Key inspection report
Care homes for older people
Name: Address: Marsh House Residential Home Ulnes Walton Lane Ulnes Walton Leyland Lancashire PR26 8LT The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marie Cordingley
Date: 1 1 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: Marsh House Residential Home Ulnes Walton Lane Ulnes Walton Leyland Lancashire PR26 8LT 01772600991 01772601893 marshhouseres@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Marsh House Care Home Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 33 Date of last inspection Brief description of the care home Marsh House is registered to provide residential care and accommodation for up to 33 people. Currently the home is in administration and is being managed on behalf of the administrators by a company called Healthcare Management Solutions. The home is situated in a rural area close to the towns of Chorley and Leyland. There are 23 single rooms and 5 double, some of which have en-suite facilities. There is a large dining room and a number of communal areas available for residents use as well as Care Homes for Older People
Page 4 of 32 Over 65 33 0 1 9 1 1 2 0 0 9 Brief description of the care home well maintained grounds with seating and patio areas. These areas are accessible to people who use a wheelchair and there is also a stair-lift in place. Ample car parking space is provided. At the time of this visit, the information given to the Commission showed that the fees for care at the home vary from 367 - 410 pounds per week, with added expenses for newspapers, hairdressing and chiropody. Care Homes for Older People Page 5 of 32 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this home included a site visit which was carried out on an unannounced basis. This meant that the manager and staff did not know the visit was to take place until we arrived. During the visit we spent time with residents, talking to them and observing their daily routines. We also held discussions with staff at the home and the acting manager. We carried out a tour of the home looking at communal areas and a selection of residents private accommodation. We also viewed a variety of paperwork including residents care plans and staff personnel files. Prior to our visit we wrote to the manager and asked him to complete a very comprehensive self assessment. This gave us a lot of information about how the home is managed. In addition, we wrote to a selection of residents and staff and asked them Care Homes for Older People
Page 6 of 32 to take part in a written survey about their opinions of the service provided. Care Homes for Older People Page 7 of 32 What the care home does well: The majority of people we consulted both in writing and during our visit, expressed satisfaction with the home and made some very positive comments. These included; I am very happy with the way things are and would not want them to change. We have seen a vast improvement in the home this year and we feel much happier with the way it is being managed. The carers are very good and do everything they can for you. I feel lucky to be here, first class in every way. Throughout our visit we observed carers, although very busy, going about their duties in a cheerful and pleasant manner. There was a happy, friendly atmosphere in the home and residents and carers appeared to get along very well. We noted that carers addressed residents in a courteous and respectful manner. We found care needs assessments had been carried out for all residents prior to their admission. This is important because it helps ensure that the prospective residents needs can be met at the home and that it is the right place for them. Good assessment procedures also help ensure that carers have a good understanding of peoples needs and can plan their care effectively. Some areas of peoples care plans contained a very good level of information and provided carers with person centred guidance. This level of information helps carers provide individualised support which is in line with residents personal needs and wishes. In every care file we viewed, we found thorough risk assessments in areas such as falling or pressure sores. Where a resident had been assessed as being at risk, there were clear guidelines in place to help staff ensure peoples safety. We found evidence that the home work well with other professionals and act quickly to ensure that residents have access to care from community health care professionals when they need it. At the time of our visit the manager was observed making a referral to a community health service on behalf of a resident who had just arrived that day. The majority of people we spoke with told us that they enjoyed their meals and that they were happy with the quality and variety of food provided. It was pleasing to see that residents are now enabled to choose from at least two meal options on a daily basis. We received some very positive feedback about the new manager, from residents, staff and a relative. People described the manager as very approachable and supportive. One resident commented that in the past she had not always felt able to raise concerns but that she felt very comfortable about approaching the new manager at any time. Care Homes for Older People Page 8 of 32 What has improved since the last inspection? Following the last inspection of the home we identified a number of serious concerns about the service and made a number of requirements and recommendations. We found during this inspection that the new manager of the home and the management agency in charge of the homes running, had responded very positively to these findings and had made good progress in addressing the requirements we made. We found that care plans were much improved and far more focused on peoples individual preferences about how they wanted their care to be provided. This helps carers ensure that people receive their care in a way that meets their individual needs and wishes. We made a requirement following the last inspection of the home that all staff dealing with residents medicines, including night staff, receive training in this area. We were able to confirm that this training had been provided and as such the requirement was met. The area of activities has improved and following clarification of the homes budget for activities, the manager has been able to arrange a varied activities programme. One resident told us There does seem to be more going on these days, and a staff member said It has been nice to get people out on trips, that hadnt happened in a long time. During our last inspection we were concerned to find that there was very little choice for residents about the food they ate and on occasions, residents were not even told what was on the menu for each day. During this visit we were pleased to find that residents are now offered a choice of at least two options for their main meal and that they are provided with menu information to help them make their choices. We spoke to one resident who had just joined the home that day, she told us that she was very pleased she had been enabled to choose what she had for her lunch. An area where we found significant improvement was that of complaints. A number of people we spoke with commented on the approachability of the manager and one resident told us she felt much more comfortable raising any concerns with the new manager than she had previously. We also noted that information about the homes complaints procedure had been improved and contained details of relevant contacts from Health Care Management Solutions should a complainant wish to take a matter to a higher stage. We noted that there had been a number of improvements to the environment including the redecoration and re-carpeting of some areas. We were also pleased to find that areas we had found to be malodorous in our previous inspection had been improved and were much fresher and cleaner. One relative commented on this improvement stating that Marsh House was now a much more pleasant place to be. There had been some improvements to the homes recruitment procedures and we were able to confirm that in general, the appropriate background checks including police checks and references were carried out for all candidates before an offer of employment was made. We did however, make some more recommendations to support further development in this area. Care Homes for Older People
Page 9 of 32 Records viewed demonstrated a much improved approach to the induction and ongoing training of staff. We found that all new staff members are now provided with a formal induction and also noted that training in important areas such as moving and handling was being provided on a more regular basis. Management arrangements for the home had been clarified and in line with a requirement made following our last inspection, lines of accountability have been confirmed. As a result staff told us that they were feeling much more settled and morale was clearly improved. The manager advised us that he had good support from his seniors and we also saw evidence that robust quality assurance processes had been implemented to enable the homes manager and his seniors to constantly monitor standards within the home. We found that some health and safety concerns relating to access into the home and coshh (control of substances hazardous to health) had been addressed by the new manager to help ensure the safety and wellbeing of people who live and work at the home. What they could do better: The homes Statement of Purpose and Service User Guide had been recently reviewed at the time of our inspection. However, we did find some examples of information that was out of date or no longer accurate. These are important documents and in particular, the Service User Guide may be used by people to help make the decision as to whether the home is right for them. As such, it is important that the information contained within them is accurate. We have made some requirements and recommendations in relation to this matter including that information in the documents relating to the homes complaints procedure and residents right to manage their own medication is updated. We found that there had been some improvements to residents care plans but still noted some examples where information in care plans did not consistently reflect peoples needs. However, in discussion carers showed good understanding of residents individual care needs and the action required to ensure their needs were met. As such, we were satisfied that the problem was in the record keeping as opposed to a failure to provide appropriate care. We talked to the acting manager about how gaps in peoples care plans could potentially lead to gaps in their care and made a recommendation in relation to the matter. Improvements were noted in procedures for manging peoples medication. However, we made some more recommendations to help support further development in this area. We advised the manager to ensure that carers include all the necessary information about variable dose or time medications on peoples medication administration records (such as the actual dose given or time administered). We also made a recommendation that the level of information about residents as and when required medicines be improved to help ensure that residents receive their medication at the correct times. Finally, we made a recommendation that clearer information about external preparations (creams) be included in residents medication administration records, for example, on which area of the body the cream should be Care Homes for Older People
Page 10 of 32 administered. We did note some improvements to the variety of activities being provided and this was commented on by some residents we spoke with. However, according to discussion and records viewed we found that some residents are still not being provided with regular opportunities to take part in valued activities. The manager is aware that this area needs further work to improve outcomes for people. We received generally positive feedback about the standard of meals provided and also were pleased to find that choices for residents about what they eat had been improved. However, one resident raised a concern that the home sometimes ran out of certain provisions, for example, jam and ice cream. As a result of this information we advised the manager to review food budgets and ordering procedures to help ensure that residents favorite foods are generally available. Improvements have been made to the home including the decoration of some areas and the provision of new flooring. However, there remain some areas that require attention, including bathrooms and residents bedrooms. The manager advised us that there was an ongoing improvement plan in place which on completion, would ensure that all of these areas are updated. We made some recommendations to help ensure that recruitment practices are more robust including the checking of peoples employment history and the investigation of any gaps. This is to help ensure that only suitable people are offered employment at the home. During our visit we noted that some records relating to health and safety checks on equipment within the home were not accurate. We pointed this out to the manager and asked him to ensure that a system is put in place whereby such records are regularly checked to ensure that the checks recorded as completed have actually been done. 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 11 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 12 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can be confident that carers have a good understanding of their needs. Evidence: A Service User Guide is available for anyone making enquiries or requesting further information about the home. This is a useful document which provides important information such as fees charged for care and accommodation, facilities available and arrangements for areas such as mealtimes and activities. At the time of our visit we noted that the Service User Guide had been recently updated to provide more accurate information. However, we did note that some pieces of information contained within it were still out of date. We advised the manager to review the guide to ensure that all the information provided within it was accurate and up to date. Care Homes for Older People Page 13 of 32 Evidence: We were able to confirm that there are processes in place to ensure that an assessment of any prospective residents needs is carried out prior to them being offered a place at the home. Such assessments are important because they ensure that the manager has a full understanding of a persons needs before agreeing to admit them. In addition, thorough assessments mean that staff can plan peoples care effectively from the point of their admission. We found that assessments contained a good level of information about peoples care needs and that this information had been properly taken into account when developing peoples care plans. We also noted that the assessments included a good level of social information such as peoples hobbies, important relationships and preferred daily routines. This sort of social information means that peoples care can be planned in a more individual way whilst taking into account the things that are important to them. Care Homes for Older People Page 14 of 32 Health and personal care
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care is planned in line with their individual needs and preferences. More accurate record keeping will help ensure that residents receive their medicines as prescribed. Evidence: We viewed a selection of residents care plans and found that they provided a good level of information and were generally comprehensive. We noted that all the residents assessed needs had been included in their care plans as well as guidance for staff in how to meet each assessed need. We found examples of very good person centred information about individual residents which would help staff ensure that care was provided in line with peoples individual needs and preferences. We did note that there were areas in some residents care plans that could have been expanded upon, for instance in relation to peoples more complex needs and in some cases, areas such as dental and eye care. However, the manager had already
Care Homes for Older People Page 15 of 32 Evidence: identified these areas as being in need of development during regular audits that he carried out. We noted that the home had good systems in place to ensure that any resident who required support from community health professionals such as GPs or district nurses was supported to access it. On the day of our visit the manager was observed making an occupational therapy referral for one resident who had been admitted to the home just that day. For each resident whose care was tracked we found comprehensive risk assessments in place in areas such as falling or developing pressure sores. Where a resident had been assessed as being at risk in any such area, there was a detailed care plan in place to assist staff in reducing the risks as much as possible. We were able to determine that all staff who deal with residents medication had received the appropriate training and a requirement we made following the last inspection and regarding the training of night staff in dealing with medication, had been addressed. Discussion with residents confirmed that they were enabled to look after and administer their own medicines if they wished to. We were also able to determine that the home had risk assessment procedures in place to ensure that any resident administering their own medicines was able to do do safely and competently. However, in viewing the homes Statement of Purpose we noticed that residents rights to self medicate wasnt clearly stated. We advised the manager to address this. We viewed the homes medication stock and records and found that they were in generally good order. However, we made some recommendations to support further development in this area. Although residents medication administration records were generally clear and accurate, we found examples of variable dose and time medications being signed for without the staff member making all the necessary information clear. For example, one resident had been prescribed a medicine on an as and when required basis with instructions to administer one or two tablets. Staff had signed to confirm they had given the tablet but not stated how many they had administered. We pointed this out to the manager and asked him to ensure that carers provide this important information at the time of signing. Some residents had been prescribed medicines on an as and when required basis. It Care Homes for Older People Page 16 of 32 Evidence: is important in these circumstances that there are clear guidelines in place for staff so that they know exactly when they should administer the medicine. We found in some cases that this information was not clear. In addition, information relating to the administration of creams was not always clear for example, where cream should be applied and how often. We discussed our findings with the manager and have made some recommendations in relation to the issues identified. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are regular opportunities for people to take part in enjoyable activities but some people would benefit from more one to one opportunities. Evidence: We found that since our last inspection, there had been some improvement in the provision of activities for residents. In addition, arrangements for the activities budget had been clarified so that the manager was able to plan a varied programme. Activities regularly provided included, arts and crafts, baking, pet therapy and gardening. Also some residents had enjoyed trips out to places such as Morecambe and local markets. One resident we talked to said There does seem to be a bit more going on these days. and a staff member said We usually have enough staff on so that we can spend time with residents doing activities, but not always. Each persons care plan we viewed contained some information in relation to their hobbies and preferences about how they spent their time. In addition, a record of activities was in place for each resident although these had not always been fully
Care Homes for Older People Page 18 of 32 Evidence: completed. Some records of activities we viewed showed that there were residents at the home who often chose not to take part in group activities. However, there were no references to this in their care plan and we couldnt find any evidence of one to one activities being offered to these people on a regular basis. We talked to the manager about this and advised that the activities programme be reviewed to ensure that it is person centred and in line with peoples individual preferences. Most people we spoke with said that they enjoyed the food at the home. One resident said I have no complaints at all, it is always very good. However, one person commented that the quality of food varied at times and also raised a concern that the home sometimes ran out of items like jam and ice cream. In light of this, we advised the manager to review budgets and ordering procedures to ensure that residents favourite foods are generally available. Menus showed that people are offered a varied and nutritious diet at the home. We were also able to confirm that people are now provided with a choice of main course on a daily basis, in line with a requirement made following the homes last inspection. During our visit we observed residents having their lunch. The meal served was nicely presented and looked appetising. It was pleasing to note that people were being provided with different meals further demonstrating that residents are now able to make choices about what they have to eat. Tables were nicely set and also had menus on, so that residents were provided with information about meal choices available to them. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are enabled to raise concerns and their concerns are taken seriously. Evidence: The home has a complaints procedure in place which provides guidance for people who wish to raise a concern or make a complaint. We were able to confirm that the guide had been updated to reflect changes in management arrangements and now contained the correct details of the relevant contacts. However, we noted that the homes Statement of Purpose still contained some out of date information in relation to complaints and we advised the manager to rectify this as soon as possible. The home has a record of all complaints received and their outcome. We viewed the record and found that all complaints received since the appointment of the new manager had been or were being dealt with appropriately. Residents we spoke to told us that they were aware of the homes complaints procedure. One resident told us that she had not always felt comfortable in raising concerns in the past, but explained that the new manager was extremely approachable and that she had no concerns about raising any issues with him. She said I know he will always do his very best to sort things out for me, he really is very good.
Care Homes for Older People Page 20 of 32 Evidence: All homes are required to have written procedures in place that must be followed if it is alleged or suspected that a resident has been the victim of any kind of abuse. These are generally referred to as safeguarding procedures. We found that the manager and the staff members we spoke to had a good understanding of the procedures. We were also able to confirm that the majority of staff members had received training in safeguarding and were aware of their responsibility to report abuse or bad practice in line with the homes whistle blowing procedures. In addition, staff members told us that they felt they would be supported by their manager in the event that they made any such report. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The completion of the homes improvement plan will help ensure that people who live at the home are provided with a good standard of comfortable accommodation. Evidence: Marsh House is a spacious home with a variety of communal areas for the use of residents including well maintained outdoor space. During our visit we carried out a tour of the home, viewing all communal areas and a selection of residents private accommodation. We noted that there had been a number of improvements made since the last inspection including decoration and new carpeting in some areas. However, there were still some areas that were in need of improvement, in particular some bathrooms and residents bedrooms. The manager advised us that an improvement plan was in place and that all areas in need of refurbishment were included in the plan and as such, would be addressed in the near future. It was pleasing to note that residents and relatives had been kept updated about the homes refurbishment and in a recent meeting had been invited to give their input for things such as colour schemes. Care Homes for Older People Page 22 of 32 Evidence: Following the last inspection of the home we made a requirement due to the fact that we found some areas of the home to be quite malodorous. We noted a huge improvement during this visit and found all areas of the home to be clean and fresh. One relative who was visiting at the time of our inspection commented on this and said The home feels so much fresher now, its much more pleasant to be in. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. More robust recruitment procedures will help ensure the safety and wellbeing of people who live at the home. Evidence: During our visit we viewed a selection of staff files to check that the home follow safe recruitment procedures when appointing new staff. We found that these procedures had improved since our last inspection and that processes to carry out the relevant background checks on candidates such as criminal records checks and previous employment references, were usually followed before offering employment. Whilst we found some improvement in recruitment processes we did make some recommendations to help support further development in this area. We noted when viewing one staff members file, that none of the references obtained for them were from previous employers. We advised the manager that references should always be obtained from previous employers wherever possible. We also noted that some staff that had been recruited had gaps in their employment history and we could find no evidence that these had been investigated. We advised the manager to ensure that any such gaps are investigated and a record made of explanations provided. Care Homes for Older People Page 24 of 32 Evidence: Records viewed demonstrated a much improved approach to the induction of new staff and their ongoing training. We noted that all new staff had been provided with induction training and that a record of this training had been made and signed by both parties. In addition, we found that training for staff in areas such as moving and handling and medication was being offered much more regularly. Staff we spoke with confirmed that they were being provided with support to carry out their National Vocational Qualifications in care and some carers were working towards these qualifications at level 4. The inspector observed the manager providing support and assistance to one staff member with regards to her NVQ training. Information provided by the manager confirmed that 7 out of 15 carers at the home hold NVQs in care at level 2 or above. This figure means that the home are falling slightly short of the national minimum standard but are on course to meet the 50 per cent target. We observed staff going about their duties and did note on the day of our visit that they seemed to be under pressure at times. We spoke with carers about staffing levels and people told us that they were generally adequate but that there were times when carers found themselves struggling to keep up with their duties. One carer said Sometimes we miss breaks because we dont get time to take them. We spoke to the manager about this who advised that there had been a recent increase in the number of residents and that he had recognised the need to increase staffing levels. He assured us that this was in hand and that arrangements were in place to increase the numbers of staff on duty. Despite the feedback from some staff regarding staffing levels we found that there appeared to be a marked improvement in staff morale. Staff told us that they felt well supported by the new manager and that he was approachable and helpful. One carer commented that the whole team felt more stable and that staff felt much more secure than they did when the home first went into administration. Records of staff meetings and one to one supervisions confirmed that the manager keeps staff informed of important developments and also invites them to have involvement in the running of the home. We noted that supervision was now being provided on a much more regular basis, and that the manager had responded well to issues that had arisen regarding individual members of staff, for instance where concerns relating to practice had been identified. Care Homes for Older People Page 25 of 32 Management and administration
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home have benefited from a much improved management structure and a competent manager who is committed to improving standards. Evidence: An acting manager has been in place at the home since December 2009 at which time we had identified a number of concerns about various aspects of the service provided, and as such, a number of requirements had been made. During this inspection we found a good deal of evidence to demonstrate that the management agency and the new manager of the home had made very positive progress toward meeting the requirements and addressing our concerns. People we consulted both in writing and during our visit spoke highly of the new manager, describing him as very supportive and approachable. One resident commented that she felt very comfortable in raising any concerns that she had with the manager and also told us that she felt he would always do his very best to sort things out for her.
Care Homes for Older People Page 26 of 32 Evidence: In discussion, the manager demonstrated an understanding of and commitment to, person centred practice. We found some very good examples of improvements the manager had made to ensure that residents care was more individualised and in line with their wishes, including improvements to care plans and more focus during pre admission assessments of peoples social histories. We noted that the manager was making regular efforts to keep people who live and work at the home as well as relatives, updated on any developments within the home by holding regular meetings and supervisions for staff. The manager completed an Annual Quality Assurance Assessment (AQAA) for us and completed this to a satisfactory standard. We noted that the manager had referred to our previous requirements and recommendations in the AQAA and advised us of the progress he had made. He was also able to describe areas for development and shared ideas about various improvements he had planned. We found that the home now benefits from a much more robust approach to quality assurance. A number of processes are in place to ensure that all standards are regularly monitored by members of the management team. In addition, there are good support networks in place for the manager, should he require any support, assistance or advice from his seniors. The home has a health and safety policy in place which is supported by a number of individual policies and procedures such as fire safety and infection control. We were pleased to note a much improved programme of staff training in key health and safety areas such as moving and handling. We had, during our last inspection, raised same health and safety concerns in relation to access to the home and coshh (control of substances hazardous to health) and were pleased to find during this visit that these had been addressed. In viewing some safety check records which has been completed by a staff member at the home, it became quite obvious that some of the information about checks that had been completed was incorrect. We pointed this out to the manager and advised him to ensure that this important information was always accurate and up to date. Care Homes for Older People Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 19 23 All parts of the home must 19/05/2010 be kept clean and reasonably decorated. This is so that people are provided with safe, comfortable accommodation. Care Homes for Older People Page 28 of 32 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 16 22 It must be ensured that the homes Statement of Purpose and Service User Guide contain up to date details about how to make complaints. This is to help ensure that people are enabled to raise any concerns they have. 11/06/2010 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 1 The Service User Guide should be made available in a variety of formats, such as audio to help ensure that more people have access to the information. The homes Service User Guide and Statement of Purpose should be reviewed to ensure that all the information contained within them is accurate and up to date. Systems should be in place to enable the manager to ensure that daily records for example, bathing charts are properly completed at all times. Guidance in relation to peoples more complex needs
Page 29 of 32 2 1 3 7 4 7 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations should be expanded upon to include detailed information for carers. This is to help ensure that carers are enabled to deal with challenging situations consistently and confidently. 5 7 It should be ensured that peoples care plans contain detailed information about all aspects of their daily needs. This is to help ensure that people receive the support they need at all times. All medication in original packaging should be dated on opening. This is to assist in effective auditing and to help ensure that medicines are disposed of within the correct timescales. Clear guidance should be in place for all residents who are prescribed external preparations. This is to help ensure that people are administered their creams as prescribed. Detailed guidance should be in place for all residents who are prescribed medicines on an as and when required basis. This is to help ensure that people receive their medicines when they need them. The homes Statement of Purpose and Service User Guide should provide accurate information in relation to arrangements for residents who wish to administer their own medication. This is so that residents are fully aware of their rights in this area. Where a variable dose/time medication is administered by staff, the dose administered or the time given should be recorded on the residents medication administration record. This is to help ensure that residents receive their medication as prescribed. The activities programme should be reviewed to ensure that is in line with all residents individual needs and preferences. Food budgets and food ordering processes should be reviewed to help ensure that residents requests can be met at all times. The complaints procedure should be made available in a variety of different formats. This is to help ensure that more people have access to the information. The homes environmental improvement plan should
Page 30 of 32 6 9 7 9 8 9 9 9 10 9 11 12 12 15 13 16 14 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations continue. This is to help ensure that people are provided with a good standard of comfortable accommodation. 15 27 Staffing levels should be kept under constant review, in line with residents changing needs. This is to help ensure that people who live at the home receive the care they need at all times. The NVQ training programme should continue and at least 50 per cent of staff should hold NVQs in care at level 2 or above. This is to help ensure that people who live at the home receive their care from suitably trained staff. Any gaps in a candidates employment history should be investigated and a record made of any such investigation. This is to help ensure the safety and wellbeing of people who live at the home. It should be ensured that the induction package currently being provided to new staff members is in line with Skills for Care standards. If a candidate does not name their current or most recent employer as a referee this should be investigated and a record made of any such investigation. This is to help ensure that only suitable people are employed to work at the home. Results of quality assurance exercises should be published and provided to residents, staff and other stakeholders. This is to help ensure that all stakeholders are kept fully informed of developments within the home. A process should be implemented to enable the manager to monitor that all health and safety checks are completed when signed for. This is to help ensure the safety and wellbeing of people who live and work at the home. 16 28 17 29 18 30 19 30 20 33 21 38 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. Care Homes for Older People Page 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
