Inspection on 14/09/09 for Oatlands

This is the latest available inspection report for this service, carried out on 14th September 2009.

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.

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report Care homes for older people Name: Address: Oatlands 210 Anerley Road Anerley London SE20 8TJ     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: David Lacey     Date: 1 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Oatlands 210 Anerley Road Anerley London SE20 8TJ Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Oatlands Care Ltd The registered provider is responsible for running the service care home 56 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 56 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 Mental Disorder Code MD Dementia - Code DE Date of last inspection Brief description of the care home Oatlands offers care and accommodation to residents who have dementia or mental health problems. In 2007, the owners extended the care home, which increased the number of residents who can be accommodated. The home is situated on a main road and is within walking distance of Anerley rail station for those with unrestricted Care Homes for Older People Page 4 of 31 Over 65 56 56 56 56 Brief description of the care home mobility. It is also on several bus routes and backs onto a park. There is some off-road parking to the front of the home. The fees for this home are 504-672 pounds sterling per week (this information given to CQC in September 2009). Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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 key inspection included an unannounced visit to the home, which took place over two days. Two inspectors visited on the first day, one of whom focused on looking at how the staff team assist those residents with restricted mobility to move around the home. One of the inspectors visited again on the following day. To gain the views and understand the experiences of people living in the home, we spoke with residents and one of us carried out structured observations of the care being given to a small group of people on two of the homes three units. We met with the homes registered manager, other members of the management team and with members of the homes staff. Documentation such as care plans and records of care provided, staff recruitment files, and policies and procedures were sampled for inspection. Before the visit took place, we surveyed samples of the homes residents and their relatives, staff members and visiting professionals. We selected twenty people from the list of residents sent to us by the home and sent out survey forms to these residents Care Homes for Older People Page 6 of 31 and to their relatives. We sent out eight survey forms to staff members working at the home and sent forms to seven visiting social or health care professionals. By the time of writing this report, completed survey forms had been received from twelve residents, three relatives, six members of staff, and three visiting social or health care professionals. Five of the residents who responded indicated they had received help in completing their forms. The feedback we received from this survey has been taken into account in reaching our judgements about the quality of services provided by the home. The care home had provided us with its annual quality assurance assessment (AQAA) when we asked for it. This self-assessment document focuses on how outcomes are being met for residents and also gives us some numerical information. Information from the homes AQAA has been used to inform the inspection process. Since the last key inspection in September 2007, we carried out a random inspection in January 2008 and an Annual Service Review in September 2008. We have used findings from these regulatory activities in planning this present key inspection. Since our previous inspection, the ownership arrangements for the care home have changed from Mr and Mrs Jawaheer as individual providers to the service being provided by Oatlands Care Limited. This change was the subject of a variation application, which was assessed and approved by our regional registration team. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? The company has made considerable investment into the service and has made sure the environmental standards in the two new units are high. A holistic view of residents needs has been taken into account in designing this new provision, so it not only benefits people currently living in the home but also takes into account the diverse needs of people who might use the service in the future. The company has planned further environmental improvements to be carried out during 2010. Since the previous inspection, the home has developed further its use of a care home specific software programme for documenting detailed information about each resident. Staff are now confident in using this software, which has had a positive impact on care delivery for residents. The home now arranges two sittings for lunch, which makes it easier for staff to ensure residents can enjoy their meal in a relaxed and unhurried way. There is a staggered early shift to accommodate the needs of the residents at this time Care Homes for Older People Page 8 of 31 of the day, with staff on the very early shift working with the night staff to assist residents. The home has met our previous requirement about recruitment checks and has addressed our previous recommendation about the storage arrangements for internal and external medications. 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 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives have the information they need to make a choice about whether to move into the home. Prospective residents are assessed to ensure the home can meet their needs. The home does not offer intermediate care, thus standard 6 does not apply. Evidence: The homes statement of purpose and service user guide were available for inspection. Their content had been kept under review and met requirements, providing helpful information for prospective and current residents and their representatives. All of the twelve residents who responded to our survey stated they had received enough information to help them decide if this home was the right place for them, before they moved in. Each of the three relatives who responded to our survey stated they always get enough information about the home to help them make decisions. People are encouraged to visit the home before making a decision to move in. Care Homes for Older People Page 11 of 31 Evidence: All of the residents who responded to our survey confirmed they had received a contract, with written information about the homes terms and conditions. Five residents files were sampled during the inspection. Three had completed contracts on file and two people were waiting for their contracts to be returned from the local authority that had arranged their placement. Of the three visiting social or health care professionals who returned our survey, two stated the homes assessment arrangements always ensure that accurate information is gathered and that the right service is planned for people and one stated this is usually the case. Senior staff from the home carry out pre-admission assessments of people referred for placement. This includes assessment of their capacity to carry out activities of daily living, and risk assessments. Residents files sampled for inspection showed these assessments had been completed. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have ready access to health care services. Residents have individual plans for their care, based on their assessed needs, and these plans are kept under review. People with restricted mobility are being helped to move around the home safely. The home is managing medicines effectively. Staff members treat residents with respect and maintain their dignity. Evidence: On both days of the inspection visit, residents looked well groomed, with hair tidy and nails clean and trimmed. They were dressed appropriately for the time of year. Observation and discussion showed that care delivery was being organised and monitored well by the care coordinator and other team leaders. Ten of the twelve residents who responded to our survey stated they always receive the care and support they need, with one stating this is usually the case, and one resident that s/he sometimes receives this. A resident commented that something the home does well is that it looks after its residents first and foremost. Two of the three relatives who responded to our survey stated the home always meets the needs of their relative, with one stating this is usually the case. All of the relatives stated the home always Care Homes for Older People Page 13 of 31 Evidence: gives the care to their relative that they expected or agreed. One commented, Im happy that she receives the best possible care. Each of the six staff members who responded to our survey stated they always receive up to date information about residents needs, for example, in the care plan. A sample of six residents care plans and supporting documentation was examined. Residents physical, social and psychological needs had been assessed and set out in their individual plans. Risk assessments were in place, for example, for skin integrity, manual handling and nutrition. Care plans sampled for inspection had been reviewed regularly and where necessary amended in line with residents changing needs. Plans were sufficiently personalised with details such as when the person prefers care to be delivered, how they like to have their hair cut and their dietary preferences. Since the previous inspection, the home has developed further its use of a computer software programme for documenting care for each resident. Care plans and supporting risk assessments are completed using this software and the inspectors were shown how this works in practice. The software is a comprehensive suite of tools that allows the home to construct individual care plans, based on their assessment of the residents needs. The software prompts at various points depending on what needs have been identified and also allows the use of free text to further explain the nature of a particular need or to support the assessment of it. The home makes sure that residents have access to specialist health care services as they need. All of the residents who responded to our survey stated they always receive the medical care they need. Discussions with staff confirmed the GP support to the home is good. People moving into the home can retain their existing GP if they wish and if that GP agrees, although most of the residents have registered with the homes GP who visits once each week routinely and at other times as needed. Visits made by health and social care professionals, including the GP and district nurses, had been recorded. Other health care services that residents had received included optical and dental services. Of the three visiting professionals who returned our survey, two stated the home always properly monitors, reviews and meets residents social and health care needs, and one stated this is usually the case. Two professionals stated the home always seeks advice and acts on it to meet residents social and health care needs and improve their well-being and one professional stated this is usually the case. One inspector focused on looking at how the staff team assist those residents with restricted mobility to move around the home. This included reviewing the file of a resident about whom unsubstantiated concerns had been raised. The care plan, review and moving and handling assessment were all complete and up to date. The inspector Care Homes for Older People Page 14 of 31 Evidence: judged that the moving and handling aspect of the care plan was sufficiently detailed that should a new staff member need to support the resident, they would know exactly how to do so. The inspector found no evidence of any shortfalls in the homes provision or practices for moving and handling residents. Two of the three visiting social or health care professionals who returned our survey stated the home always supports people to administer their own medication or manage it correctly where this is not possible. The third professional stated the home usually does this. Medication administration to three residents was witnessed and was carried out safely. The medication procedure was available to staff, and there was an up to date list of signatures and initials of those staff members who administer medicines. Storage of medicines was in locked cabinets or trolleys, in two rooms in different parts of the home. The homes supplying pharmacist (Boots) had recently asked that these trolleys be clamped to the walls when not in use and the care coordinator confirmed this is to be done. Thus, we have not made a requirement in this respect. Our previous recommendation that internal and external medications be always stored separately had been met. The medicine administration records (MAR) sampled for inspection were complete with no unexplained gaps. Two residents were on temazepam, which was being stored in the homes clinical room. The stock held tallied with the records in the homes controlled drugs register. The temperature of the homes drugs refrigerator was being recorded regularly and was within safe limits on the day of my visit. However, the temperature of the clinical room felt uncomfortably warm and it was apparent this temperature should be monitored to make sure it remains within appropriate limits for medicines storage. There is no natural or artificial ventilation within the room. This was raised with the manager who said the matter was to be addressed by installing a ventilation unit. If this does not solve the problem then the home will install air conditioning in the room. A recommendation has been made to support the homes plans to address the matter (recommendation 1). The care coordinator confirmed that staff have to complete an externally delivered and certificated medication training programme before they can administer medicines. The care coordinator supervises them when they first start giving medicines, and they start with the evening rounds when there are less medicines to give out and so more time is available for additional teaching and supervision. One inspector spent two hours observing residents experiences in two communal areas of the home. Analysis of the data from these observations indicated both care settings were supportive, with residents showing positive or passive mood states. The residents were treated by staff with dignity and respect. Staff members were seen addressing residents respectfully and attending to them promptly. Carers were making sure they were at eye level while communicating with a resident sitting in a chair. Care Homes for Older People Page 15 of 31 Evidence: Each of the three visiting social or health care professionals who returned our survey stated the home always respects peoples privacy and dignity. Of the three relatives responding to our survey, two stated the home always responds to the different needs of individual residents and one stated this is usually the case. This question asked respondents to consider needs relating to disability, gender, age, race and ethnicity, faith and sexual orientation. Staff members we surveyed were asked a similar question, all replying they always have enough support, experience and knowledge to meet the different needs of residents. The three visiting professionals responding to our survey stated the home always responds to the diverse needs of individual people. Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can choose to take part in various planned activities. The home supports its residents to maintain contact with their families and friends. Residents are given a balanced and nutritious diet, and their dietary needs and preferences are met. Evidence: An inspector spent one hour observing residents experiences in the day room on Unit 1 and an hour observing a separate group on Unit 3. There was provision of individually planned activities for residents throughout both observation periods, such as playing games or reading newspapers together, as well as having the radio playing music at low volume in the background. To enable interaction and conversations, there were no televisions on at high volume in these communal areas and chairs were arranged in smaller groups rather than only around the outer walls of the room. Staff members offered residents opportunities to take part in activities sessions being run by the activities coordinator, which were taking place elsewhere in the home. The activities coordinator explained these sessions are organised as far as possible to meet the individual needs of residents, recognising that their interests and capacities will differ. Residents said they enjoyed the activities and entertainments that the home arranges for them. For example, a pianist comes into the home once a week to play for the residents and several people said how much they enjoy this. All of the twelve Care Homes for Older People Page 17 of 31 Evidence: residents who responded to our survey stated there are always activities arranged by the home that they can take part in if they want. Two of the three relatives responding to our survey stated the home always helps their relative to keep in touch with them, if that was applicable, and one said this is usually the case. Of the three relatives responding to our survey, one stated the home usually supports people to live the life they choose, and two did not answer this question. One relative commented, The home is happy to cater for individual needs. I gave the home my mothers complicated weekly timetable of trips to church and day centres when she moved in, and the home have been extremely good about organising it for us, enabling my mother to carry on doing the things that she enjoys and leading an active life for as long as possible. All of the three visiting social or health care professionals who returned our survey stated the home always supports people to live the life they choose wherever possible. Nine residents responding to our survey stated they always like the meals at the home and three stated they usually do. A relative responding to our survey stated the food appears good, fresh fruit is available for residents. Residents who were able to give their views during the inspection visit were positive about the food provided at the home. Lunch was observed in both dining rooms during the inspection. The home now arranges two sittings for lunch, which makes it easier for staff to ensure residents can enjoy their meal in a relaxed and unhurried way. The food served matched what was on the menu. It was well presented and residents said the meal was tasty. Choices of food were available and juice was served during the meal. People were asked what they would like from a choice of two main options. One resident asked for an alternative to these two options and was given a different meal that she preferred. Staff were aware of those residents with special dietary needs, such as those with diabetes. Condiments were not placed on tables and this was said to be because accidents could occur. The manager agreed to consider trying this again, as being able to add condiments themselves enhances independence for residents. Staff members offered sensitive and unhurried assistance with feeding to the few residents that needed some help. Throughout the inspection visit, staff members were encouraging residents to take fluids, including fortified drinks when necessary. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home follows its policies and procedures for complaints and for safeguarding adults. Staff receive training about protecting residents from abuse. Evidence: The home has a complaints procedure, which is available to residents and any other interested parties. All of the twelve residents who responded to our survey stated there is someone they can speak to informally if they are not happy, and all knew how to make a formal complaint. Of the three relatives who returned our questionnaire, all stated they knew how to make a complaint about the care provided if they needed to. One commented that although their relative had been living in the home for many years throughout that time I have had no reason to complain about her care. Each of the three relatives stated the home always responds appropriately if they have raised any concerns. All of the six staff members responding to our survey confirmed they knew what to do if someone has concerns about the home. Each of the three visiting social or health care professionals who returned our survey stated the home has always responded appropriately when any concerns have been raised. Information provided to us by the home showed that one complaint had been received within the past twelve months, and that this complaint had been resolved within the timescales set out in the homes procedure. The homes complaints file was seen during the inspection and this complaint had been documented. The homes safeguarding procedure and the local councils safeguarding guidance Care Homes for Older People Page 19 of 31 Evidence: were readily available and staff members spoken with had received relevant training. They understood how to raise any concerns they might have about residents safety and welfare. The commission is aware of safeguarding allegations made in April 2009 about moving and handling practices at the home. We are also aware that the provider (Oatlands Care) complained to the local authority about the initial investigation of these allegations and that, following further investigation by the authority, these allegations were not substantiated. As noted elsewhere in this report, we found no evidence at this inspection of any shortfalls in the homes arrangements for moving and handling residents. We were told the homes business manager is to accept a recent invitation from the local authority to contribute to the further development of local safeguarding arrangements. There was evidence of well being amongst residents, who appeared comfortable and relaxed when interacting with members of the staff team. An inspector spent one hour observing residents experiences in the day room on Unit 1 and an hour observing a separate group on Unit 3. On each of the units the 60 minute structured observation time was divided into 12 five-minute timeframes. Across both units, residents experienced engagement with staff in 39 per cent of these timeframes. The observations included the nature of staff interaction with residents. The observation data from both units suggested that staff interactions contributed to people having a positive state of being. Eighty per cent of staff interactions with residents were positive and 20 per cent neutral, such as simply exchanging information. No negative interactions were observed on either unit. Although residents who appeared better able to communicate tended to receive more interaction from staff, it was evident that staff members on both units also made effort to interact with residents who were less able or willing to communicate verbally. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is clean, comfortable and well maintained. Improvements to the homes environment over the past two years benefit people currently using the service and also plan for the diverse needs of people who might use the service in the future. Evidence: On both days of our inspection visit, the home was clean, tidy and communal areas were free from odour. Each of the twelve residents who responded to our survey stated the home is always fresh and clean. One commented that the home is clean and I like the care they give to me. Relatives commented positively about the cleanliness of the home. Comments we received included: The home has a high standard of cleanliness; A very well kept home which is exceptionally clean; The cleanliness is to a high standard. Individual bedrooms seen during the inspection were personalised, and residents who were in their bedrooms had call bells and fluids at hand. The home is organised into three units, two of these in the newly extended part of the home. The company has made significant investment into the service and the environmental standards in the two new units are high. For example, there is good environmental orientation for residents, with colours being used to differentiate areas and signage on individual residents room doors. A holistic view of residents needs Care Homes for Older People Page 21 of 31 Evidence: has been taken into account in designing the new provision, for example, by installing a hot tub in the garden and broadband points in the new bedrooms. During the registration process for the new extensions, the commission had raised issues about the location of a new lounge adjacent to a stairwell, in terms of potential risk to residents. At our last inspection, this lounge was not being used to intended capacity and we decided outcomes would need to be judged at the next inspection. The owners have continuously monitored the situation with regard to the lounge, and have decided to enclose the stairwell during the further building works that are planned to replace the older part of the premises. The owner/manager has recognised for some time that residents and staff will benefit from the laundry being re-sited away from food areas, and showed plans that confirmed this will be part of the rebuilding of the older part of the home. It was understood the re-building of the older part of the home is to commence in early 2010 and that the work will be carried out to the same high standards as the recent improvements. Thus, the home should be able to achieve an excellent rating for its environmental standards in due course. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suitably qualified and competent staff are employed to meet residents needs. The home has appropriate recruitment procedures that support and protect residents. Staff members undertake training that is relevant to their work in the home. Evidence: Since our last inspection, the home has been organised into three units, now that it has been extended and can accommodate more residents. Each unit has its own separate staffing, with team leaders for each. On both days of our inspection, there were enough staff on duty to meet the needs of the residents. From examination of the staff rotas and discussions during the inspection visit, appropriate staffing levels were being maintained. One inspector spent two hours observing residents experiences in two of the communal areas of the home. The observations included staff interaction with residents, and these findings are summarised in the section above on Complaints and Protection. It was noted that staff members were prompt in responding to both groups of residents being observed and appeared to have enough time to meet their needs. Eleven of the twelve residents who responded to our survey stated staff are always available when they need them, with one stating this is usually the case. The six staff members who responded to our survey all stated there are always enough staff to meet residents individual needs. There is a staggered early shift to accommodate the needs of the residents at this Care Homes for Older People Page 23 of 31 Evidence: time of the day, so two people start at 06:00hrs before the rest of the early shift come in at 08:00hrs. Staff members said this arrangement works well, with the very early shift working with the night staff to help residents who want to get up and about and have a cup of tea. The registered manager said they had noticed most accidents occurred in the early morning when residents were getting up and that this staffing arrangement had also been put in place to address that trend effectively. Each of the three relatives responding to our survey stated staff always have the right skills and experience to look after people properly. A relative commenting about what the home does well stated they look after my relative - who can be difficult - with kindness and consideration and a great deal of patience. Other written comments from relatives included, the staff are always cheerful and caring and the staff are all kind and friendly and know how to deal with all residents appropriately. Of the three visiting social or health care professionals who returned our survey, one stated the homes managers and staff always have the right skills and experience to support peoples social and health care needs, and two stated this is usually the case. Eleven of the twelve residents who responded to our survey stated staff always listen to them and act on what they say, and one resident stated staff usually do this. All of the six staff members who responded to our survey confirmed their employer had carried out checks, such as references and Criminal Records Bureau (CRB) disclosures, before they started work in the home. Five staff members files were examined, all of which contained the necessary recruitment information. The requirement about CRB checks from our last key inspection had been met. Staff members spoken with during the inspection said the training they had undertaken was relevant to their work in the home. Evidence of completed training was seen both on staff files and on the training matrix held electronically on the homes computer system. All of the staff members who responded to our survey stated their induction had covered very well everything they needed to know to do the job when they started. Staff were either undertaking or had completed NVQ programmes, and staff spoken with had completed dementia training. Staff files and information held electronically showed evidence that staff had completed essential training such as food hygiene, first aid, manual handling. Each of the six staff members who responded to our survey stated they were being given training that is relevant to their role, helps them understand and meet peoples individual needs, keeps them up to date with new ways of working, and gives them enough knowledge about health care and medication. When questioned, the registered manager confirmed that staff members receive at least three days paid training each year. He said this includes NVQ sessions with assessors in the workplace, such as portfolio Care Homes for Older People Page 24 of 31 Evidence: discussions, during which staff are not on duty. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes registered manager is experienced and holds an appropriate qualification. The home communicates well with residents and their representatives, and seeks their views about the quality of services provided. The health and safety of residents, staff and visitors is promoted. Evidence: Since our previous inspection, the ownership arrangements for the care home have changed from Mr and Mrs Jawaheer as individual providers to the service being provided by Oatlands Care Limited. This change was the subject of a variation application, which was assessed and approved by our regional registration team. The homes registered manager (Mr Jawaheer) has experience in providing care to people with dementia. He is registered with the commission and holds the Registered Managers Award, as does the homes business manager. The home has appointed care coordinators who organise and monitor the day to day care given to residents and report directly to the registered manager. Care Homes for Older People Page 26 of 31 Evidence: All of the three relatives responding to our survey stated they are always kept up to date with important issues affecting their relative. Copies of the homes newsletters showed that residents and relatives were regularly updated about matters to do with the home, and it was understood the newletter is available by email to people who prefer to receive it in this form. The notes from the most recent residents meeting in July 2009 were seen. The meeting had been chaired by the activities coordinator and ten residents had attended. The minutes of three staff meetings held in 2009 were seen. These had been chaired by the registered manager and various matters to do with the running of the home had been discussed. The homes managers were able to show how they assure the quality of the homes service provision. Before the inspection, they provided the commission with a detailed annual quality assurance assessment (AQAA). Since becoming registered as a corporate provider, Oatlands Care has been subject to the regulatory requirement for monthly provider monitoring visits and reports. These had been carried out by one of the companys directors and the reports of the visits were seen on file. The company had also produced a quality assurance report for 2009/10, which had evidence of consultation with residents, relatives, staff members and some of the homes visiting professionals. The home has linked its computers to improve internal communication and uses care home specific software that provides detailed information about residents, such as risk assessments, and health care appointments and interventions. The software enables analysis of trends and has the potential to become a very useful tool for quality assurance, as records are updated and data become available. The homes policies and procedures had been reviewed by the manager in July 2009. All of the staff members returning our questionnaire stated the ways in which they share information about residents with other carers and the manager always work well. We were not made aware of any people living at the home subject to a deprivation of liberty authorisation. The home employs an accounts officer who deals with the financial procedures. At the time of this inspection, no one working at the home was an appointee for any residents. The home makes extra charges for services such as chiropody and hairdressing, and will charge for cream bath and shampoo unless residents prefer to supply their own. The accounts officer showed how residents or their representatives are asked to confirm if they want these extra services. A non-interest bearing account is used for residents monies, with receipts retained and transactions and balances recorded. The accounts officer showed the systems used for this and the individual records sampled for inspection were accurate and up to date. Financial statements are produced for residents or their representatives and either posted or emailed as they prefer. Care Homes for Older People Page 27 of 31 Evidence: A matrix for staff supervision is held electronically and this was made available for inspection. Written notes of supervision sessions, signed by both parties are held on paper files. Staff members spoken with during the inspection visit said they are supported well and can obtain advice and guidance as they need. There were similar responses to our survey of a sample of staff members. Each of the six staff members responding to our survey stated the manager gives them enough support and regularly meets them to discuss how they are working. It was evident the home promotes the health and safety of residents, staff members and visitors. Health and safety documentation sampled for inspection was up to date and within the appropriate timeframes. The home uses the services of health and safety consultants who carry out building and fire risk assessments, and who provide advice to the home as needed. The local council had carried out a food safety inspection in September 2009 and awarded a 5 star excellent rating, which was an improvement from the 4 star very good rating awarded in January 2008. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The registered person should ensure the temperature of the clinical room is monitored and kept within the recommended maximum of 25 degrees centigrade for a room where medicines are stored. This is because a higher temperature may have an adverse effect on the efficacy of some medicines. 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