Inspection on 02/06/09 for Kallar Lodge

This is the latest available inspection report for this service, carried out on 2nd June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kallar Lodge 31/10/05

Kallar Lodge 09/08/05

Kallar Lodge 15/02/05

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

Key inspection report Care homes for older people Name: Address: Kallar Lodge 75 Gregory Road Chadwell Heath Romford Essex RM6 5RU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Parnell-Hopkinson     Date: 0 2 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Kallar Lodge 75 Gregory Road Chadwell Heath Romford Essex RM6 5RU 02082706750 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: London Borough of Barking & Dagenham care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who may be accommodated is: 35 The Registered Person may provide the following categories 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: Dementia Code DE Date of last inspection Brief description of the care home Kallar Lodge Residential home is operated by the London Borough of Barking & Dagenham and is located in a residential area within the Padnall Estate. Care is available to 35 older people over the age of 65 years living with dementia. The accommodation is split between 3 floors and has a passenger lift. All bedrooms are single with an en suite facility. Currently the ground and first floors are for the use of permanent residents, and the third floor is dedicated for use as a respite care unit. All floors have communal lounges and dining areas. In addition there is a large lounge on the ground floor which is used for social events for all residents and as a private Care Homes for Older People Page 4 of 31 Over 65 0 35 Brief description of the care home visitors room. All rooms are spacious and have TV points and a call system in place. The rear garden is with disabled access to the grounds and there are car parking facilities at the front of the property. The home is situated close to local services and facilities which are easily accessible by car and public transport as is the M25 and A12. Fees are available on request but all of the beds are purchased by the London Borough of Barking & Dagenham and residents are subject to a financial assessment undertaken by that local authority. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We arrived at the home at 07:30 on Tuesday, 2nd June 2009 to undertake an unannounced key inspection. The inspection took place over 9 hours and involved talking to residents, relatives and staff. It also included a tour of the building, case tracking 6 residents, viewing all related and relevant documentation including the staff recruitment process. Contact has also been made with social care professionals to obtain their views on the service, and we were able to speak to an Admiral nurse who was visiting the home on the day of the inspection. Information was also taken from the annual quality assurance assessment (AQAA) which had been returned by the service. Care Homes for Older People Page 6 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Care plans should include night care and end of life care in a more comprehensive way, and daily recordings must be more reflective of the outcomes identified in the care plans. When residents are taken to a doctors surgery by either a member of staff or a relative, accurate information as to the outcome of that visit must be recorded on the residents file to ensure continuity of care. Risk assessments for those residents who are unable to use the emergency call system when alone in their bedrooms, and the possible use of some assistive technology which may be beneficial for them in alerting staff to difficulties. Protocols must be in place for the administration of PRN (as required) medication. Also two signatures should be obtained for hand written entries onto the MAR (medicine administration record), the source of any instruction as to the decrease, increase or stopping of medication to be recorded, and also dosage recorded where there is flexibility in the prescription, for example 1/2 tablets or 5ml/10ml. Care Homes for Older People Page 7 of 31 All staff must undertake training in the implications of the Mental Capacity Act 2005, and also ensure that all training undertaken is put into practice. 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 8 of 31 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 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their family/friends are given the information needed to enable them to choose a home that will meet their needs. Evidence: The service has a comprehensive statement of purpose which was available in the reception area of the home, together with the last inspection report. Each service users is given a copy of the service user guide in a format that is appropriate to his/her care needs. All residents have a contract, a copy of which is kept on his/her file. All new residents receive a comprehensive needs assessment before admission. This is carried out by staff with skill and sensitivity. The service also ensures that a summary of any assessment undertaken through care management arrangements is received prior to admission. The assessment focuses on achieving positive outcomes for people with dementia, and this includes ensuring that the facilities, staffing and other services Care Homes for Older People Page 10 of 31 Evidence: provided by the home meet the ethnic and diversity needs of the individual. Before agreeing the admission, the service carefully considers the needs assessment for each individual prospective resident, and the capacity of the home to meet the identified needs. Significant time and effort is spent planning to make the admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make. Prospective residents and their families are given a guided tour of the building and introduced to other residents. They are also invited to join in with any activities, stay for lunch and view the room which they may occupy. During this time an ongoing assessment of care needs is continued in a relaxed manner without the individual feeling under pressure. The service has also found that for people living with various stages of dementia, moving into a residential home can be extremely traumatic and disorientating, often leading to a decline in abilities. Therefore, in order to try to alleviate some of these problems the service has developed a day care programme where prospective residents visit the home on a daily basis so that they become familiar with the surroundings, staff and other residents before making the final transition into residential care. One relative told us the staff were excellent when my mother moved in, and they made the whole process stress free for us and for my mother. Care Homes for Older People Page 11 of 31 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. Generally the health and personal care that people receive is based on their individual needs, and delivery is based on the principles of respect, dignity and privacy. Evidence: From observations, discussions with some residents, relatives and staff we are satisfied that people living at the home receive personal and healthcare support using a person centered approach with support provided based upon the rights of dignity, equality, fairness and respect. The delivery of personal care is individual and is flexible. One relative told us the care at this home is second to none. My mother has been well cared for even though she can be very difficult at times. Care plans are generally comprehensive but do need to include more information around night care and end of life needs. These areas were discussed with the manager during the inspection and we are satisfied that arrangements for the further development of these areas was already in hand, and will be implemented. Weights are being monitored on a monthly basis or more frequently if the need is identified. Staff have undertaken training in caring for people living with dementia but must Care Homes for Older People Page 12 of 31 Evidence: ensure that such training is always put into practice. For example it is not important if a resident puts on a dress over a nightdress, or a jumper on back to front, and addressing this causes distress to the resident. This causes no harm to the individual but may only annoy the onlooker because it is not viewed as correct. It is more important that the independence of people living with dementia is maintained for as long as is possible. All residents have access to healthcare services and staff ensure that those residents who are able to visit their GP, are enabled to do this rather than have the GP visit the home. However, where necessary visits to the home are made by the relevant GP. The service must ensure that where a resident visits the GP surgery with either a member of staff or a relative, that accurate information is obtained of the outcome of the visit, and that accurate recordings are kept within the home. This is particularly relevant where a residents blood sugar levels are being taken at the surgery. We did find that accurate records were not being kept at the home, and that there was no clear audit trail for the monitoring of such levels. The service has developed extremely good relationships with local GPs and other health professionals. The service has also provided funding for a monthly memory review clinic with a local psychiatric geriatrician. This person visits the home to undertake reviews of both memory and medication. All residents have access to a chiropodist, dentist and optician. Risk assessments are in place for areas such as personal care, continence care, moving and handling, nutrition and behaviour which challenges, and these are reviewed monthly or more frequently if necessary. However, the service needs to ensure that only risk assessments relevant to the individual resident are in place. The service may have generic risk assessments for things such as use of stairs and lifts which only need to apply to those residents who make use of these. The emergency call alarm system may not be able to be used by all residents, and a risk assessment should be in place for residents unable to use this system. Non-use of this system may involve the use of other assistive technology such as mat alarms, mattress alarms or infra-red beams and this was discussed with the manager during the inspection. All staff have undertaken training around infection control,but we did find that some staff were not using protective gloves appropriately, and were not able to give a clear reason as to why gloves were being used in certain situations, for example for serving meals to residents. This was discussed with the manager and the deputy during the inspection, and they have already taken steps to address this matter. We looked at the medication administration records and processes and generally found these to be in good order. However, the service needs to develop protocols Care Homes for Older People Page 13 of 31 Evidence: around the administration of PRN (as required) medication relevant to each individual. We would also recommend that when making hand written entries onto MAR (medication administration records) that two signatures be obtained to ensure that the entry is correct, and also that the source of any instruction to increase, decrease or stop medication is recorded together with the date of the instruction. Also the administration of all prescribed creams, lotions and ointments must be recorded on the MAR sheets. The staff demonstrated a good understanding of the rights of residents in the area of health care and medication. They work with individuals regarding any refusal to take medication and reviews are regularly undertaken by the GPs. Currently there are no controlled drugs within the home. Although end of life care plans require further development, we are satisfied that residents receive the care they need at the end of their life. Staff support both the family and homes other residents during the bereavement process. Staff understand and are sensitive to the particular religious or cultural needs of the individual and families. Care Homes for Older People Page 14 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are able to make choices about their life style, and are supported to maintain their life skills. Social, cultural and recreational activities are designed to meet the needs of the individual resident, both separately and in small/large groups. Evidence: Although all of the residents are living with dementia, central to the homes aims and objectives is the promotion of their rights to live ordinary and meaningful lives both in the home and the community. Staff demonstrated the importance of enabling residents to follow interests and leisure activities in a way that is directed by the individual resident. All residents are able to enjoy a full and stimulating lifestyle with a variety of options to choose from. There is a programme of morning and afternoon activities, but staff also spend a lot of time in 1:1 activities such as sitting and chatting to individuals or taking them out for walks in the garden or to the local shops. The home has access to transport and trips are organised to the coast, countryside, pubs and shopping centres. Birthdays are celebrated with families being invited, and other festivals are also celebrated again with residents and their families being invited. One family told us that we came on Mothers Day, and had lunch with Mum. It was wonderful to spend this time with her and the atmosphere in the home was great as Care Homes for Older People Page 15 of 31 Evidence: we were not the only family having lunch. Another relative told us there always seems to be something nice going on in this home. We are always made welcome and can visit at any time. All of the staff are always pleasant and helpful. The home hosts a church service every month for those residents who wish to take part, and a local priest visits the home on a fortnightly basis to take communion and confession, again for those residents who wish to take part. Arrangements would be made for any resident who wishes to attend their own place of worship, or for clerics from other religions to visit the home if a resident wishes this. Routines to daily living are flexible and residents can make choices in the major areas of their lives. They can choose when to get up and go to bed. Bedrooms seen had been personalised by the resident and/or his/her family. We observed breakfast and lunch being served and the meals were appealing, well balanced and nutritious. Meals are also appropriate for those residents who no longer remember to use cutlery, but prefer to use their fingers. For residents who need support during mealtimes, including those who have difficulty swallowing or chewing, staff give assistance. Staff were observed to be discrete and sensitive to the feelings of the person they are helping and also to others present. Although mealtimes are set, these can also be flexible to meet the needs of the individual, and staff are patient and helpful allowing residents time to finish their meals comfortably. Bowls of fresh fruit were seen in the dining rooms, and drinks/snacks are freely available around the home during day and the night. The dining tables were well laid and looked really pleasing with artificial, but realistic, floral decorations. One resident told us I love those flowers and I like to hold them because they feel so nice. It is important that residents can touch, feel and hold things around the home as this keeps them in touch with the world around them, and enhances their state of well being. Menus were available in pictorial format which enabled residents to make more informed choices, but we would recommend that choices be made on the day and not the day before due to the very short term memory of people living with dementia. We were told that the home is looking at providing two choices of meal served on tea plates at the time of the meal so that residents can touch, smell and feel food, and this would add to their ability to make choices at the time. All routines, activities and plans are person centered, individualised and reflect the diverse needs of the residents. There are regular reviews and the service is very responsive to the changing needs of the individual resident, and changes can be very time limited due to the fact that all of the residents are living with dementia. Care Homes for Older People Page 16 of 31 Evidence: The service also has taken account of the fact that families need more support as their relative who has dementia deteriorates and displays complete personality changes and more behaviours which challenge. Currently some counselling is given and support is being gathered from Admiral nurses (who specialise in supporting people caring for those living with dementia) and from the Alzheimers Society. This area is being developed further and training will be provided for key members of staff. Care Homes for Older People Page 17 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. They are protected from abuse and have their rights protected. Evidence: Conversations with some residents, relatives and staff confirmed that the ethos of the home is that it welcomes complaints and suggestions about the service, use these positively and learns from them. One relative told us the managers door is always open and if I have any concerns I know that I can always talk about them. The good thing is that I always feel listened to. Staff demonstrated the importance of taking the views of residents seriously, and of listening to and responding to issues raised by them, or relatives. Residents are given a copy of the complaints procedure in a format that they can understand, and currently this has been further developed into a pictorial format and an audio format. The complaints procedure is clearly displayed around the home. 4 complaints have been received in the past 12 months, and these were dealt with in line with the complaints procedure. The complaints made and the actions taken in response to them were fully recorded, and a review of the number and nature of complaints made is used as part of the quality assurance procedures in use. Care Homes for Older People Page 18 of 31 Evidence: The service has a whistleblowing policy and staff demonstrated an understanding of this. Staff who blow the whistle on bade practice would be supported by the organisation. Policies and procedures regarding safeguarding adults are available to staff and give them clear guidance about what action should be taken. The service is clear when an incident needs to be referred to the local authority as part of the local safeguarding procedures. However, there have not been any safeguarding issues at this home. The service is open and transparent when discussing incidents and access to external agencies or advocacy services is actively promoted within the service. All staff working within the home are fully trained in safeguarding adults. Knowledge and understanding in this area is constantly checked at team meetings and during supervision sessions. Staff were able to demonstrate an understanding of what restraint is , and alternatives to its use would also be looked for. Equipment which may be used to restrain individuals such as bed rails, keypads, recliner chairs and lap belts would only be used when absolutely necessary, and with the involvement of the resident, and/or family, and health/social care professionals. Staff recruitment procedures are robust, but no new staff have been recruited since the last inspection. New staff have transferred from other services within the organisation and, therefore, no new applications, criminal records bureau disclosures or references were required. Care Homes for Older People Page 19 of 31 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. The physical design and layout of the home enables residents to live in a safe, wellmaintained and comfortable environment which encourages independence. Evidence: This building was a registered care home and was closed for a period so that extensive redecoration and refurbishment could be undertaken. This has resulted in an improved living environment which is now appropriate for the lifestyle and needs of those people living with dementia. The home is clean, safe and comfortable, well maintained and free from offensive odours, and systems are in place to control the spread of infection. All of the bedrooms are single with en suites and exceed the requirements of the National Minimum Standards. Residents are encouraged to see the home as their own and are supported to personalise their own bedrooms with ornaments and photographs and other furnishings if they wish. The environment is fully able to meet the changing needs of people living with dementia, along with their cultural and specialist care needs. The service positively encourages people with a limited capacity to be as fully involved as possible in decisions about the decor. There are various lounges which enable people to access quiet areas if they wish. Care Homes for Older People Page 20 of 31 Evidence: Televisions are sited in the lounges so that residents can view this from various seating areas. Although the corridors are long there are seats located at various locations along these corridors so that residents can sit down if they wish. Dining areas are bright and provide an inviting ambience. There is a variety of external areas, and the main garden area is subject to a planned project to improve this area so that it is more accessible and attractive for residents. The bathrooms and communal toilets are fitted with appropriate aids and adaptations to meet the needs of the people using the service and are in sufficient numbers and of good quality. The kitchen and laundry areas are clean and well maintained. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, and to support the smooth running of the service. Evidence: We spoke to some residents and visitors who told us that they have confidence in the staff who care for them. On the day of the inspection staffing levels were appropriate to meet the needs of the residents, and we are confident that the staffing structure is based around delivering outcomes for residents. The service puts a high level of importance on training and in discussions with staff they told us that they are supported through training to meet the needs of the residents in a person centred way. Some staff told us that they had received training in caring for people living with dementia as well as in palliative care, infection control, moving and handling, safeguarding and food hygiene. All care staff have been trained in basic first aid and dealing with emergencies. Training records also indicated that 100 of staff have been trained to NVQ level 2 and some are doing the NVQ level 3. However, it is important that all staff receive training in the implications of the Mental Capacity Act 2005, and plans are in place for this to be undertaken in the future. As well as having the training, it is important that daily on the job supervisions ensure that staff put into practice the training which they have undertaken. This is particularly Care Homes for Older People Page 22 of 31 Evidence: relevant to the use of protective gloves and some areas of dementia care. In discussions with some staff they were not able to demonstrate a clear understanding as to why they were using such protective clothing in certain circumstances. Also as previously stated it is not important if a resident dresses incorrectly such as putting a jumper on back to front, if addressing this issue causes distress to the individual. We looked at some staff records and are confident that staff recruitment processes are robust. Supervisions on a 1;1 basis, group or staff meetings are undertaken on a regular basis with the necessary records being maintained. Staff have job descriptions with clearly defined roles and responsibilities. The staff team have been made up with staff from other services (within the organisation) that have now closed. Some staff did tell us that they have found the move from caring for frail elderly people to caring for people living with dementia quite challenging. However, with support from management, other staff and training they are now finding the work rewarding. We were also told that the staff are now gelling more as a team which is to the benefit of the residents. Care Homes for Older People Page 23 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. Evidence: The manager has the required qualifications and experience and is competent to run the home. He is aware of the organisations strategic and financial planning systems and the business plan for the home links into these. The manager has previously been registered with the Commission as the manager of another home, but is still awaiting the completion of the registration process for this service. The manager was able to demonstrate a clear understanding of the key principles and focus of the service, and works continuously to improve services. Residents enjoy an improved quality of life and there is a strong focus on equality and diversity issues and the promotion of human rights, especially in the areas of dignity, respect and fairness. There is also a strong focus on person centred thinking with residents at the heart of the service. Care Homes for Older People Page 24 of 31 Evidence: There is a strong ethos of being open and transparent in all areas of running of the home, and this was confirmed in discussions with both staff and relatives. One relative told us Chris is wonderful, he or his staff are always ready to listen and they give us great support in often difficult times, especially when Mum is behaving oddly. I couldnt find a better home for my mum. The manager demonstrated a good understanding and awareness of equal opportunity issues, good people skills, Strong leadership of staff and a responsive approach to the needs of the residents. The manager is very aware of the areas which require improvement or further development and is very aware of current developments in the care of people living with dementia, both locally, nationally and by the Care Quality Commission. He is working hard at the moment to ensure that there is support for the relatives of people living with dementia by the involvement of Admiral nurses and people from the Alzheimers Society within the home. Training is given a high profile within the service, and this was confirmed in looking at training records and in discussions with staff. Various audits systems are in place and these are supported by the quality assurance systems of the larger organisation. We were told that the manager is an excellent role model who is an effective leader. All staff receive supervision on a regular basis and this includes 1:1, on the job, group and team meetings. Staff have practice handbooks and practice and performance are discussed during supervision, staff training and team meetings. The service has appropriate, effective and regular support from the organisation and there are clear lines of accountability. The home has effective systems to ensure the safeguarding and management of residents money and valuables. Records are kept securely and staff are aware of the requirements of the Data Protection Act. All working practices in the home are safe and the home has a comprehensive range of policies and procedures to promote and protect residents and employees health and safety. Staff are trained, understand and follow these policies and procedures. There is written recording of all safety checks and accidents, including analysis, and the home complies with statutory reporting requirements and other relevant legislation. Care Homes for Older People Page 25 of 31 Evidence: The manager, senior team and staff have a good understanding of risk assessment processes which is underpinned by the promotion of independence and choice. There have not been any referrals under the deprivation of liberty safeguards. Care Homes for Older People Page 26 of 31 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 27 of 31 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 7 12 The registered person must 31/07/2009 undertake a risk assessment for all residents around the ability to use the emergency call alarm system in his/her bedroom. Residents should be able to summon assistant in the event of an emergency. Systems in place must be appropriate to meet the needs of the individual resident and may involve the use of assistive technology. 2 7 15 The registered person must ensure that the care plans include night care and end of life needs. Also clear care plans around specific health needs such as diabetes. This will ensure that all residents receive the right care in relation to a specific need, at night and at the 31/07/2009 Care Homes for Older People Page 28 of 31 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 end of their lives, and also that care staff will be aware of these needs. 3 9 13 The registered person must 30/06/2009 ensure that protocols are in place for the administration of PRN (as required) medication. Also that the administration of prescribed creams, lotions, ointments are recorded on the MAR sheets. Also that the actual dosage or number of tablets is recorded where this is discretionary, such as 1 or 2 tablets, 5ml or 10 ml. This will ensure that residents will be given the medication according to their needs, and that staff are aware of when to administer such medication. 4 30 18 The registered person must 31/08/2009 ensure that all staff receive training appropriate to the work they are to perform. This refers particularly to the Mental Capacity Act 2005. In order to ensure that the rights of residents are maintained staff must be aware of the implications of the Mental Capacity Act 2005. Care Homes for Older People Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 That two signatures be obtained when writing medications onto MAR (medication administration records), that the source of instructions to increase, decrease or stop medication is recorded together with the date. Care Homes for Older People Page 30 of 31 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. 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