Inspection on 28/04/10 for Granby Care Home

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

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Granby Care Home 12/11/07

Granby Care Home 24/02/06

Granby Care Home 18/11/05

Granby Care Home 10/03/05

Granby Care Home 21/10/04

Granby Care Home 16/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for older people Name: Address: Granby Care Home 50 Selborne Street Liverpool Merseyside L8 1YQ     The quality rating for this care home is:   one star adequate 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: Debbie Corcoran     Date: 3 0 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Granby Care Home 50 Selborne Street Liverpool Merseyside L8 1YQ 01517093988 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): denise.lamphier-osborne@liverpool.gov.uk Liverpool City Council Name of registered manager (if applicable) Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 30 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Granby Care Home is a purpose built property owned and managed by Liverpool City Council. It is situated in the Granby area of Liverpool, and is close to shops, local amenities and other facilities. Accommodation comprises of 30 bedrooms, which are divided into three self-contained units linked by a central area called the atrium. The atrium serves many purposes and Care Homes for Older People Page 4 of 32 Over 65 30 0 2 8 0 1 2 0 1 0 Brief description of the care home is used for social gatherings and activities, sitting, reading or meeting with family and friends. Each unit has 10 bedrooms all with en-suite facilities, shower washbasin and toilet. All bedrooms are furnished but service users can bring their own furniture, if it meets the required safety standard. There are two lounges in each unit and a dining room with kitchenette were light refreshments can be made. There is one designated smoking areas at the home. The units also have a large bathroom and toilet, one of which provides assisted bathing facilities. A utility room with a washing machine and dryer is available for service users who choose to do their own laundry. The home has been designed to meet the needs of people with different cultural and religious backgrounds and a multi faith prayer room is available. The home stands in its own grounds and there is a small car park to the front of the building. There are garden areas at various points around the home. The current fees for residing at Granby Care range between £110.30 to £375.00 per week depending on the nature of the persons stay. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate 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: We visited the home on an unannounced basis. The visit was carried out over two seperate days and the regulation inspector was accompanied by a pharmacist inspector for the first day. During the visit the majority of the people living at the home were met and a number were spoken with on a one to one basis. A sample of records for people living at the home were looked at. We also looked at other records including, staff files, staff training records and health and safety records. These help to show us how peoples health and wellbeing are being promoted and whether staff have the skills and training needed to support people appropriately. A tour of the home was carried out which included all communal areas and a sample of bedrooms. Care Homes for Older People Page 6 of 32 Discussions took place with three members of care staff, the deputy manager and two service managers. The registered manager was not available at the time of the visit. A self assessment of the service had been returned to us a number of months prior to the visit. The self assessment enables the service provider to inform us of what they do well, where they have improved and where they can improve in the future. It also includes information on how they promote equality and diversity, how they seek the views of people living at the home and includes data on staffing and health and safety. The self assessment is referred to as an Annual Quality Assurance Assessment (AQAA). Some of the information in this has been used to inform the findings of the inspection. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? A small team of service development managers have been brought in to oversee the running of the home and ensure practices and procedures are developed. We could identify that there has been some improvements on matters such as care planning, arrangement of activities and staff communication. However, not all planned developments had been implemented at this stage. Care Homes for Older People Page 8 of 32 Each of the people using the service has a new and up to date care plan. These include a good level of detail as to the needs of the person and how to meet these. A member of staff has been charged with ensuring activities are taking place and the need to ensure a greater range of activities has been recognised and is being worked upon. Regular staff team meetings have been introduced, although these are not always recorded. 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 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information about the service to aid their decision in moving to the home. People are only admitted to the home following an assessment of their needs and when it has been established that their needs can be met at the home. Evidence: We looked at the statement of purpose and service user guide for the home. These are documents which provide information on the services and facilities provided at Granby Care. We were told that the service user guide has been produced in a variety of different languages in line with the needs of the people using the service. The service user guide provides information on the services and facilities provided at the home including information on the provision of care, supporting people with their health and medication needs, supporting people to practice their religious beliefs, staffing, arrangements for meals, arrangement for activities and social life, how peoples views and opinions are gained, the payment of fees for residing at the home, Care Homes for Older People Page 11 of 32 Evidence: emergency procedures and information on how to make a complaint. People who are thinking of staying at Granby Care can use this and information in the statement of purpose in order to aid their decision as to whether or not to stay at the home. We were told that people interested in staying at the home and their relatives or representatives are invited to visit the home and spend time there before deciding whether or not to move in. We looked at what sort of information is gained about the needs of a person before they stay at the home. We found that assessments of need are attained from the referring agency. Assessment of needs are not carried out by staff at the home. We talked to the deputy manager and service manager about introducing an assessment tool for use by the home so that where the information received from a refering agency is not particularly detailed then the home can demonstrate that they have carried out a comprehensive assessment of the persons needs and are then confident in being able to meet these. It is clear from the standard of detail of information in peoples care plans that staff have gathered a lot of information on the needs of the person in addition to the information provided by the referrer but this is not documented as an assessment of needs. Granby Care provides intermediate care for up to five people. People staying at the home on an intermediate care basis are usually accommodated in a separate unit. At the time of our visit we were told that this unit was not being used as a result of staff shortages. We were told that when people stay at the home for intermediate care they are encouraged to use and develop their skills and keep active. Staff told us that each of the people who stays at the home for intermediate care has a specific plan with regards to their rehabilitation which has been drawn up by an Occupational Therapist and we were shown an example of one of these. Staff also told us that regular multi disciplinary meetings take place in order to monitor the needs and progress of people staying for intermediate care purposes. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each of the people using the service has a detailed care plan which provides a good level of information as to the needs of the person and how to meet these, however the practices for managing medication need to be developed so as to ensure people using the service are appopriately supported to remain healthy. Evidence: We case tracked three people using the service. By this we mean that we looked in more detail at their needs, the type of support they were receiving and their care plans. Each of the people we looked at had an up to date care plan. The level of information in care plans was very good. Care plans included information on how to meet the needs of the person in areas such as their communication needs, eating drinking and dietary needs, strengths and needs regarding mobility, strengths and needs in personal care, how to promote the persons health, support with sleeping and rest, social and recreational needs and interests, spiritual and cultural needs. We found the care plans were easy to follow and they explained the needs of the person in a good Care Homes for Older People Page 13 of 32 Evidence: level of detail. We visited the home a couple of months prior to this inspection following receipt of safeguarding information. At this point the level of information in care plans was not sufficiently detailed so as to describe the health and welfare needs of people using the service and we found that key information on pressure area care and the prevention of pressure areas had not been documented. We gave the service a requirement to address this. Since the visit service managers have ensured that each of the people living at the home has a new, up to date and detailed care plan. We saw that risk assessments are carried out where a person living at the home is thought to be at risk of harm. These include risks such as falling, risks of developing pressure areas, nutritional risks. Where a risk had been identified then we saw information as to how to manage or reduce this. Care plans described the health care needs of the people living at the home and records showed us that people are well supported with their health care needs and are regularly supported to see their GP, nurse, optician etc. We were told that a GP carries out a surgery at the home on a weekly basis and carries out additional visits as required. A community matron also visits the home 2 to 3 times per week. District nurses also visit on a regular basis as per the needs of the people living at the home. A visiting healthcare professional was asked to provide feedback on the home and they gave good feedback on the care of the people living at the home and on staffs response in dealing with health matters. People living at the home told us that they felt well supported with their personal care and health care needs. People felt that staff would get a nurse or doctor to see them straight away if they were feeling unwell. We observed people staying at the home to be well presented and they appeared comfortable in their surroundings. We looked at medicines administration. All medicines were administered by staff who had completed certificated medicines training. No-one had currently chosen to selfadminister their medication, although staff at the home had previously supported people with this. The home had a policy in place for the use of home remedies so people can receive prompt treatment for minor ailments without a prescription. We looked at how information within peoples care plans supported the administration of medication. We found that written individual guidance about the use of when Care Homes for Older People Page 14 of 32 Evidence: required medicines could be usefully added or expanded upon to provide clear guidance to staff about when these medicines may be needed, and how this need is made known. We looked at a sample of medicines stocks and records. We found that medicines including controlled drugs were stored securely. This helps to reduce the risk of mishandling or miss-use. The medicines administration records were generally clearly and accurately competed enabling medicines both in the monitored dosage system and in boxes and bottles to be accounted for (tracked). But, recent records for the application of eye drops had been missed; this meant it was not possible to tell whether they had been given correctly as prescribed. Most medicines administration records were pre-printed by the pharmacy, but where handwritten records were made by staff these were not always so well completed. It is recommended that handwritten medication administration records are always checked and countersigned by a second person to help reduce the risk of errors. We were concerned to find that on occasion some people had missed doses of medication because there were none left to give. Although new medicines supplies were obtained this could probably have been addressed more quickly. We saw one example, where a medicine was not re-started straight away when a new supply arrived at the home. Action needs to be taken to audit and improve the medicines ordering system to help ensure adequate supplies of medication are maintained to allow continuity of treatment. Medicines audits were completed at the home but consideration should be given to expanding these to help ensure that any weaknesses or inconsistencies in medicines handling are identified, so they can be promptly addressed. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to get involved in activities and to remain independent and exercise choice. People are provided with a choice of good quality food and catering arrangements are well organised. Evidence: In order to assess the level and variety of activities available to people we spoke with people living at the home and with staff and we viewed a weekly activities plan. There have been some recent improvements to activities following a reported period of infrequent activities. A member of staff has been identified to take the lead on arranging activities and there is now an activity scheduled to take place every day. These activities include daily exercises, crafts, card making, baking, quiz, community visits. There were examples of people being supported to access the community with staff support. Care plans include some information on what activities or interests the person has. The home is hoping to secure the use of a mini bus and then arrange for more outings for people. The development of a greater variety and quality of activities is still a work in progress and service managers described some of their plans for this. The home has a hair dressing salon for use of the people using the service and a shop Care Homes for Older People Page 16 of 32 Evidence: where people can buy drinks, snacks and sweets. People staying at the home on an intermediate care basis are encouraged to do chair exercises and people are involved in household type activities to retain and develop their skills. These activities are based on individualised rehabilitation programmes. People are supported with their spiritual and cultural needs. The home provides a multi faith prayer room and a variety of religious services or visits from religious leaders take place. During discussion with people living at the home and with staff we were told of how people are encouraged to make choices at the home. Examples given were that people are choosing their daily routines, given their post directly and are supported to manage their own medication when they wish to and are able to although nobody was doing this at the time of the visit. People living at the home they told us that they are making choices about where to spend the day, what time to get up and go to bed, what to eat and their own personal routine. People were observed to spend time in their own room alone or with company and people have the choice of using smaller quieter lounges. We found that there was no forum for people living at the home to air their views on the service. We would advise introducing residents meetings as a means of empowering people to have a greater say about the running of the home and to contribute to changes to the service. In assessing the provision of food and meals we looked at the menu provided. We also spoke with one of the cooks at the home. We checked the kitchen for cleanliness and to check stocks of food and food storage. At the time of the visit the cook was preparing a variety of different meals to accommodate the cultural needs of the people living at the home. Traditional English food was being prepared, alongside Chinese meals and halal meals. There were also meals prepared for people requiring a special diet. The kitchen was presented as well organised and well stocked and it was clean and tidy. One area of concern was that we observed opened food to be being stored in the fridge with no date labelling. This is not in line with safe food handling and should be addressed with kitchen staff. People living at the home gave us some individual feedback on the quality of their meals and food and we reported this back to the service managers. General feedback was that the food was nice and its ok. We observed staff asking people what they wanted from the choice of menu for the following day. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Practices and procedures in place for safeguarding people from abuse have not been followed appropriately and this may leave people using the service at risk of harm or abuse. Evidence: A copy of Liverpool City Councils adult protection policy and procedure was in place. This outlines responsibilities for responding to an allegation of abuse and any subsequent investigations. We found that practices for safeguarding people from abuse were not robust. We have evidence of recent safeguarding allegations whereby staff had not followed the necessary protocols for responding to abuse, in terms of reporting the incident through the Local Authority procedures and notifying CQC of an allegation. We found that records relating to allegations of abuse and the outcomes to these have not been maintained appropriately and where we found records these gave no indication of outcomes. We also found that risk management following allegations of abuse had not been implemented to protect both staff and people using the service. This is with the exception of a very recent example. These practices may leave people living at the home at risk of not being protected from abuse. Care Homes for Older People Page 18 of 32 Evidence: We have received a number of pieces of information about the home with regards to safeguarding from Liverpool City Council safeguarding team and we visited the home on 28/01/10 as a result of this. The visit was a random inspection and a report on the findings of this can be accessed through CQC. We have also received information through direct public contact with us. A number of allegations made have been substantiated or have identified concerns as to other practices at the home. Service managers from within the organisation have been brought in to the service following concerns regarding practices and they have looked at introducing a new system to ensure staff are fully aware of their responsibilities in responding to allegations of abuse and what action they need to take in the event of an allegation. At the time of the visit this had not been implemented into practice. We were provided with information on staff training and this indicated that the majority of the staff team have been provided with safeguarding / adult protection training. This should be extended to include all members of the staff team as relevant to their role. The home has a complaints policy and procedure which is time scaled appropriately and includes contact details for the Commission, although these need to be updated to reflect the change of contact details. People living at the home are provided with information on how to make a complaint in the service user guide. People living at the home who were asked about complaints said that they would let staff know if they were not happy about something. Staff were also asked what they would do if a person living at the home raised a complaint with them and staff provided appropriate answers to this. A log of complaints is maintained. This was looked at and showed that there have been no complaints made to the service over the past 12 months. We looked at accident records over the past four month period. These showed no particular pattern to accidents. There has been no auditing or analysis of accident records. This is a practice which we were told is going to be reintroduced. We met with the registered person for the service following the inspection visit and they provided us with an action plan to address our concerns regarding safeguarding Care Homes for Older People Page 19 of 32 Evidence: practices. The provider has taken immediate action to address our concerns. All staff have been provided with adult protection training, staff have been provided with up to date guidance on dealing with safeguarding concerns, a system to test staff competency in this area has been introduced and a system for auditing concerns and complaints has been introduced. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a clean and comfortable home environment which is presented to a good standard. Evidence: The home was purpose built and it meets required standards in relation to size, facilities, and accessibility. It is a one storey building situated in accessible grounds. The home is divided into three separate areas. Two of these areas accommodate people on a long term basis and a respite basis. The third area accommodates people who require intermediate care. There are a total of seven lounges, two on each of the three designated areas and there is also a large main lounge to which all areas have access. There is a main kitchen from which meals are prepared and each area has a dinning room and satellite kitchen facilities. These are used for making drinks and snacks and people living at the home are encouraged to use and develop their domestic skills in these areas. We looked at a sample of bedrooms and these were seen to be furnished and presented to a suitable standard. Each bedroom has en suite shower and toilet facilities and we were told that these are due to be upgraded in the near future as part of the maintenance of the home. There is a fully equipped hairdressing salon for use Care Homes for Older People Page 21 of 32 Evidence: of people living at the home. The home was presented as clean and domestic staff are employed. The home is fitted with aids and adaptations such as hoists, handrails and bath chairs so as to assist people to move and transfer safely and to promote peoples independence. Health and safety policies, procedures and practices are in place to ensure a safe living and working environment is provided. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are being supported by staff who havent been provided with up to date training as appropriate to their role and to promote their health and safety. Evidence: Staffing levels were good at the time of the visit and this allows staff to spend some quality time interacting with the people living at the home. The turnover of staff is low and most of the staff have worked at the home or within a similar establishment for many years. There have been no new recruits since the last inspection visit. Therefore we did not assess the staff selection and recruitment practices on this occasion. We looked at a sample of training records held on file for members of staff and we looked at some staff training information held on a data base. These showed us that a significant proportion of the staff team have not been provided with training in topics such as moving and handling and fire safety. There was no information to hand which would give us an overview of staff training and we therefore asked for this to be forwarded to us following the inspection visit. We did receive copy of this information following the visit and this confirmed that many of the staff do not have up to date training in core skills required for their role. The manager should carry out a review of staff training for the staff team and develop a training plan to ensure all staff have Care Homes for Older People Page 23 of 32 Evidence: appropriate and up to date training for their role. Not providing staff with relevant and up to date training may compromise the health, safety and wellbeing of people living at the home and staff. We met with members of the staff team and asked them questions about their role, their training, about meeting the needs of the people living at the home and about the service in general. Staff gave us answers which supported the aims and objectives of the service and staff felt confident in their roles and responsibilities. The staff team consists of thirty people and twenty two care staff have attained a relevant National Vocational Qualification (N.V.Q) in Health and Social Care or equivalent. The minimum ratio of 50 trained staff has therefore been achieved and exceeded. Care Homes for Older People Page 24 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of the service is not being appropriately monitored so as to ensure the health, welfare and wellbeing of people using the service and staff. Evidence: The registered manager was not available at the time of the inspection visit. The registered manager has recently returned to work following a period of absence. A temporary manager had been brought in to oversee the management of the home for a number of weeks in the managers absence. However, for the majority of the period of absence of the manager a temporary manager had not been identified to oversee the management of the service. More recently a team of senior managers have been working to oversee the management of the home. Since the last key inspection of the service there have been significant periods of time when the service has not been managed by a person registered as such with the Commission. We have identified poor practice with regards to the management of safeguarding concerns under concerns and complaints. This is an area which has not been Care Homes for Older People Page 25 of 32 Evidence: managed effectively and in line with appropriately safeguarding people using the service. We have found that staff have not being appropriately supervised (see below) and there has been a lack of co-ordination of staff training. This means that the manager is not aware of what training staff have undertaken and whether or not this is up to date and relevant to their role. We saw that there has been no effective means of quality assurance in place to monitor the quality of the service. Records indicated that there has been only one visit to the home by a representative of the organisation to check on quality of the service in line with regulation 26 of the Care Home Regulations over the past twelve months. These visits should be carried out on a monthly basis. People using the service are not surveyed as to their views on the quality of the service. We did note that exit surveys have recently been introduced. We looked at how people living at the home are supported to manage their money. People manage their own money when possible. Staff also support people with relatively small amounts of money. This is documented appropriately. Regular staff meetings have been introduced more recently and staff told us that these are of great benefit. A record of these meeting should be maintained. Staff files showed us that staff are not being provided with regular and recorded supervision and members of the staff team have not had the opportunity of a supervision meeting for many years in some cases (see notes under staffing). This should have been identified and addressed as part of the quality assurance checks on the service. It is important that staff are provided with regular and recorded supervision as this aids the development of the person as a worker and gives them the opportunity to explore their practice and better ways of working. Health and safety policies, procedures and practice are in place to safeguard the well being of people living at the home, staff and visitors. A safe working practice risk assessment has been carried out. This identifies potential areas of risk and includes information on how these are being managed. We met with the registered person for the service following our inspection visit. The provider had taken immediate action to address our concerns. A designated manager had been appointed to oversee the management of the service. Monthly visits / audits Care Homes for Older People Page 26 of 32 Evidence: have been reintroduced and the purpose and quality of these have been reviewed and developed. All staff have undergone a review of their performance and development. A resource officer had also been introduced into the service with the aim of setting up new systems for monitoring practices. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 18 13 The registered provider must 28/02/2010 ensure safeguarding concerns are fully investigated in line with Local Authority procedures. To safeguard the health, safety and wellbeing of the people using the service. 2 30 18 (c) Staff must receive training 28/07/2009 appropriate to the work they perform and that it is updated at the appropriate intervals. A programme outlining dates of when this training is to be undertaken should be submitted to CSCI. (Not assessed on this occasion). 3 31 38 The registered provider must 28/02/2010 ensure the service is managed by an appointed person at all times in the absence of the registered manager. To ensure the service is appropriatley managed at all times. Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Sufficient stocks of medication need to be kept at the home to enable continuity of treatment. 31/05/2010 2 18 13 Systems must be in place to 28/05/2010 ensure that people using the service and staff are appropriately supported and safeguarded following an allegation of abuse. To protect the health, welfare and safety of people using the service and staff. 3 18 13 Staff competence in 28/05/2010 identifying and reporting allegations of abuse must be demonstrated. To protect the health, welfare and safety of people using the service. Care Homes for Older People Page 29 of 32 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 4 30 18 Staff must be provided with up to date training as approriate to their role. To promote the health, safety and wellbeing of people using the service and staff. 28/07/2010 5 31 8 The registered person must ensure that the home is effectively managed at all times. To ensure the health, safety and wellfare of people using the service and staff. 28/06/2010 6 33 26 The home must be visited 28/05/2010 on an unannounced basis once per month and a report on the findings of these visits should be made. To monitor the running of the service. 7 37 17 Records required for the protection of people using the service and the effective running of the business must be appropriately maintained. To promote the effective running of the service and protect the health, safety and well being of people living at the home. 28/06/2010 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 Information collated about the needs of a new person to the service should be documented in the form of an assessment of needs. Particularly when the assessment information as provided by the referrer does not include a good level of detail as to the day to day care needs of the person. The medicines ordering system should be audited and improved to help reduce the risk that doses of medication will be missed because there are none left to give. Staff training in safeguarding people should be extended to include all relevant members of staff. A training analysis should be carried out and a training plan should be produced out to ensure have up to date training appropriate to their role. Staff should be provided with regular and recorded supervision meetings. 2 9 3 4 18 30 5 36 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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