Inspecting for better lives Key inspection report
Care homes for older people
Name: Address: Orchard House 107 Money Bank Wisbech Cambridgeshire PE13 2JF The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lesley Richardson
Date: 2 2 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 30 Information about the care home
Name of care home: Address: Orchard House 107 Money Bank Wisbech Cambridgeshire PE13 2JF 01945466784 01945588856 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ranc Care Homes Ltd care home 67 Number of places (if applicable): Under 65 Over 65 37 0 30 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 5 5 0 10 The age range of residents with mental disorder (MD) and dementia (DE) and physical disability (PD) is 58 years to 64 years only Date of last inspection Brief description of the care home Orchard House is owned by Ranc Care Homes Limited. The company also owns three homes in Kent and two in Essex. It is a purpose built home providing residential and nursing care and is registered for 67 places. On the ground floor the home has twentysix single bedrooms with en-suite facilities and two double rooms. The first floor is designated for residents with a diagnosis of dementia. Nursing staff are always on duty and are supported by a team of care staff and other domestic and catering staff. The weekly charge varies from 354 to 745 pounds, depending upon peoples needs. A copy Care Homes for Older People
Page 4 of 30 Brief description of the care home of the most recent inspection report is available in the entranceway to the home. Care Homes for Older People Page 5 of 30 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 quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection of this service and it took place over 10 hours and 30 minutes as an unannounced visit to the premises. It was spent talking to the manager and staff working in the home, talking to people who live there and observing the interaction between them and the staff, and examining records and documents. The requirements from the last inspection have been met. There have been 2 further requirements and 2 recommendations made as a result of this inspection. The last key inspection was carried out on 22nd July 2008. Care Homes for Older People
Page 6 of 30 Information obtained from the Annual Quality Assurance Assessment (AQAA) and from returned surveys was used in this report. The AQAA is a self assessment that focusses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. We received 3 surveys from people living at the home, 3 surveys from visitors and 8 surveys from staff members. What the care home does well: The home is a large purpose built property and it is situated in its own grounds. There are 2 lounge areas on each floor, plus other quiet areas for people to use if they wish. Staff members are polite and talk to people with respect. We talked to people during this inspection and they said the staff are nice, respect their privacy and one person said, I always get 100 care. Staff are always cheerful and caring. Assessments are completed before people move into the home, they have contracts with the home and they say they have enough information before they move in. People are referred to health care professionals, like dentists, opticians and dieticians. These visits are recorded in their care records. Medication is administered safely and there are very few errors in medication administration records. There is an activities co-ordinator at the home, who organises trips, activities and events for people. Information is kept about what people do and the time the activities co-ordinator spends with them. People can have visitors when they want and there are places where they can meet in private. Visitors said they are kept up to date with issues that arise and one person said staff help their relative keep in touch with them. One persons relative said, I find Orchard House to be a very well run home. With a friendly, well ordered atmosphere. The staff, & management seem to have a genuine concern for the residents. There is a choice of main meals each day and staff members stay with people who need help to eat. People we spoke to said they like the meals and the food is good. Two people who returned surveys said the meals could be hotter, but they were very hot when we visited and had lunch with people on the ground floor. There have been no complaints made to the home in the last year. People said they know who to talk to and most people know how to make a complaint if they need to. Staff members have training in how to keep people safe and what to do if they think abuse has happened. There have been four safeguarding referrals in the last year. None of these involved staff at the home. Staff members are given induction training when they first start working at the home. There are updates of mandatory training when this is needed, and staff have other training, such as continence care, to help them care for people properly. One staff member said, There is always on going training going on and up to date information available. Non-nursing qualified care staff also complete National Vocational Qualifications and the AQAA told us that just over 50 of these staff have the qualification. A quality assurance survey is carried out every year at the home, where visitors and visiting health care professionals are asked what they think of the service that is provided. People who live at the home are asked their opinion every week by the activities co-ordinator. Money that is kept and transactions that are made on behalf of people at the home is Care Homes for Older People Page 8 of 30 recorded. Records are also kept of the health and safety checks that are carried out, which means the home can show if things are in good working order and what they have done to repair problems. What has improved since the last inspection? What they could do better: The amount of detail about how to meet care needs must improve, as many care plans contain the same information for many people living at the home and do not look at each person as an individual. Plans are not always updated when needs change, or there is new information about how to care for them, including advice from health care professionals. Reviews of care plans should be completed every month, which evaluate what has happened in that month and whether the care plan is working or not. The reviews completed do not show any evaluation of the care. There is also not enough information written on records that show how much food people eat and records for how much people drink are not looked at after they are completed. This is so that there is a clear record of what staff do to prevent malnutrition and dehydration. Although staff are polite and talk to people with respect, they also use terms of endearment like darling and sweetheart that not everyone living at the home likes to be called. One person told us that if staff need to address people they should use their names. Recruitment checks are not completed properly before people start working at the home. Gaps in employment histories are not checked, references from previous employers are not obtained and a health declaration had not been obtained for 1 new staff member. This information is required so that new staff members are safe to work Care Homes for Older People Page 9 of 30 at the home. Although people are asked what they think of the home, there is little information to show the home looks at what they need to improve and how they are going to do this. This must be done to make sure the service is developed and improved in the interests of people who live there. 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 set out 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 10 of 30 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 11 of 30 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. People have enough information before moving into the home, which means they are able to decide if they would like to live there. Evidence: All (3 out of 3) of the people who we received surveys from said they had received a contract and that they had enough information before moving to the home. Two of the 3 visitors who returned surveys also said their relative had enough information about the home before moving in. Assessments are completed before people move into the home and assessments by health and social care teams are also obtained to provide more information. We looked at the care records of 2 people who had moved into the home since the last inspection. There were assessments completed by the home, although these contained only brief information and consisted of mostly yes/no responses. More detailed assessments
Care Homes for Older People Page 12 of 30 Evidence: from health and social care teams were available in both peoples care records. All of the information had been obtained before the people had moved into the home. The home does not provide accommodation specifically for intermediate care or for rehabilitation purposes. Care Homes for Older People Page 13 of 30 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. Care records are not completed in enough detail for all staff to be able to care for people in a person centred way. Evidence: People who commented in surveys said they get the care and support they need from staff members and during the inspection most people told us care staff are nice, are polite and treat them with dignity and respect. We saw this during the inspection, and that staff knock on doors before entering rooms. A comment from one person who returned a survey was, I always get 100 care. Staff are always cheerful and caring. However, we also heard staff members calling people by terms of endearment, such as darling and sweetheart. One person said during the inspection that they dont like being addressed like this and if staff need to address people it should be by name. Care plans for 6 people were looked at as part of this inspection. They show that each person has a set of plans that give staff members information about what they need
Care Homes for Older People Page 14 of 30 Evidence: to do to care for people. Risk assessments, for things like falls and moving and handling, are completed and reviewed regularly. All of the long term care plans are printed and contain the same or similar guidance for everyone. For example, communication plans state that people have hearing problems but are able to hear without needing to use a hearing aid. We found the care plans give staff members advice about how to meet most of peoples needs, but that there is little information specifically about each person. One persons plan tells staff they should spend time getting used to individual non verbal communication, and although it has been reviewed there is no more information about how the person communicates or lets staff know whether theyre happy or not. Another persons plans do not contain any of the information about them that was obtained before they started living at the home. The pre-admission assessment shows that the person can be physically aggressive when having personal care carried out and it can take up to 4 staff to do this safely. They are still able to feed themselves if they are given time, but only if they are given food they can hold. None of this information is in the care plans. We spoke to staff members who were able to tell us about these people and what they need to do for them. The person mentioned above who can be physically aggressive is not often like this and staff members told us they only ever need 2 people to carry out personal care. Staff were also able to tell us about the person who is not able to communicate verbally and how they know if the person is not happy. Because the home has a stable staff group who know the people they care for and how they like to be looked after, not having this information in the care plans is less of a problem than it could be. However, we spoke with one staff member who had cared for one person during our inspection, but had been on leave and only returned to work that week. The staff member was not confident in explaining about the person and their needs, although they told us that they get a verbal handover and read the care plans after being away. Care records include a form for people to sign to say they have looked at their care plans. We found these in all the care records we looked at. We spoke with one person who told us they had seen their care plans, but couldnt remember how long ago this was. The person had signed the form in November 2008, but staff members had signed the form in more recent months. Plans are reviewed monthly, although this is only a staff members signature and a date. There is no review or evaluation of care given over the month, how well this is going or if there are any problems. We spoke to 2 senior staff members who confirmed reviews of the care plans only consist of a signature and a date. One of these staff members said if there are any changes this is written in the daily notes, but there is nowhere to comment about all of this during the review.
Care Homes for Older People Page 15 of 30 Evidence: All of the people (3 out of 3) who returned surveys said they receive medical attention when they need it. There is information in care records to show health care professionals, such as specialist nurses, opticians and chiropodists, are contacted for advice and treatment. We looked at one persons care plan specifically because they need a lot of care. The person had been seen by a dietician who had recommended a fortified diet and had written instructions about how to do this. None of this information had been written into the care plan. We talked to the cook who told us no one living on the same floor as this person was being given a fortified diet, although butter and cheese are added to mash potato. When we had lunch during the inspection it was evident that the rice pudding dessert had not been made with full cream milk or cream. The dietary recommendation made by the dietician for this person has not been put into place. We also looked at records that show what people eat, drink and when and which position they are turned to. The records for food are not completed in enough detail to show the person is getting enough to eat. They dont show what people actually eat or give specific enough detail to show how much they eat. One persons records show they have a few spoons of meals, but there is no information of the size of spoon or how many spoonfuls. We talked to staff in the kitchen who said records are not kept there of what each person has to eat at each meal. Records are kept for many people in the home to show how much they have to drink, although these records are not added up at the end of the day. Staff give us a number of different reasons for what is done with them, but these didnt include that they would be looked at as part of the persons care. Charts are kept to show when and which position people are turned to, and clearly show these details. Medication administration records (MAR) were looked at for 7 people, including 2 people whose care records we looked at. The MAR sheets are completed and there are no records with entries missing. Entries for medications that have not been given show the reason for this. Amounts of medication remaining in blister packs of medication tally with the amount the MAR indicates are remaining. Records are generally well kept and accurate, but when staff check in new medication they must put the amount of medication recieved, rather than simply a tick. This is so they can show they have received the correct amount of medication. Antibiotic medication is given, but if this is prescribed for 3 times a day it should be given over as large a time scale as possible to obtain the greatest possible therapeutic effect. We saw this medication for one person, but it was being given in a time frame of less than 12 hours. This means therapeutic levels drop and the medication may not be working as well as it should. We saw care plans for medication in peoples records, although these were all very
Care Homes for Older People Page 16 of 30 Evidence: similar and dont always show individual needs or preferences. One persons plan tells staff the person cannot manage their own medications, although an assessment of the persons ability to self medicate shows the person is able to do everything expected to be able to give their own medication. The only reason shown for the person not to be able to continue managing their own medication is that they can be non-compliant. We talked to the person who told us staff now give them their medication to make sure they take it when its given, instead of leaving it and taking it when they wanted to. Another persons medication care plan is very similar to others we looked at, but doesnt mention a medication the person must have for a medical condition. We checked controlled drug (CD) medications for 2 people against the records, which showed when the medications had been given, who by and how many were left. The amount of medication remaining was the same as the amount in the records. The name and address of the dispensing pharmacy for controlled drugs received into the home must be written into the CD register. Medication fridge and storage room temperatures are taken and recorded as being at an acceptable level for the safe storage of medication. Care Homes for Older People Page 17 of 30 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. Activities are available and people can choose what they do, which means most people have control over their lives. Evidence: The home has an activities co-ordinator who arranges for entertainers to visit the home, activities and events. Information about activities is available and displayed around the home. All of the 3 people who returned surveys to us said there are activities that they can take part in. People we spoke to during the inspection said they are able to do what they want during the day and can join in activities if they want. We saw entertainers visiting the home during our inspection, who spent time on both floors. One person though, did say they are not always able to do what they want, when they want and prefers to stay in her own room. The activities co-ordinator keeps records to show the time spent with people on a one to one basis and when they join in activities. These are separate from care records and located in a different area, which means they do not form part of the care records and care staff do not comment on or review social needs. Most people are able to make everyday choices about when to get up and go to bed,
Care Homes for Older People Page 18 of 30 Evidence: how to spend their days, whether that is in their own room, or in the main lounge/dining area. We saw and listened to how staff members interact with people and found they ask what people would like and how they would like it rather than telling people or giving limited options. Staff members we spoke to generally know the people they care for and most of the time they were able to tell us their preferences and how they like to be cared for. The home has an open visiting policy and people can have visitors at any time of the day. One of the visitors who returned a survey said the home helps their relative keep in touch and they all said they are kept up to date with issues concerning that person. Two comments were, Gives 100 care, always willing to talk to and about the patient, always a clean and homely atmosphere and I find Orchard House to be a very well run home. With a friendly, well ordered atmosphere. The staff, & management seem to have a genuine concern for the residents. The main meal is served at lunchtime and there is a choice of meals every day. We saw lunch being served in the main dining room on one floor. Food was served appropriately in a relaxed and unhurried way and drinks were offered throughout the meal. Everyone we spoke to said they like the meals and the food is good. Everyone returning surveys said they always or usually like the meals that are served. Staff help people if they need this and we saw them being attentive and concentrating on what they were doing without being distracted. There were only 2 comments in surveys about meals; 1 person living at the home and their relative said, Provide better food and make sure it is served hot. The meal served to us during the inspection was hot. Care Homes for Older People Page 19 of 30 Complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know how to make complaints and concerns known and can be confident that these will be listened to. Evidence: All of the people returning surveys said they know who to speak to and 2 of the 3 people said they know how to make a complaint if they have to, and that staff listen to what they say and act on it. One person said staff only sometimes listen to them and act on it. Everyone we spoke to during the inspection also said they know what to do if theyre not happy about something. Two of the 3 visitors who returned surveys said they know how to make a complaint and they are appropriately dealt with. All but 1 person we spoke to during this inspection said they are happy with the service given to them. The home has a complaints procedure and keeps a complaint log to show how they have looked at and the outcome of complaints that have been made. We were told before the inspection there have been no complaints made to the home in the last 12 months. Training records are kept in staff files and show that staff members are given training in safeguarding people (adult protection). We talked to care staff, who said they had received training in safeguarding people. We saw information in one persons file that
Care Homes for Older People Page 20 of 30 Evidence: protection from abuse training is in the form of a DVD only. This method of training is not generally suitable if it is not accompanied by practice and discussion. One staff member we spoke to told us what should be done if abuse was suspected and was able to tell us where details of the local safeguarding team are kept. Although the staff member was correct in where the details would be kept (the policy and procedure for abuse), there were no details entered into the space for this. This means that staff do not have the ability to report incidents easily if they need to inform the local safeguarding team. Information provided to the Care Quality Commission before the inspection shows there have been 4 safeguarding referrals and 1 investigation in the last 12 months. None of these involved staff at the home. Care Homes for Older People Page 21 of 30 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and provides a safe environment, giving most people a pleasant place to live. Evidence: The home is a large purpose built property situated close to the centre of Wisbech. People living at the home have access to a number of communal areas, including fenced garden areas around the property. The general decor in the home is satisfactory, and it was clean and tidy, with no offensive smells. Two of 3 people returning surveys said the home is clean and tidy and people at the home said the home is clean. One comment we received was, always a clean and homely atmosphere. Care Homes for Older People Page 22 of 30 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. There are enough staff members most of the time with the training and skills to be able to care for people properly. Evidence: Training records show new staff members are given induction training, which includes mandatory health and safety training. Seven of the 8 staff members who returned surveys said their induction training covered everything they needed to know before starting work. Additional training is given to staff so that they are able to properly meet peoples needs, such as training in managing challenging behaviour and continence. However, one staff members file shows that much of this training is given in the form of watching a DVD. This particular staff member watched 8 DVDs and completed training in 2 other subjects on the same day. Training by watching DVDs or videos is not recommended as it does not give staff the opportunity to discuss and practice what they are being taught. Staff members who returned surveys said, There is always on going training going on and up to date information available and The home also gives the staff plenty of training and is updated on a regular basis. Information in the AQAA tells us 51 of non nursing qualified care staff have a National Vocational Qualification in care at level 2 or above. The recommended number of staff with a NVQ is 50 .
Care Homes for Older People Page 23 of 30 Evidence: Two of the 3 people who returned surveys said staff members are available when they are needed, the other person said staff are only sometimes available when needed. All 3 people said that they get the care and support they need. Comments from the surveys about staff members were all positive, although 2 people (1 person living at the home and a visitor) said there could be more staff in the evening and at weekends. Most people we spoke to during the inspection said there are enough staff on duty, but one person told us they are sometimes unable to do things because care staff are not available. Seven of the 8 staff members who returned surveys said staffing levels are usually high enough. One staff member said staffing levels are only sometimes high enough. However, all the staff we spoke to during the inspection said there are usually enough staff on duty and one staff member told us that staffing levels are the same at weekends as during the week. We looked at recruitment records for three staff members employed since the last inspection and they contained most of the appropriate recruitment documents including references, application forms, and PoVA/CRB checks. There were gaps in employment histories and one person had written no dates against their previous employment at all. These were not looked at before people started working. Two references were obtained for all 3 people, although many of these were personal not professional references. One person had worked for a care agency previously and a reference had not been requested from them. One persons file did not have a health declaration. All of this information is required before people start working to make sure they are fit and safe to do the job. Care Homes for Older People Page 24 of 30 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. The home is a safe place to live and people are asked their opinion, but there is little to show the service changes as a result of this. Evidence: The manager is a nurse and is registered with the Nursing and Midwifery Council. She has been managing the home for a number of years and has qualifications in care. Staff members told us they feel supported by the management team, 2 comments were, It has got good managers, who is always available when needed and If I have had any concerns about anything there is always someone on the management team to offer guidance and help. The manager told us that since the last inspection all staff members have received supervision, and all staff have had this at least twice this year. Staff members should receive 6 supervision sessions per year. We saw supervision records for staff members, which show that the meeting has been recorded, although there is very little information on the form about what was discussed. One staff member we spoke to said they had not received any one to one supervision, but has
Care Homes for Older People Page 25 of 30 Evidence: had contact with the management team who watch how she works and discuss issues with her. Staff must be adequately supervised and supervision should give staff the opportunity to discuss privately their work practice and learning and development needs. An annual quality assurance survey was carried out by the home earlier this year, although a report has not yet been written to show the results of the surveys. Surveys are sent to relatives of people living at the home, and visiting health care professionals, but not to people living at the home. Their views are obtained by the activities co-ordinator every week and passed on to the manager in a short report. We asked the home to complete and return an Annual Quality Assurance Assessment (AQAA) before the inspection. They did this within the time we asked for it. However, the information in the self-assessment was very short and gave us very little detail about what the service does well, and what has improved. Few of the sections about what could be improved were completed at all. The home keeps some money on behalf of people who live there. Accounts are kept of transactions of money put in and taken out. We looked at 2 of these records; both were clearly written and show how money has been spent. Information provided before this inspection shows equipment, like hoists, lifts and firefighting equipment has been serviced or tested as recommended by the manufacturer. We looked at fire equipment around the home; this has been tested within the last 12 months. We also look at fire safety records, which show that emergency lighting and fire alarm tests are carried out at the required intervals. The records also show that night staff have practiced fire drills 3 times in the last 3 months. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be specific to each person and must be reviewed. Care plans must be revised when there are changes to how peoples needs are met. This is so that people receive the care that is right for them and all staff members are aware of their individual needs. 31/12/2009 2 29 19 All the required checks and information must be obtained before people start working at the home. This is so that people living at the home are safe and new staff members are safe to work there. 31/12/2009 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 Care Homes for Older People Page 28 of 30 1 8 Recommendations made by a health care professional should be written into care plans so that all staff have this guidance. Training should not rely solely on staff watching a DVD or video as this does not give them the opportunity to practice what they have learnt or ask questions. 2 30 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 30 of 30 - 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!
