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Inspection on 27/05/10 for Ladydale Residential Home

Also see our care home review for Ladydale Residential Home for more information

This is the latest available inspection report for this service, carried out on 27th May 2010.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People using the service were happy with the meals provided, and told us that they were satisfied with the care and support that they received from staff. Staffing levels had been maintained, to include extra staff for some activities and or outings. Staff spoken with were knowledgeable about the individuals they cared for, and were sensitive to the needs of the people using the service. Staff supervision and staff training is a high priority.

What has improved since the last inspection?

Three requirements in regard to the administration of medication, made following our previous key inspection visit have since been met. We confirmed that daily and weekly audits of medication continue to be maintained by the staff, the deputy manager and care manager. Written Protocols were in place for all as required medication (PRN). Thus ensuring the health, safety and welfare of the people using the service. Policies and Procedures in relation to medication were also in place. The Annual Quality Assurance Assessment (AQAA) document completed by the care manager told us about the following improvements made: Hairdresser room refurbished. New water shower system. New chairs. Decoration and furnishings. One member of staff had been given responsibility for training of staff for Manual Handling, Fire Marshalls, Health and Safety Coordinators, staff are about to be trained in infection control. The home is decorated throughout to a good standard.

What the care home could do better:

Individual risk assessments should be clear, concise and up to date. Bathrooms on the middle and top floor should be refurbished to improve the facilities for the people using the service. Consideration should be given in regard to installing appropriate and adequate shelving in individual bathrooms. Staff rota should be uniformly presented, clear and concise, and should contain information relating to the staff role, any changes made to the rota should be included and up to date. Staff training should include dementia care, Mental Capacity Act 2008 and Deprivation of Liberty Guidelines (DOLs).

Key inspection report Care homes for older people Name: Address: Ladydale Residential Home 9 Fynney Street Leek Staffordshire ST13 5LF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Pam Grace     Date: 2 7 0 5 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 28 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 28 Information about the care home Name of care home: Address: Ladydale Residential Home 9 Fynney Street Leek Staffordshire ST13 5LF 01538386442 01538385158 ladydale@arc-homes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Aegis Residential Care Homes Limited Name of registered manager (if applicable) MS Deborah Karen Johnson Type of registration: Number of places registered: care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 54 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 (OP) 54 Mental Disorder, excluding learning disability or dementia (MD) 10 Learning disability (LD) 3 Physical disability (54) Date of last inspection Care Homes for Older People 1 2 1 1 2 0 0 9 3 10 0 54 Over 65 0 0 54 0 Page 4 of 28 Brief description of the care home Ladydale Residential Home is situated in a quiet, mature residential area in the historic market town of Leek. It is a well-established care home for the elderly that provides accommodation for up to fifty-four people. The main house has four floors. The majority of bedrooms are situated on the ground and first floors. A shaft lift and stair chair lift provide easy access to various levels in the home. The newer single-storey wing accommodates ten people and has its own communal lounge/dining area. Ladydale also has two small annexes, The Coach House with three semi-independent units and The Lodge with two semi-independent units. People who use the service are able to access all areas of the home as they choose. Ladydale is attractively decorated and furnished throughout to a high standard. Fifty of the bedrooms are single, two are double and 45 have en-suite facilities. Assisted bathing and shower facilities are situated throughout. The home has ample communal lounge and dining space. There are off-road parking facilities and attractive mature gardens surrounding the property with a very pleasant secluded patio area with seating. There is a comprehensive activities programme for people who use the service to access as and when they wish. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The overall quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This key unannounced inspection was carried out over one day, by one inspector. The inspection had been planned using information gathered from the Care Quality Commission (CQC) database, the Annual Quality Assurance Assessment (AQAA) document that had been completed by the registered care manager, and comments or surveys received from people who use the service and or their relatives. The key National Minimum Standards for Older People were identified for this inspection and the methods in which the information was gained for this report included case tracking, general observations, document reading, speaking with staff, people who use the service and their relatives. Observation of the environment was Care Homes for Older People Page 6 of 28 also undertaken. At the end of our inspection feedback was given to the registered care manager, and deputy manager, outlining the overall findings of the inspection, and giving information about the requirements and recommendations that we would make. People spoken with were mostly very positive about the care they were receiving. We observed people who were unable to communicate. Our observations showed that these people were well cared for, and were happy in their surroundings. There had been no complaints made to the home, since the previous inspection. Complaints would be dealt with in a timely way under the homes complaints procedure, by the care manager. One referral had been made to Social Services under the Safeguarding and Protection of Vulnerable Adults Protocol. Surveys previously returned to the Care Quality Commission (CQC) totalled five Have Your Say documents. These have contributed towards this report. There were no requirements, and five recommendations made as a result of this unannounced inspection. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Individual risk assessments should be clear, concise and up to date. Bathrooms on the middle and top floor should be refurbished to improve the facilities for the people using the service. Consideration should be given in regard to installing appropriate and adequate shelving in individual bathrooms. Staff rota should be uniformly presented, clear and concise, and should contain information relating to the staff role, any changes made to the rota should be included and up to date. Staff training should include dementia care, Mental Capacity Act 2008 and Deprivation of Liberty Guidelines (DOLs). Care Homes for Older People Page 8 of 28 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 28 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 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service provides information so that people are able to make an informed choice about whether the home is suitable for them. No person moves into the home without having their needs assessed. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us that people wishing to visit and use the service are made welcome at the home, people can bring in their own personal possessions, and there is involvement with relatives and representatives throughout this process. Respite care is also available, subject to assessment. No requirements were made in this outcome group in the last inspection report. People told us that they received information about the care home prior to moving in. We saw a copy of the Statement of Purpose and Service User Guide displayed on the Care Homes for Older People Page 11 of 28 Evidence: Notice Board in the front entrance hall of the home. We were told that the Statement of Purpose had been reviewed for this year, and that necessary amendments were made immediately following the prevous inspection. The document was available for us to view. Literature and documentation provided by the care home gives clear and unambiguous information about the service and its proprietors. The home consists of the main house together with a single storey extension known as the new wing, and semi independent accommodation in the grounds, known as The Coach House and The Lodge. The home was fully occupied on the day of our visit with fifty two people in residence. Where possible, people are invited to sample the service by visiting the home prior to admission. Decisions about permanent admission to the home are not made until the person has been in residence for some four weeks to enable everyone to consider whether Ladydale is suitable for their needs. A key worker care assistant is allocated to each person. The key worker is responsible for a small group of people who use the service. The key worker is responsible for ensuring daily records for her group are up to date. A senior care worker is also deployed on each shift. The Statement of Purpose for the home tells us prior to agreeing the admission of a potential resident the Care Manager will visit the person at home or in hospital unless the person prefers to visit the home and is able to do so. We looked at three care plan records for people using the service. Care plans seen included assessments completed by social workers and or a representative of the care home. This ensures that peoples needs are fully assessed, and determines whether the service can meet their needs prior to admission. Ladydale does not provide intermediate care. Therefore Standard 6 Intermediate Care does not apply. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Medication systems ensure the health, safety and welfare of the people using the service. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us that the home encourages individuals to be independent, and that personal care is maintained to a high standard. People using the service have access to health services including their General Practitioner, District Nurse, Optician, Dentist, Chiropodist. Individuals unable to go to the surgery are visited in the home. We looked at care plan records for three people using the service. These were all satisfactory, with sufficient information generated from the needs assessment to clearly inform and enable staff to meet their individual care needs. We found that each person is weighed at point of admission, and records seen told us Care Homes for Older People Page 13 of 28 Evidence: that this is being carried out thereafter on a monthly basis. Weight loss or gain would be noted and reported, with appropriate actions taken by senior staff. For example referral to the General Practitioner or Dietician. Records seen were clear and informative and were reviewed every month. However, risk assessments were not always appropriately written, and were sometimes taken out of context. We highlighted and discussed this with the care manager, further training for staff in regard to risk assessment was recommended. We spoke with the people using the service. They told us that they were happy at the home, the food is good, and there is plenty of it, we like it here, and we are comfortable with this place. People also told us that care staff are caring, sensitive and respectful. Surveys received told us that people receive the care and support they need. Comments received included, my relative is very happy at Ladydale, the staff have always been very friendly and helpful, we try to visit once or twice a week and sometimes we are able to have a meal with her.The staff are very caring and considerate, could not be bettered.Nice food, resident involvement in activities. We undertook a spot check of medication systems at the home. There were no errors found. Controlled medication had been audited on the day of our visit and showed no anomalies. We saw that ear and eye drops were appropriately dated and temperature controlled. An appropriate and safe system is in place for the ordering, checking, administering and return of medication, showing a clear auditable trail. We confirmed that daily and weekly audits continue to be maintained by the staff, the deputy manager and care manager. Written Protocols were in place for all as required medication. Thus ensuring the health, safety and welfare of the people using the service. Policies and Procedures in relation to medication were in place, staff told us that they had received appropriate training and induction, and that they had recently changed over to a Monitored Dosage System (MDS), training had been given to staff by a health professional, and the local Pharmacist, ensuring correct procedures. We discussed competency assessments for staff, the care manager is in the process of planning and implementing this for all staff responsible for the administration of medication. The home had liaised with the local General Practitioners to ensure that the prescription labels on all medicines were explicit and easily understood. A Random Medication inspection visit had been made by the Care Quality Commission (CQC) to ensure that previous Requirements had been met. This was undertaken following the previous key inspection visit, and a follow up visit was then made in December 2009, the visit confirmed that those Requirements had been met. Care Homes for Older People Page 14 of 28 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 who use services are able to make choices about their life style, and are supported to develop their life skills. Social, cultural and recreational activities meet individual expectations. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us that people who have special diets are catered for, and individual weights are recorded and monitored monthly. A Dietician referral would be made if needed. There is a varied menu with fresh food daily. Drinks and snacks are available throughout the day. Varied activities are available, provided by in house and external entertainers and staff. The Library service provides talking books and reminiscence boxes. Meetings for people using the service are held regularly. Church services are available for Church of England and Catholic denominations. No requirements were made in this outcome area in the last inspection report. Staff spoken with were aware of the need to support people who use the service, to develop their skills including social emotional, communication and independent living skills. Care Homes for Older People Page 15 of 28 Evidence: There is a varied Activities Programme in place to provide enjoyment and stimulation. Copies of the Activities Programme are displayed in the home. The service issues a bimonthly Newsletter which outlines activities and planned outings. The newsletter is also sent out to relatives. We were given a copy of the homes activities programme for the month. Activities included Bingo, hairdressing, pop mobility, what the papers say, dominoes and card games, musical movements, cake decorating, flower arranging, film shows, trips out. The home had employed an extra Activities Co-ordinator since the last key inspection so that there are now two Activities Co-ordinators. One works twice a week for two hours on a one-to-one basis with people who use the service and will take people out of the home on various visits and shopping. The second Co-ordinator works for two hours on Tuesday and Friday and will take the lead on board games, providing a trolley shop, arranging entertainers and other in-house activities. We observed people moving freely around the home. The majority of people who presently use the service spend the morning in their bedrooms also having their breakfast there, and then have lunch in the dining room. Other people choose to have breakfast in the communal dining room. People we spoke with confirmed that the daily routines in the home were relaxed, flexible and varied to meet individual choice. We observed staff practices which promoted individual rights and choices, for example asking permission before moving people, giving people choices of meals and drinks, knocking on bedroom and bathroom doors. We noted that the wishes of people who do not want to take part in activities is also respected. One person told us that they preferred to spend all their time in their own room but had left their bedroom door open so that they could see people passing by. The home offers a four-weekly rotational menu which contains fresh meat and vegetables. The majority of cakes are cooked in house and everyones birthday is honoured with a Birthday Buffet that includes a birthday cake. The cook attends Residents Meetings as food is often an agenda item so that she can respond to individual food choices. Fresh fruit salad is offered every afternoon. At the previous inspection visit we discussed with the manager the possibility of allocating a tea making area for staff to reduce the numbers of people entering the kitchen environment and thereby reducing the risk of cross-contamination. This recommendation had been met, and staff can now make tea in the new wing area. Care Homes for Older People Page 16 of 28 Evidence: We were told that the home had received five stars from the Environmental Health Officer visit a week prior to our visit, and that this had been a celebrated achievement. The kitchen and laundry areas were clean and hygienic. Menus were set out on tables, and there were tablecloths and napkins used, ensuring a homely and comfortable feeling to the home. People said the quality of the food was always good, and that they enjoyed each others company in the dining areas. We observed people interacting, and enjoying their meals in the dining areas. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us, We have a clear and accessible complaints procedure, there is a copy of this in our brochure, which is given to anyone who views the home. We have a set of policies and procedures in place that are reviewed annually, these include Safeguarding. Abuse training is included in our induction of new members of staff. We found that details about the homes complaints procedure are contained in the Service User Guide. The complaints procedure is also displayed in the home. Staff and people we spoke with said they knew about the complaints procedure, and how to complain. People told us that they felt confident that any complaints they raised would be dealt with promptly. The AQAA told us that no formal complaints have been raised with the home since the last inspection. We were notified of one safeguarding referral, appropriately referred to the Local Authority Safeguarding Team for investigation. Care Homes for Older People Page 18 of 28 Evidence: The care manager is aware of the protocols and procedures in respect of Safeguarding Adults from Abuse. We were told that Safeguarding and Mental Capacity Act Training for staff is already planned for. The home has an open culture that allows people using the service to express their concerns in a safe and understanding environment. People told us they were happy with the service provided and feel safe and well supported. There is a clear system for staff to report concerns about colleagues and managers. Staff have access to whistle blowing polices and procedures at the start of their employment. Care Homes for Older People Page 19 of 28 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 location and layout of the home is suitable for the needs of the people who use the service. The home is attractively decorated, clean and hygienic. Refurbishment and redecoration of the middle and top floor bathrooms would greatly improve facilities for people who use the service and provide a more pleasant and relaxing environment. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager confirmed that necessary servicing and maintenance had been undertaken. The home is well maintained, they kept records of necessary maintenance and servicing. The grounds were safe for people to use, and there were comfortable and homely dining areas, and two lounges with televisions for people to use. Most rooms had ensuite facilities or had a toilet nearby. There was a lift, stairlift, hoist and also wheelchair accessibility for people using the service. A call system was in place, which was also linked to the outside of the building. We observed that the laundry and kitchen areas were kept clean, and that appropriate uniform and protective clothing was used by staff working in those areas. Staff spoken with confirmed that they had received training in relation to the Control of Substances Hazardous to Health (COSHH), and for Food Hygiene. The cook confirmed that they Care Homes for Older People Page 20 of 28 Evidence: had received a five star rating for the kitchen, from the Environmental Health Officers recent visit. We viewed six individual bedrooms, which were clean and tidy, and were personalised. Shelving was needed in some bathrooms seen, this was subsequently highlighted and discussed with the care manager. A previous recommendation was that bathrooms needed to be refurbished, we saw that two of the three bathrooms previously noted had yet to be done, these were situated on the middle and top floors of the home. This was subsequently highlighted and discussed with the care manager. We were told that this work would be done as soon as possible. Refurbishment work had been completed on the downstairs bathroom and hairdressing room. People we spoke with and surveys received confirmed that the home is always fresh and clean, and that bedrooms can be personalised with some of their own furniture if they wish. Care Homes for Older People Page 21 of 28 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. The service provides sufficient skilled and experienced staff to meet the needs of people who use the service. Robust recruitment procedures and Induction Training protect the people who use the service. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us that National Vocational Qualifications (NVQ) level 2 or 3 training for staff is ongoing. We have a high ratio of NVQ trained staff in levels 2 and 3. Care manager has level 4 and RMA. Trained bank staff to cover shifts. extra staff, for example, one to cover activities, staff to cover outings, to help with appointments etc. Staff are appointed and given Code of Conduct, Staff Handbook, Terms and Conditions. One member of staff responsible for training of staff for Manual Handling, Fire Marshalls, Health and Safety Coordinators, about to train staff in infection control. Staff recruitment records seen, evidenced that a robust system of recruitment is in place for new staff. Care Homes for Older People Page 22 of 28 Evidence: The staff rota for weeks beginning 24th May and 31st May 2010 evidenced that staffing levels had been maintained. However, the rota needed clarification, we subsequently highighted and discussed this with the care manager, and we recommended that the format used should be more uniformly and clearly completed, to include the role of the person named, and that any changes to the rota are included and kept up to date. The records showed a thorough induction training that focused on key policies and procedures, and which staff have signed. Ongoing update training had taken place in a range of subjects. However, we found that some staff had not received dementia care, or Mental Capacity Act, Deprivation of Liberty guidance training. This was highlighted and discussed with the care manager. We were told that this training has been planned for. We found that regular supervision of care assistants and seniors is carried out by the deputy manager and the care manager, this is well documented and recorded. Staff spoken with and surveys received confirmed that staff received the training they needed to do their job. Staff told us that managers are approachable and supportive. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed by a qualified and experienced manager. There are clear lines of accountability throughout. The best interests of people who use the service are promoted by staff at all levels. Evidence: The Annual Quality Assurance Assessment (AQAA) completed by the care manager told us Seminars are attended to gain up to date knowledge. Reg 26 visits carried out monthly by Regional Manager. Policies and Procedures are regularly updated. Residents, families, representatives, control income and personal monies are held on request and is well documented, and kept in individual wallets. Maintenance is carried out by professional bodies and services at correct time set. Audits are completed in the home. The company has access to legal advice if required. The health and safety of residents, visitors and staff are protected and views are listened to. Care Homes for Older People Page 24 of 28 Evidence: The manager has the required qualifications and experience to run the home. There is a strong ethos of being open and transparent in all areas of the running of the home. The care manager completed the AQAA, which is a legal document, and returned it to us in the timescales given. The AQAA gives us an adequate picture of the current situation within the service, although there were areas that could have provided us with more information to illustrate what the service intends to do in the next year, for example improvements that are planned for. We noted that staff training in medication, the change over to the Monitored Dosage System (MDS), the monitoring procedures in place for medication administered in the home, have all greatly improved, and are ensuring the health, safety and welfare of the people using the service. The AQAA told us that the service has policies and procedures in place and that these are reviewed. However, the dates for those reviews were not included in the information we were given. The service has an Administrator who has input into the homes recruitment procedure, ensuring that new staff have appropriate checks in place and that all documents are full and accurate. We looked at three recruitment files for staff, these evidenced that the home has a robust and safe procedure in place for new staff. There had been no complaints received, and one Safeguarding referral made since the previous inspection. We saw quality assurance surveys that had been returned to the service. These were in the process of being collated and the information used to improve the service. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 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 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 2 7 19 Individual risk assessments should be clear, concise and up to date. Bathrooms on the middle and top floor should be refurbished to improve the facilities for the people using the service. Consideration should be given in regard to installing appropriate and adequate shelving in individual bathrooms. Staff training should include dementia care, Mental Capacity Act 2008 and Deprivation of Liberty Guidelines (DOLs). Staff rota should be uniformly presented, clear and concise, and should contain information relating to the staff role, any changes to the rota should be included. 3 4 19 30 5 37 Care Homes for Older People Page 27 of 28 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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