Inspection on 12/06/09 for St David`s

This is the latest available inspection report for this service, carried out on 12th June 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St David`s 14/11/06

St David`s 29/12/05

St David`s 13/07/05

St David`s 23/10/04

St David`s 29/06/04

St David`s 23/10/02

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for older people Name: Address: St David`s 65 West Hill Road St Leonards On Sea East Sussex TN38 0NF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Deborah Calveley     Date: 1 2 0 6 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 34 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 34 Information about the care home Name of care home: Address: St David`s 65 West Hill Road St Leonards On Sea East Sussex TN38 0NF 01424-439266 01424440789 melvenia@stdavids.wanadoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Miss Melvenia Davidson care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 23 The registered person may provide the following category of service : Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home St. Davids Care Home is a large detached property located in a residential area of St. Leonards-On-Sea. It provides nursing and personal care for up to 23 residents of an older age or who have a physical disability. The Home is set out on three floors and a passenger lift provides access to all floors. A large lounge area with a sunroom attached provides sea views and some of the upper floor rooms also have spectacular views to the sea. At the front of the building there is a small area providing off road parking facilities. The home provides care and support to residents who are both privately funded and Care Homes for Older People Page 4 of 34 Over 65 23 0 Brief description of the care home those who are funded by Social Services. Additional costs for extra services such as the provision of chiropody, hairdressing and newspapers are available from the manager. The homes literature states that one of its main aims is `the management of St Davids Nursing Home pride ourselves on offering a highly professional care service for the elderly with a personal touch. Care Homes for Older People Page 5 of 34 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 reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term service user to describe those living in care home settings. For the purpose of this report those living at St Davids Nursing Home will be referred to as residents. This was a key inspection that included an unannounced visit to the home and follow up contact with residents representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6 hours on the 12 June 2009 with a further visit on the 15 June 2009. There were 18 residents living in the home on the day of which four were case tracked and visited. During the tour of the premises five other residents both male and female were also spoken with. Care Homes for Older People Page 6 of 34 The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Two members of care staff were spoken with in addition to discussion with the two registered nurses, cook and appointed manager. Telephone contact was made with visiting professionals following the visit and their views and comments are incorporated into the report along with the information received verbally during the site visit. An Annual Quality Assurance Assessment was received from the previous relief manager completed in full prior to this key inspection. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service Users Guide though informative in some areas did not reflect the changes to the management structure of the home thus not stating who is in day to day charge of running the home, the document also needs to be updated to reflect the correct commissioning body and address. The care plans and risk assessments need to be further developed to ensure that person centred care is delivered in a consistent manner to residents. The able residents in the home would benefit from being involved in their care plan especially in respect of choice and their preferred daily lives. Residents would benefit from an improved quality assurance and monitoring system in the home as some very able residents were able to discuss ways that would improve their lives in the home that staff are not aware of. The activity and meal provision in the home is not meeting the residents expectations and preferences and is in need of improving to ensure that there is a more stimulating and inclusive atmosphere. The recruitment process at this time was not sufficiently robust to protect and promote the residents safety and well being. The training and supervision practices do not ensure that the staff are competent and safe to do their job. Care Homes for Older People Page 8 of 34 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 34 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 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission, however little information is documented thus not exploring that all their needs can be met. Evidence: The home have a Statement of Purpose and Service Users Guide in place which contains clear information about the home, the facilities and the services it provides. These documents give prospective residents and their families the information they need to make an informed choice about where to live. The documents need to be updated to reflect the current management structure of the home and the correct details of the commissioning body. It was confirmed whilst talking with residents that the contract arrangements were Care Homes for Older People Page 11 of 34 Evidence: clear and understood. There is a copy of the terms and conditions of residency included in the Service Users information, this also agrees the bedroom decided on. The home uses a care planning system which includes a pre admission document. A review of the care documentation confirmed that pre-admission assessments are completed by the appointed manager. The format of the pre-admission document was seen to be relevant, however more information could be recorded which will inform the inspection process and ensure that the home can meet the identified needs of the prospective residents in respect of their health, social and welfare needs. The prospective residents are seen either in their home or hospital before admission and it was confirmed that wherever possible the family or representatives are involved. One visitor confirmed that they were involved in the whole admission process. A recommendation of good practice is that the venue and all the people involved in the assessment are documented. The appointed manager was able to verbally demonstrate her knowledge and awareness of the different specialties required in the home and states that she will ensure that staff employed have attended relevant courses to deal with the needs of the elderly and also specialised courses for certain diseases, including dementia. Trial visits to the home can be arranged. The appointed manager confirmed that residents are invited to a trial period to ensure suitability of the home, this is clearly stated in the Statement of Purpose and in the statement of terms and conditions. Intermediate or rehabilitative care is not provided at St Davids Nursing Home. Care Homes for Older People Page 12 of 34 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. Whilst care plans provide a good framework for the delivery of care with guidance for staff to follow, residents would benefit from a more person centered approach which involves their participation and agreement. The home was found to be meeting residents health and general needs with accessed additional specialist support when needed. Medication practices in the home promote and protect the health needs of residents. Evidence: The care documentation pertaining to five residents were reviewed as part of the inspection process. These were found to include plans of care, nutritional assessments personal histories and individual risk assessments to ensure that the health and personal needs of residents are identified. On the whole, the care documentation demonstrated that the health social and welfare needs were reviewed and evaluated. The care plans however do not evidence any involvement of resident and whilst the care plans evidenced regular review, there was no evidence of the reviews being carried with the involvement of the resident or their representative. Shortfalls within the care plans were identified and discussed and these include: monitoring and cross Care Homes for Older People Page 13 of 34 Evidence: referencing of identified weight loss, and the promotion of continence. Little information was documented about the sensory needs of residents e.g poor eyesight and lack of hearing and to ensure that person centered care is provided this needs to be developed. From direct observation and talking with staff and residents the care practices at present are performed by rote so as to get the care completed within the time restraints and therefore lack the important person centered approach that would benefit and improve the quality of life experienced by the people who live in the home. These identified areas were acknowledged by the manager and will be discussed and addressed with the staff at the staff meeting and the staffing levels will be reviewed. Therefore a requirement has not been made at this time, but will be followed up at the next key inspection. Risk assessments for assessing residents health needs are included in the care planning format used by the home, and all risk assessments were found to be completed but not all followed through with an appropriate plan of action when identified as required, this pertains in particular to documented weight loss. Access to a call bell for those who are physically frail needs to be reviewed within a risk assessment framework so as to ensure residents are safe. The home has a clinical room to store the residents medication safely. There is a clinical fridge and temperatures of the room and fridge are recorded daily. The home have a range of policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. However some were in need of review and updating to ensure that they are in line with current legislation. e.g Homely remedies and status of controlled medications. The home have an oxygen cylinder that is specifically used for emergency and first aid purposes, to ensure that it is used safely and appropriately there needs to be a policy and procedure in place for the protection of residents and discussed and agreed by the homes G.Ps. Medication Administration Charts (MAR) were found to be in the main competently completed which ensures that the health and safety of the residents are promoted and protected. The comparison signatures of staff able to administer medication were available and provide a clear audit trail. Some areas of good practice were discussed with the senior nurse on duty and the manager during the inspection and include agreeing on a rationale for P.R.N (As required)medication and the code used when not needed or refused. Staff were seen to be respectful and considerate to all residents and visitors. Each of the residents were addressed by their preferred term and dressed appropriately in well laundered clothing. Due to time constraints staff tend to presume that residents do not change their minds and do the normal day to day routine, however when residents talked about Care Homes for Older People Page 14 of 34 Evidence: themselves they would appreciate being asked if they would like to move to a different room, get up at a different time, go to bed later/earlier, bath or shower and would like to keep up with local and world news. Not being given the choice impacts on their dignity. The staff were very conscientious in protecting residents privacy when using the hoist and when offering personal care. Care Homes for Older People Page 15 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lifestyle and meals experienced by residents at this time does not always meet their expectations choices or preferences Evidence: The home has an activities programme displayed on the lounge notice board and this reflects the activities available and includes card and board games. Activities take place every afternoon for one hour, 2-3 pm. From direct observation on the day it evidenced that this is not ideal time as many of the residents were sleepy and dozing in their chair after their mid day meal. From talking with staff throughout the day the staff do not have the time to provide activities to residents in their rooms and some residents spoken with were unaware of what activities are available. The activities in the home need to be developed and structured to match residents expectations and preferences and meet their social and recreational interests and needs. The residents religious views are explored on admission to the home and there is a monthly interdenominational church service. From discussion with staff and visitors it was confirmed that there are no restrictions on visiting as long as consideration is shown to all the residents. From talking with visitors it is clear that relatives are made to feel welcome when they visit. The documentation reviewed did not evidence that Care Homes for Older People Page 16 of 34 Evidence: residents are enabled or supported to go out on trips or outings and some residents expressed that this would be enjoyed. There is no separate dining area and residents either eat in their bedroom, in the lounge from a small individual table or in the conservatory. The meal time was seen to be a solitary experience for the residents and there are some able residents that would benefit from a more stimulating environment and company. There is a 4 week rolling programme of meals with the residents being asked daily of their preferences for lunch and supper by the cook. Residents have the option of two choices both at supper and lunch and the supper menu generally has a light cooked option. The menus demonstrated a nutritionally balanced and varied diet which change seasonally. The cook was knowledgeable regarding the residents needs in respect of diabetic, soft and vegetarian meals. There is no formal recording of meals eaten and from the records of weights viewed and the food returned, it would benefit the residents if this was commenced so as to monitor weight loss and seek expert advice pro actively. The residents feedback in respect of the meals provided was mixed with some residents saying its alright nice food, good choice usually and others saying that that it was bland sometimes good, sometimes not. Discussion with residents also identified that they would like breakfast to be varied and perhaps a cooked breakfast occasionally. One resident stated that supper was at 5-5.30 pm and because the individual gets so hungry as that is the last meal until the next morning at 07 am that the individual saves half the sandwich to eat later. This is something he should have been able to share with staff and discuss a late supper provision. The manager stated that this long period of time without the choice of something to eat would be addressed and reviewed, therefore a requirement has not been made at this time, but will be reviewed at the next key inspection. The quality assurance systems in the home therefore should include residents views of the meals in the home as at present they do not meet all residents likes and preferences. The last environmental health inspection report was available and positive. The catering team complete the safer cooking, better business book daily. Care Homes for Older People Page 17 of 34 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. Practice in the home ensures that complaints are responded to with residents and their representatives being confident that they are listened to and demonstrated that robust procedures are followed Practice in the home ensures that adult protection issues are responded to when identified Evidence: The complaint policy and procedure is clear and uncomplicated and a copy of this is readily available in the home and the Service Users Guide. A system of recording complaints was demonstrated to the inspector during her visit to the home. The AQAA stated that the home has not received any complaints since the last inspection and the complaint book was empty. Residents spoken with confirmed that they were confident that any complaints or concerns that they had would be listened to and responded to effectively. comments included I moan and then its dealt with I dont like to grumble. The home has relevant guidelines on the protection of vulnerable adults and most staff have received appropriate training, a further training course is due this week for the new members of the staff team. The staff team have a clear understanding of adult protection guidelines and are aware of how to initiate an investigation if required. There have been no safeguarding Care Homes for Older People Page 18 of 34 Evidence: referrals since the last key inspection. The appointed manager could not find the new Sussex Multi- Agency policy and procedures for Safeguarding Vulnerable Adults and will request a copy from Social Services. Care Homes for Older People Page 19 of 34 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. St Davids Nursing Home provides a comfortable clean and safe environment for those living there and visiting. Residents and their families are enabled and encouraged to personalise their room and rooms are homely and reflect the residents personalities and interests. Evidence: The visit to the home confirmed that the residents benefit from a safe and well maintained environment. The AQAA stated that that there is a rolling plan of decoration in place that includes the fittings and fixtures. A maintenance person takes responsibility for ensuring that the routine and emergency problems are dealt with in a timely fashion and then dates and signs the maintenance book. The communal space consists of a lounge and conservatory, the latter having a moveable dining table and provides access to a small patio garden overlooking the sea. This is underused at present with most residents sitting in the lounge area or their bedroom. The residents individual accommodation consists of six double rooms, two of which have ensuite facilities, consisting of a WC and washbasin and twelve single rooms of which four have ensuite facilities. Those rooms without ensuite all contain hand washbasins. Care Homes for Older People Page 20 of 34 Evidence: The home has assisted bathing and showering facilities and grab rails, hoists and other aids to enable residents to maintain an independent life style. A call bell facility is available in all areas of the home and in the main all residents were seen to have this facility in their reach. One resident said that sometimes staff forget to ensure its in his reach, this was brought to the managers attention. All floors are served by an appropriate sized shaft lift. The residents private accomodation were found attractively decorated with good quality furniture and fittings, those sharing a room all have privacy screens. Bedrooms have a lockable drawer for residents personal effects and most rooms are equipped with variable height beds dependant on their physical needs. Water temperatures to resident outlets are monitored on a regular basis and records showed that these were within recommended parameters. Polices and procedures for infection control are in place and are updated regularly. Good practice by staff was observed during the day and there were gloves and aprons freely available in the home. The home was clean and free from offensive odours on the day of the inspection. Sluice and laundry areas were found clean and safe and this demonstrated that the staff follow the homes policies and procedures in respect of infection control measures. Care Homes for Older People Page 21 of 34 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. The homes recruitment procedures need to improve to fully protect their residents and whilst staff training is provided not all staff have received the training required to ensure they are able to provide the support and care the residents need. Evidence: The home currently have eighteen residents living in the home and there has been a management decision to reduce the amount of staff on duty. The dependency levels of the residents however have not been fully taken in to account to meet the health, social and welfare needs of the residents. The staff are committed to giving a good level of personal care,which does impact negatively on the social and welfare needs of residents. The mornings are very busy and this leaves little time for staff to interact positively with residents, both in their rooms and the lounge areas. The night shift evidenced one Registered General Nurse and one carer and residents and staff stated that they start waking residents up at 5-5.30 am. One resident said they wake me up early but I do doze, another said its a long day when you get up early. There is no documental evidence to suggest that this is the residents wishes. The manager needs to ensure that there is flexibility to the staffing levels and that they are adjusted according to the changing needs of the residents so as to ensure that the residents are safe and protected at all times. A selection of staff recruitment files five were viewed and demonstrate that the home Care Homes for Older People Page 22 of 34 Evidence: follow a recruitment process to protect residents and contained most of the relevant information required. There was evidence of health questionnaires, POVA first, Criminal Record Bureau checks, two references, a resume of previous employment and work permits where necessary. However as discussed the process does need to improve to fully protect the residents in ensuring that the POVA check is in place before the staff member works in the home, that there are two references in place and on file to be viewed and all staff have an identity photograph on file. The files did not contain an up to date job description and these were found and will be distributed to the staff and it was unclear from talking to staff whether they have a copy of the Codes of Conduct published by the General Social Care Council. All the paperwork is kept within a locked room to ensure confidentiality. The AQAA stated that there are 16 permanent members of staff and of those 16 have completed the induction training recommended by skills for Care, however this could not be confirmed by the staff spoken with and there was no documentation available at this time. All care staff undertake an induction day on commencing work at the home, however the newly appointed manager has not received an induction in to her role as the manager. Seven of the care staff have completed the National Vocational Qualification level 2 or 3 in care or the equivalent and staff said that they were encouraged to undertake this and other training relevant to the care of the residents in the home. The staff training file was reviewed with staff as they were gaps in respect of their mandatory training files and this was identified to the manager who would arrange training in the near future. Staff confirmed that they had missed training due to annual leave and some had attended but it was not recorded and no certificate in place. The training records need to be up to date and accurate to ensure that staff are trained and competent to perform their job, thus ensuring that the residents needs are met by trained and competent staff. Care Homes for Older People Page 23 of 34 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 management systems found within the home at this time are not sufficiently robust to ensure that the home is run in the residents best interests. Evidence: The registered manager and owner is Ms Davidson who is a level 1 registered nurse with the Registered Managers Award and is registered with the Commission. At the last key inspection in June 2007, a relief manager was to be in post for six months as the registered manager/owner was taking time away from the home and deciding whether to continue managing the home on a daily basis or whether she will employ a manager to do this. This was not confirmed or put in writing and it is therefore a concern that this has not be formalised since. Ms Davidson is currently abroad and the relief manager is no longer in post and an appointed manager has been in post since May 2009 without the commission being informed. This is a breach of regulation 38 and 39 of the Care Standards Act 2000 and a letter has been sent to the registered manager/owner in respect of these breaches. The Statement of Purpose Care Homes for Older People Page 24 of 34 Evidence: and Service Users Guide do not reflect the changes to the management structure and therefore not ensuring residents are kept informed. The manager has been working in the home since February 2009 in the first instance as a registered nurse and then as appointed manager in May 2009. The appointed manager has not had a thorough handover and is developing her knowledge and skills with the support of the staff team. She is aware that there is lot to learn and is also aware that she does need support in the running of the home. There are areas of management that are currently not in place and these include supervision, training, internal monitoring systems that include residents thoughts on the home, e.g food provision and lifestyle, and robust recruitment processes. These impact negatively on the outcomes for the people who use the service. The appointed manager demonstrated a willingness and open mind to the information shared and was enthusiastic about this role. At the present time she is still having to seek guidance from the registered manager (who is currently abroad) in respect of staffing levels and therefore does not have full management responsibilities. She has recently enrolled on an NVQ level 4 in management course at the local college. The appointed manager has been directed to the CQC website in order to submit her application to register as manager. It was stated in the AQAA and confirmed during the visit that residents and their representatives receive questionnaires on a regular basis regarding their views on the services offered by the home responses from these are then collated and acted upon. Residents feedback indicated that these systems would benefit from review as there are areas that residents feel strongly about, that are not reflected in the results of the audits seen. Staff meetings are held at regular intervals and the staff are due to have one soon, this will be the first one held by this manager. Regulation 26 visits by the registered provider are not in place as the registered person is abroad and therefore do not contribute towards the quality assurance systems in the home to ensure that the home is run in the best interests of residents. The Annual Quality Assurance Assessment was received by the CSCI prior to its due date and provided sufficient information about the home, but did not include the management changes. The home does not act as appointee for any of the residents, but does keep monies for safekeeping with appropriate records in place. These were seen and in order, thus safeguarding residents monies. The supervision of staff was discussed and this was an area of confusion with both the Care Homes for Older People Page 25 of 34 Evidence: appointed manager and staff. The records evidenced that last year they had clinical supervision but not formal supervision and this needs to be commenced As mentioned previously the records did not evidence all mandatory training and therefore does not ensure that the health safety and welfare of residents promoted and protected The Annual Quality Assurance Assessment stated that all utilities and equipment had been regularly serviced and certificates of this were seen at the inspection and risk assessments throughout the home were in place. Care Homes for Older People Page 26 of 34 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 34 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 1 4 That the registered person 19/08/2009 ensures that the management details of the home are correct and reflect any changes of whom is in day to day charge of the home and of who to contact if they wish to make a complaint. To ensure perspective service users have the information they require to make an informed decision about where they are to live. 2 7 15 That the registered person 19/08/2009 ensures that the care plan is drawn up with the involvement of the service user and or representative and are involved in the regular reviews. To involve the service user in how their needs will be met. Care Homes for Older People Page 28 of 34 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 3 10 12 That the registered person ensures that the residents dignity is respected at all times and with particular regard to their individual choices of personal care and every day choices. To ensure that service users feel they are treated with respect. 19/08/2009 4 12 16 That the registered person 19/08/2009 ensures that the routine of daily living and activities are flexible and varied to suit the individuals living in the home. That service users are enabled to make choices, in regard to daily living, food and meal times leisure and social engagements. That services users find the lifestyle in the home matches their expectations and preferences. 5 27 18 The registered person needs 19/08/2009 to ensure that: There are sufficient suitably qualified, competent and experienced persons working in the the care home in such numbers as are appropriate for the health and welfare of service users. Care Homes for Older People Page 29 of 34 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 That service users are reassured that their needs are met by the numbers and skill mix of staff. 6 29 19 That the registered person operates robust recruitment procedures and ensures the protection of service users by: POVA first in place before commencing work with the service users. Two references in place before employment. Identity photographs of prospective staff. That all staff receive a job description and code of conduct set by the General Social Care Council. That service users are supported and protected by the homes recruitment policy and procedures. 7 30 18 That the registered person 19/08/2009 ensures that all staff are trained and competent to perform their role and meets the needs of service users. That the service users are cared for by trained and competent staff. 8 31 38 That the registered person ensures that if absent for a 19/08/2009 19/08/2009 Care Homes for Older People Page 30 of 34 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 continuous period of 28 days or more, the registered person shall give notice in writing to the Commission of the proposed absence. the notice shall specifya) the length or expected length of the absence b) the reason for the absence c) the arrangements which have been made for the running of the care home during that absence. d) the name, address and qualifications of the person who will be responsible for the care home during that absence. That the home is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. 9 31 39 The registered person shall give notice in writing to the Commission as soon as it is practicable to do so if any of the following events takes place or is proposed to take placea) a person other than the registered person carries on or manages the care home. 19/08/2009 Care Homes for Older People Page 31 of 34 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 b) a person ceases to carry on manage the care home. To ensure that people are informed of any changes to the running of the home. 10 33 24 That the registered person 19/08/2009 ensures that there are effective quality assurance and quality monitoring systems based on seeking the views of service users are in place to measure success in meeting the aims, objectives and statement of puropose of the home. That the home is run in the best interests of service users. 11 36 18 That the registered person ensures that the the employment policies and procedures adopted by the home and its induction, training and supervision arrangements are put in to practice. Thast staff recieve formal supervision at least six times a year and includes all aspects of practice, philososophy of care in the home and career debvelopment needs. 19/08/2009 Care Homes for Older People Page 32 of 34 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 That staff are appropriately supervised. 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 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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