage a care home and had the support of senior managers in the national organisation. There was also an administrator working in the home for such tasks as managing the residents finances. The manager had made progress in addressing some inherited problems concerning lack of stable management and direction, and there was optimism amongst the people spoken with at the site visit that the home was improving. There was evidence of some improvements made, for example in medication and staffing matters. There were a range of systems to monitor the care practices and to take into account Care Homes for Older People Page 24 of 29 Evidence: the views of residents and relatives. Questionnaire surveys had been completed by residents and relatives and were being analysed at the time of the site visit. Residents spending money was managed safely and according to the Southern Cross system of pooling the cash and keeping detailed records of the amounts belonging to individuals and of individuals spending. The pool of cash spending money was checked against the record of the total and found to be correct. The home had policies and procedures to promote the health and safety of the residents and staff. Staff undertook health and safety associated training such as infection control, moving and handling and first aid and there was no evidence of unsafe practices. We were provided with evidence that showed that the equipment and installations, including the central heating, the electrical wiring and the fire equipment, in the home were maintained and serviced at the appropriate times. Staff had undertaken fire training and the fire precautions were satisfactory. Care Homes for Older People Page 25 of 29 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 26 of 29 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 29 19 Staff must be recruited 19/03/2010 according to the care homes regulations and must not commence work in the home until the criminal records bureau check and 2 authentic written references have been received. To ensure that only suitable people work in the home. 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 Residents mental capacity should be assessed according to government legislation and guidance by staff trained and competent to do so. The homes preadmission assessments, with useful information about peoples needs at the time of admission, should be written down. Peoples personal details written on the assessment documents should be accurate. The home should ensure that peeoples needs in relation to Page 27 of 29 2 3 3 4 3 4 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations dementia are specifically assessed and demonstrate how these needs are met 5 7 The care plans should include sufficient information on all matters of health and social care, including mental health/dementia, communication, managing aggression, personal care and information about peoples ability to use call bells and how to alert staff in an emergency. Medicines should be given at the correct and best time according to the prescribers instructions or medication information. Information about peoples hobbies, leisure interests and religious interests should be written down. Staff should uphold the residents rights to choose how their personal care is given and the right to determine when to get ready for bed. All incidents that are of a potential safeguarding nature and referred to social services should be followed up by the home if necessary to ensure that correct action is taken. All staff working in the home should have training in caring for people with dementia 6 9 7 8 12 14 9 18 10 30 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!