Inspection on 05/05/10 for Laurels Nursing Care Centre

This is the latest available inspection report for this service, carried out on 5th 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.

Other inspections for this house

Laurels Nursing Care Centre 11/08/08

Laurels Nursing Care Centre 13/06/07

Laurels Nursing Care Centre 11/07/06

Laurels Nursing Care Centre 11/01/06

Laurels Nursing Care Centre 12/07/05

Laurels Nursing Care Centre 11/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for older people Name: Address: Laurels Nursing Care Centre 70 Union Road The Laurels Clapham London SW4 6JT     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: Sonia McKay     Date: 0 5 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 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: Laurels Nursing Care Centre 70 Union Road The Laurels Clapham London SW4 6JT 02074987500 02074989833 laurelscare@yahoo.co.uk www.laurelscare.org.uk The Laurels Care Centre Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Urvasee Shersing Type of registration: Number of places registered: care home 68 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia physical disability Additional conditions: up to 21 frail, elderly patients aged 55 years and above up to 47 patients aged 55 years and above with dementia Date of last inspection Brief description of the care home The Laurels is a purpose built private nursing home for older people, some of whom may have a physical disability or mental health need. The home has three floors with the categories of need being grouped separately on each floor. The ground floor supports elderly people who may have a physical disability. The first and second floors support people with dementia or mental health needs. The home is located in a residential street in Clapham with good links to bus and underground train services. There is a small parade of shops within short walking distance of the home, with larger Care Homes for Older People Page 4 of 32 Over 65 0 0 0 0 Brief description of the care home shops and supermarkets available in Stockwell and Clapham. Fees range from GBP600.00 to GBP800.00 per week and depend on individual needs. Prospective residents are given a copy of the service user s guide as part of the pre-admission process. A copy of the most recent Commission inspection report is available in the main reception area. 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: 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: This inspection was carried out by two inspectors over two days. The methods used to assess the quality of service being provided were as follows. Looking at information sent to us by the home manager in the homes Annual Quality Assurance Audit, this document is sometimes called an AQAA and it provides the Commission with information about the service and staffing. A tour of the premises. Sending surveys to residents, relatives, staff and health professionals involved in the care of the residents at the home. Looking at the notifications that the service has sent to us since the last inspection and looking at the outcomes of any safeguarding investigations. Care Homes for Older People Page 6 of 32 Talking with managers, staff, residents, their visitors and a visiting health professional. Looking at records about care planned and given, medication administration and staffing. Looking at records of various meetings held in the home for example, staff meetings, residents meetings and relatives meetings. Observing how people are cared for and how they spend their day to day lives in the home. The Care Quality Commission would like to thank all those who contributed their time , views and experiences of the service to this inspection process. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? Pre-admission assessment is thorough and prospective residents are sent a letter confirming the outcome of the homes assessment of their needs and whether the home can meet these needs. Care planning is improving and plans are in place for health, social care and personal needs for each resident. Greater emphasis is placed on providing staff with person centred information and recognising and meeting the diverse cultural needs of those living in the home. The catering department are working closely with a community dietitian to improve the taste and nutrition of the meals served, for example making fresh creamy milkshakes instead of relying on cartons of liquid meal meal supplements. Health care needs are monitored properly and fully met and residents are treated with respect. Their right to privacy is upheld. Medication is administered, stored and disposed of safely. Residents and relatives can be assured that their concerns and complaints will be properly investigated and steps are taken to safeguard the vulnerable people living in Care Homes for Older People Page 8 of 32 this service. Odour control has improved in some areas of the home where there had been problems with water drainage and no unpleasant odours were noted during this inspection. 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. Pre-admission assessment is thorough and prospective residents are sent a letter confirming the outcome of the homes assessment of their needs and whether the home can meet these needs. Evidence: As required in the previous inspection report, prospective residents are now sent a letter confirming the outcome of the homes pre- admission assessment of their needs and whether the home can meet those needs. The manager said that copies of the letters sent are retained by the home and we looked at copies of the letters sent to two people who were admitted recently. The service does not provide intermediate care so standard six is not applicable. A resident had just moved in and her family were visiting. Her daughter said that they had visited the service before moving their mother in and the staff were very Care Homes for Older People Page 11 of 32 Evidence: welcoming. The admission was going well. Staff had demonstrated an understanding of how traumatic moving into care home can be and had made the process as stress free as possible. They were working closely with the resident and family to develop the care plans since admission. An inventory of possessions was in place and was being updated as new items were brought into the home. We looked at three pre-admission assessments. All were sufficiently detailed and gave a good picture of the persons support needs, including medical conditions, medication profile and social care needs like culture, communication and activities enjoyed. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning is improving and plans are in place for health, social care and personal needs for each resident. Health care needs are fully met and residents are treated with respect. Their right to privacy is upheld. Medication is administered, stored and disposed of safely. Evidence: Care plans contain sufficient information to enable staff to provide consistent support with personal care and individual preferences and routines are recorded. Residents were observed to be dressed appropriately and in styles of their choosing. The homes GP visits twice each week and he completed a survey before the inspection. He considers that the home does well by making great effort to provide care for highly at risk old folk in a difficult climate. He confirms that the services care assessment arrangements always ensures that accurate information is gathered and that the right service is planned for people. That their health care needs are properly monitored, reviewed and met. That care staff seek advice and act on it and they handle medication correctly. Privacy and dignity is always respected and residents are Care Homes for Older People Page 13 of 32 Evidence: supported to live the life of their choosing wherever possible. The service responds to a diversity of need and people and staff are appropriately skilled and experienced. If a concern is raised it is always dealt with appropriately. A community dietitian visits the service regularly and she completed a survey before the inspection. This feedback confirms that the service always seeks advise about peoples health care needs, always respects peoples privacy and dignity and always responds appropriately to a diversity of individual needs. The dietitian was visiting residents on the day of the inspection and she confirmed that the service works well with her and had facilitated a meeting with the Chef so that good nutrition could be discussed. The Chef said a follow up meeting had been arranged so that they could review the outcomes of the actions being implemented. At the last inspection we issued a requirement to better preserve peoples privacy and dignity by removing personal care information from a wall in one of the bedrooms. This has been done and we did not see any other personal information displayed during a tour of the premises. The requirement is therefore met. At the last inspection we issued a requirement because we found that blood monitoring was not being done with the correct frequency for some residents with diabetes who are insulin dependent. At this inspection we note that these checks are now being done in accordance with the planned frequency schedules so this requirement is met. We received five surveys from residents or their carers. A relative confirmed that the family are given enough information by the home, that their relatives needs are always met and that the care provided is as agreed. They are usually kept up to date with important issues and staff usually have the right skills and experience to look after people properly. We received feedback from the local team of health professionals who support nursing homes in the borough. They confirmed that the home makes timely and appropriate referrals and that pressure relieving equipment, to prevent pressure sores, is put in place when needed. They said that the home is slowly progressing toward accreditation for good end of life care. Records we saw during this inspection show that staff take swift action when they notice any areas of reddened skin to try and prevent pressure sores from developing. Care Homes for Older People Page 14 of 32 Evidence: Comments we received in surveys from residents and relatives include the following statements. They try to get me better and the staff are very nice and help me a lot. I would like to say thank you very much. There are no problems living here. Everything has been OK and I am happy. I have been in the Laurels for a long time but I will say I have had very good treatment. At times its excellent but it is up to the staff! The staff are A1 to me as they are a great lot of girls. We have very nice folk come here to entertain us and I amuse myself with my books to keep my brain working. Relatives spoke of regularly coming to the home and one said that staff are helpful and cannot do enough for the people living in the home. Another couple spoke of the confidence they had in the staff team and said that their relative was quite confused when she came to the home to live, however staff quickly reassured her and she has settled and less stressed since she was admitted. Privacy and dignity is promoted. This area is covered during induction, also how to treat residents. Records of workplace observations confirm that new staff are assessed on communicating with people with dementia and giving personal care. A selection of eight care plans were looked at and these were for residents on all three floors. We found that the care plans had improved and a new format had been introduced and this has helped. We saw that care plans were reviewed regularly and revised and new ones written as new issues arise and this is done promptly. For example, one of the residents had day surgery for an eye condition and a care plan for aftercare was put in place when she came back from the hospital. As the plans have just been introduced and developed they are at different stages of completion in terms of obtaining signatures of agreement from residents and relatives. The quality and range of areas covered in planning information has improved since the last inspection and this provides staff with more person centred information on which to base their care. The area manager recognises the valuable contribution and knowledge that care assistants have in the area of personalised care and their input in planning is encouraged. The home manager regular reads and audits each set of plans and advises staff of areas requiring clarification or additional information and this is helping nurses to develop their care planning skills. Care Homes for Older People Page 15 of 32 Evidence: We looked at how medication is being handled on the top floor of the home. Medication administration records show that medication is being administered correctly and appropriate records kept. As recommended at the previous inspection, procedures are in place for controlled drugs to be denatured before disposal and medication policy folders have been checked on each floor to make sure that each floor has the most up to date policy available. The home manager confirmed that nurses now sign and date the medication administration record when any changes are made, for example, after telephone advice from the GP. We made a requirement at the last inspection as a modified release tablet was being crushed before administration. The home manager said they had checked with the GP and pharmacist and a liquid form of the medication is prescribed instead so the requirement is met. Care Homes for Older People Page 16 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. Residents are able to maintain contact with their family and Friends. There are an increasing range of things to do in the home and community visits and outings are also arranged. Cultural and individual preferences and needs are taken into consideration in menu planning and the food is of a high standard and is served in pleasant and relaxed surroundings. Evidence: There are two activities coordinators and activities are provided every day of the week. On the day of the inspection we observed that the ground floor lounge has being used to display art work and photographs of the residents. A documentary had been made and residents were getting their first viewing. Residents of the first floor have a large well lit lounge and a smaller side lounge. We observed residents to be spending time in the lounge, engaged with their visitors, reading newspapers and magazines, looking at photographs and relaxing in chairs. Comments received include the following statement. We have very nice folk come here to entertain us and I amuse myself with my books Care Homes for Older People Page 17 of 32 Evidence: to keep my brain working. We met residents and visitors during the inspection. One of the visitors had spent time in the home on respite and was visiting friends she had made. She said that she had a positive experience, and the environment is friendly and all staff are welcoming and caring. She said she would have no problem if she moved there permanently as it is a lovely place to live. The Annual Quality Assurance Audit, sometimes called an AQAA, provides us with detailed information about how activities are organised. t says that the home employs full time activities coordinators who are responsible for social activities. Carers also take part in implementing activities set by the coordinator. Residents are given the choice to participate in activities of their choice, either in groups or on a one to one basis. The manager says that they like to get feedback about the activities so that they can adapt and improve the quality of the residents lives. The manager says that residents receive visitors in the privacy of their rooms or in communal areas. Visiting hours are open although visits are encouraged after late morning to allow residents to attend to their personal needs. Visitors from the local church are organised to take residents to the local shops. There is pet therapy on a weekly basis and really enjoy this activity. The AQAA says that residents are encouraged to bring in small items to personalise their rooms They are informed of the use of advocates who will act in their interests and have a choice of menus including European, Asian and vegetarian. Soft and liquidised meals are also available to suit individual needs and tea, coffee, biscuits and cold drinks are available at all times. The chef is always informed of any changes following a dietitian referral and given a copy of the recommendations they make. Residents are encouraged and supported to visit a local community centre and a mobile library service visits the home. We observed staff preparing for lunch on the ground floor, as recommended at the last inspection daily menus are now on the table rather than on the wall and this makes it easier for the residents to see the choices available. The resident group reflects the cultural diversity of the local community, as does the staff team. A nurse explained that this is taken into consideration when planning who will work with a resident and a degree of matching takes place so that residents can be supported by staff from a similar culture if they wish. We observed that menu options for people from Africa and the Caribbean are also available on a regular basis. Care Homes for Older People Page 18 of 32 Evidence: We sampled the lunch and it was of high quality and observed staff assisting residents with eating and drinking and this was done respectfully and patiently. A resident said she enjoyed having tea and biscuits. Residents are encouraged to provide feedback about the meals in residents meetings and changes are made as a result of their request. The second day of the inspection was election day and residents were being supported to go and vote if they wished. All residents are added to the electoral role when they move into the home and posters of local candidates, who had visited the home, are on the wall in a communal lounge. We saw records of a recent residents meeting and this showed that residents are asked about the activities and whether they are enjoyed. Care Homes for Older People Page 19 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and relatives can be assured that their concerns and complaints will be properly investigated and steps are taken to safeguard the vulnerable people living in this service. Evidence: Four staff completed surveys and all four confirmed that they knew what to do if someone raises a concern about the home. We looked at the records of complaints that the manager maintains and this shows that concerns and complaints are investigated properly and complainants are given feedback about the outcome of their complaint. We looked a copy of the minutes of a recent residents meeting and noted that when a resident had raised a verbal concern as she could not find an item of clothing this had been followed up quickly in a staff meeting and the matter resolved. The home manager and staff have access to a copy of the local authority safeguarding procedures and most staff are trained. Further training is planned this month and the manager said that when this training is completed all staff will have been trained about safeguarding. There was evidence during our case tracking that residents are closely monitored, and Care Homes for Older People Page 20 of 32 Evidence: that prompt action is taken when changes take place. For example a resident developed bruises on her hands. She was seen by the GP who reviewed the prescribing of aspirin for the person. There have been three safeguarding investigations since the last inspection. The findings of these investigations show that the allegations were not substantiated or, in one instance, were inconclusive. The service has worked with external professionals to address any issues raised and none of the staff have been referred to the list of people who should not be allowed to work with vulnerable people. Throughout the inspection we observed that staff took care to monitor and safeguard residents and managers raise issues with health providers when they consider that residents have not received adequate medical care in hospital. We examined how residents money is looked after and records show that there are adequate safeguards in place. The records are audited by the company accountant on a regular basis and the area manager conducts random spot checks during her monthly inspection visits. Care Homes for Older People Page 21 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. The purpose built home is comfortable and clean and hygienic. Residents have their own bedrooms which they are helped and encouraged to personalise if they wish. Refurbishment is ongoing and this has improved the environment since the last inspection. Evidence: The home is purpose built and provides residents with accommodation over three floors. The ground floor rooms surround a small courtyard garden. Outdoor space is limited. Each floor has at least one communal lounge. The ground and first floor have large lounges and the second floor has two smaller lounges. Meals are served in the communal lounges. There are sixty two bedrooms and they are all single occupancy. The ground floor accommodates people who are frail and elderly and the first and second floors are for people with dementia. Access to the lift and in between floors is controlled by electronic keypad to prevent vulnerable people from wandering. A refurbishment programme is ongoing and the building looks bright and airy with good ventilation and light colours. Hallway carpets have been replaced and the walls Care Homes for Older People Page 22 of 32 Evidence: redecorated. Bathroom and toilet doors have been painted red so that these rooms are more easily identifiable. Bedrooms seen were personalised and cosy. As required in the last inspection report en suite drainage to two bathrooms has been repaired and there is now no unpleasant odour. We recommended that the service review the laundry facilities as they are small. However, no alternative space is available. There are maintenance and cleaning staff. The maintenance staff are available to regulate the temperature of the building as residents cannot control their room temperatures. The manager said that staff have also been shown how to regulate the room temperatures in case maintenance staff are not on duty. There are sufficient fans available for use in warm weather. At the last inspection we noted that some of the waste bins did not have lids. They have all been replaced and this provides better infection control. Care Homes for Older People Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs are met by the numbers and skills mix of staff. Residents are supported and protected by the homes recruitment policy and practices, although more should be done to verify references in some cases. Staff are trained and competent to do their jobs and they are given good support and supervision. Evidence: We received completed surveys from four members of staff. All confirmed that care plan information is generally up to date, their recruitment and induction training were sufficiently thorough and they receive regular support and supervision. All consider that there are usually enough staff on duty. Staff comments include the following statements. The Laurels Nursing Care Centre try their very best to make all staff and residents happy in every way they can. We all try to make the residents comfortable, clean and their surroundings safe. The home provides a good training programme for staff and good food, activities and entertainment for the residents. It is a pleasure to work at the Laurels as there is good team spirit and everybody puts the residents first. Care Homes for Older People Page 24 of 32 Evidence: The home follows their policies very well. They conduct meetings and give continuous seminars to those who are new like me. The home supports the staff group. We all try our best to do whatever we are doing very well, and to the best of ability. We are keen to make the residents happy and keep them alert. The care of the residents in this home is good. Residents and staff are given equal opportunities. We looked at staff supervision and recruitment on the second day of the inspection. A supervision matrix is in place and records show that staff are supervised regularly and also when any need arises. Supervision also includes direct observation of practise. The service is carrying a number of vacant beds. Staffing rotas show a generous numbers of staff on duty currently due to the occupancy levels. Staffing rotas were provided for the month of April. These show that appropriate numbers of qualified nurses are on duty both on days and night time. On each unit there is a qualified nurse on duty throughout the day in addition to the required number of carers. At night the ground floor has in addition to two carers a registered nurse on duty. One nurse covers the first and second floor units at night in addition to two carers per unit. The home has good staff retention levels. We found that staff enjoy working at the home and feel supported by management. We examined the personnel files for three new carers recruited in the past twelve months. Application forms were completed by each of these staff members. Proof of identity was held for staff members. There are records of their employment history. Two of the files had supporting CVs. Records are maintained of interviews held for candidates and how they responded during the interviewing process. Work and immigration status evidence is held on each file. The service had received completed CRB Enhanced Disclosures for the applicants before they commenced work. Two references are also held for each staff member. We found that the professional references for two of the staff did not contain a stamp or headed notepaper to demonstrate authenticity. It is recommended that when requesting professional references that either stamps or headed notepaper are requested to support their authenticity. Copies of employment contracts are held on each staff file. A number of the staff newly recruited in the home have experience, some were qualified nurses in other Care Homes for Older People Page 25 of 32 Evidence: countries and are working as carers. The files have evidence of inductions for staff. The records show that the service provides staff with a good induction programme to prepare them for the role, and that these are signed off when completed successfully. The service makes sure that staff receive the guidance and support needed. The records held confirm that staff in the service are directly observed in the workplace. Senior staff observe the interaction of carers with residents with dementia, importance of record keeping including fluid balance charts, the delivery of personal care and supporting people at mealtime. There is evidence that any shortfalls identified are addressed through further training. Certificates are held on file of staff training and development. Residents speak about the calibre of staff working at the home and find them to be competent and skilled for the job. Relatives also spoke of the qualities displayed by staff. Two visitors to the home said that they see how dedicated staff are at this home and said that they know how the staff care about the people they look after. A staff training matrix is in place and this enables the manager to plan the training. She said that she has placed emphasis on ensuring that all mandatory training, including refresher courses, are up to date and in developing both resident specific training and training around medical conditions like diabetes and dementia. Both the manager and deputy are trained trainers and are able to deliver some of the training themselves. Staff are also involved in reflective practise sessions when areas of care, such as end of life care, have been identified to have been not as good as they would have liked. Further staff training and development about good end of life care is planned. The AQAA says that there are plans to promote equality and diversity by increasing staff awareness of different cultural needs. The manager aims to do this by linking with local resources. Care Homes for Older People Page 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered manager is experienced and qualified and feedback about her management style and the improvements she has made is positive. Quality assurance systems are developing and a development plan is in place for the coming year. This shows that the managers look at the service and are able to identify areas that can be improved and make plans for how this can be achieved. Evidence: The home manager has been in post since August 2008. She is experienced and qualified. A deputy manager has been recruited since the last inspection also. The managers and staff facilitated this inspection well and the AQAA, an audit completed by the manager before the inspection, was sufficiently detailed. Feedback from staff during the inspection and in completed surveys is all positive and staff observed that the home has improved and the manager is approachable and supportive. The area manager is also a nurse and she visits regularly and also conducts regular unannounced inspections, the reports of which are available in the Care Homes for Older People Page 27 of 32 Evidence: home. Copies were seen during the inspection and they are sufficiently detailed. A quality assurance system is being developed and residents and relatives were sent surveys in February 2010, the results of which are collated. The managers are disappointed with the low number of response. However, there are regular and increasing communications with relatives and we were shown minutes of a recent residents meeting and those of a recent relatives meeting and these show that the home seeks input and the views of stakeholders. The area manager and home manager have also developed an annual development plan that will, this coming year, focus on improvements in dementia care, end of life care, making the environment better for people with dementia, further staff dementia training and moving forward with the Gold Standard Framework accreditation for good end of life care. There are also plans for kitchen refurbishment and further development of the activities programme. This shows that the managers look at the service and are able to identify areas that can be improved and make plans of how improvements can be made. The manager has also facilitated relatives meetings where external health professionals have been invited to talk to relatives about improving care for those with dementia and for good end of life care. All of the requirements made in the last inspection report have been addressed and there are plans in place for further improvement in the next twelve months. The home manager is responsible for health and safety and there are policies and procedures in place. These are reviewed regularly. Environmental and fire risk assessments are in place and are reviewed regularly. Fire evacuation procedures are in place and system tests are conducted regularly. The Annual Quality Assurance Audit says that the catering department was awarded five stars by the local authority. The manager has introduced a new form and body chart for when staff see a mark or injury but do not know how it happened. These reports are now monitored by the home manager who said there have been few. There is clear direction and leadership from the management team. Staff tell us that they appreciate the way the manager communicates clearly on the standards and the codes of practice expected. As well as the registered manager the service has a deputy working supernumerary two day per week, he also oversees practice on the floors three days per week. We found that systems including record keeping are well Care Homes for Older People Page 28 of 32 Evidence: organised. The service continues to demonstrate improvements in the standards of care. We examined how residents are supported with managing their finances. A number require support to manage their monies for personal expenses safely on a month to month basis. Records for two residents were seen. There were receipts and records held for each transaction. We also looked at a spreadsheet for those residents that have their personal allowance/benefit paid directly into a bank account held for the company. The ledger print off shows that despite one account covering for all residents, balances are held individually for each person. Care Homes for Older People Page 29 of 32 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 30 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 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 3 1 12 20 The service users guide should contain residents views about the home. The service should continue to develop the range of activities available for people with dementia. The service should continue to refurbish and decorate the dementia care floors to ensure that the environments are as helpful as possible to people with dementia. References obtained during recruitment should have be accompanied by a company stamp or headed notepaper as proof of their authenticity. 4 29 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © 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. 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