Inspection on 10/06/09 for Sunrise Operations Sonning Limited (Reminiscence Neighbourho

This is the latest available inspection report for this service, carried out on 10th 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

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: Sunrise Operations Sonning Limited (Reminiscence Neighbourhood) Sunrise Operations Sonning Ltd (Reminiscence) Old Bath Road Sonning Reading Berkshire RG4 6TQ     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: Sally Newman     Date: 1 0 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 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 32 Information about the care home Name of care home: Address: Sunrise Operations Sonning Limited (Reminiscence Neighbourhood) Sunrise Operations Sonning Ltd (Reminiscence) Old Bath Road Sonning Reading Berkshire RG4 6TQ 01189444312 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): sonning.rc@sunriseseniorliving.com Sunrise Operations Sonning Ltd Name of registered manager (if applicable) Mrs Debra Ann Heyes Type of registration: Number of places registered: care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: (1) The registered person may provide the following category/ies of service only: Care home-(PC) to service users of the following gender: Either Whose promary care needs on admission to the home are within the following categories: Dementia (DE) (2) The maximum number of service users to be accommodated is 36. Date of last inspection Brief description of the care home Sunrise Operations Sonning Ltd (Reminiscence Neighbourhood) is a substantial detached property that has been purpose built to provide dual accommodation consisting of two registered homes. The thirty-six beds for the reminiscence home are on the second floor with the nursing home on the first and ground floors. The home is located in Care Homes for Older People Page 4 of 32 Over 65 36 0 Brief description of the care home Sonning, Berkshire and access to shops, church, public transport and other local services is within reach. Ten of the bedrooms are single with en-suite facilities, and there are thirteen single rooms that share a bathroom between two residents. All areas of the home are furnished to a high standard. There is a passenger lift accessing all floors. The units are secure with key pad entry and exit on all doors. The unit has access to a secure garden for residents to access at all times. There is ample parking to the front of the home. The fees at the home vary depending on the room chosen and the care needs of the individual resident and are available on request but range from £1120 to £1400 per week. The fees to not include the cost of hairdressing, chiropody, personal toiletries and newspapers. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection conducted over the course of three days and included a visit to the service of seven hours duration by two inspectors. In addition, a Pharmacist inspector employed by the Care Quality Commission conducted an inspection of the arrangements for medication within the home. At the time of the visit to the service information requested by the Commission had not been received. At the time of writing this report this information was available and the results have been incorporated into this report where appropriate. This was the first inspection involving a visit to the service since its registration in January 2009. The appointment of the manager is her first to a registered service. The manager has spent time recruiting and training staff and has put effort into building a cohesive and effective team. Care Homes for Older People Page 6 of 32 The manager has improved the quality and range of pre-admission information and is now not willing to succumb to any pressure to admit people unless she is confident that the service can meet their needs. The provider has a range of policies and procedures relating to equality and diversity. From the evidence seen the inspector considers that this service would be able to provide a service that meets the needs of individuals of various religious, racial and cultural needs. The home is currently subject to local safeguarding procedures following several concerns about the homes ability to meet the needs of individual service users. The Commission has been informed about these concerns and complaints by the Local Authority. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All prospective service users and their representatives are provided with sufficient information in order to make an informed choice as to whether the home is suitable for them. Pre-assessment information is not always sufficient to provide an accurate overview of the persons needs. Evidence: All prospective service users are provided with a copy of the Statement of Purpose and a Service Users guide. These documents provide information about the services that can be provided. It was noted that the Statement of Purpose required some updating in relation to the name of the Registered Provider and the Care Quality Commission. A pre-admission assessment is undertaken usually at the individuals own home or elsewhere if more appropriate. Written information provided by the service and requested by the Commission states that information is obtained from the General Practitioner. However, it does not confirm that other relevant professionals such as Psyco-Geriatricians, Occupational Therapists or Care Managers are consulted as part Care Homes for Older People Page 10 of 32 Evidence: of the pre-admission assessment process. The manager confirmed that she is now undertaking a much wider and comprehensive assessment to ensure that the home can meet the needs of prospective service users. This comprehensive assessment is essential to identify any needs particularly in relation to challenging behaviour or health matters and provide for a thorough evaluation as to whether the home can meet the needs of individuals that have been referred. There was evidence from recent assessments seen that there had been improvements in the range and quality of information obtained prior to a place being offered. Where any uncertainty about the ability of the home to meet individual needs exists the manager in consultation with families and referring Authorities will arrange an agreed trial period to establish whether the home can meet their needs. There was one example where to date this had proved successful and the individual involved was likely to be formally offered a place. Trial visits are arranged according to the needs of prospective service users and can take the form of tea visits or over night stays. These options are not always appropriate for particular individuals who may be disorientated by the experience and in these circumstances alternative arrangements are made. All service users are provided with a contract detailing the terms and conditions of the placement and these were evident in plans of care seen. Care Homes for Older People Page 11 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of service users in respect of their health, personal and social care are mostly reflected in plans of care. Changing health care needs are acted upon and the arrangements for medication are mostly robust. The privacy and dignity of service users is upheld and their wishes in relation to death and dying are respected. Evidence: Four plans of care were seen. Plans of care are completed by the manager and those seen were comprehensive and gave clear instructions for staff in meeting the needs of individual service users. Concerns have been raised by members of the Community Older Peoples Mental Health Team in respect of the number of referrals that have been made to them since this service opened. In particular there have been concerns about the quality of initial assessments, the consistency of staff communication with visiting professionals, the number of medication errors and the management of challenging behaviour. These concerns are still being investigated and dealt with under the local safeguarding protocols. All updating of plans of care are undertaken by the allocated senior care manager, Care Homes for Older People Page 12 of 32 Evidence: which is the title used for senior care staff. All plans of care are reviewed after 30 days following admission and 6 monthly thereafter or as required. It was noted that only information of one months duration is routinely kept in the current plan of care. Information older than one month is stored in loose leaf format and raises questions about how easy this information is to access. The manager confirmed that she had already raised this as an issue and the Regional Manager undertook to review this practice in all homes. Written information provided by the manager identified that updating of care plans on a monthly basis needs to be improved and that daily notes require more detail to accurately reflect the level of care provided. There was evidence within those care plans seen that the services of the designated General Practioner is called upon when the changing health needs of individuals indicate intervention is required. It was noted that it is Company policy that the Wellness Nurse conducts monthly health care checks on all service users but records indicated that this was not being undertaken. There was evidence that health monitoring in terms of weight management is undertaken where this is necessary. Two examples were provided where individuals had appropriately increased their weight. A sample of risk assessments was seen. It was noted that some general risk assessments had been used for individuals and it was the view of the manager that this was not correct procedure. Individual risk assessments should be specific to a particular service user and no general risk assessment should be headed with the name of an individual. It was further noted that a recent risk assessment drawn up following a challenging behaviour incident was not available on the plan of care. The manager stated that it was available on the IT system to which staff have access but conceded that this should be readily available in hard copy to ensure that staff are familiar with its contents and guidance. The relative of a temporary resident now not staying at the home had complained about the delay in the home attending to unexplained bruising. The manager was adamant that this had been addressed appropriately by seeking medical assistance and without any undue delay. It is considered that if these concerns had been managed as a formal complaint the matter would have been fully investigated and would have resulted in a clear and transparent conclusion. As a result of this incident and from experience elsewhere within the organisation body mapping has been introduced where any marks or injuries are clearly documented at the point of admission and when an individual is transferred to hospital. Medicines are managed well. The home stores medicines other than controlled drugs in the controlled drugs cupboard which is contrary to guidelines from the Pharmaceutical Society of Great Britain. When medicine are prescribed on a when Care Homes for Older People Page 13 of 32 Evidence: required basis, there was no care plan on the use of these medicines. Previous medicine administration recordcharts are stored in another service in the same building. It was clear from observations undertaken throughout the day that the privacy of individuals is respected. Staff were observed knocking on bedroom doors before entering and interacting with service users in a respectful and courteous manner. Plans of care indicated the preferences of individual service users with regard to their wishes concerning end of life care and instructions as to funeral arrangements. Care Homes for Older People Page 14 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home were able to choose their own life style, social activities and maintain contact with families and fiends and participate in a wide range of social and recreational activities. The food provided was healthy, varied and nutritious and according to individual choices and preferences. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home were able to choose their own life style, social activities and maintain contact with families and fiends and participate in a wide range of social and recreational activities. The food provided was healthy, varied and nutritious and according individual choices and preferences. Evidence: The home employs various people to arrange or provide activities including outside entertainers and a visiting massage therapist. There is a a printed programme of activities each month and the one for the month during which this site visit took place indicated that at least 5 different things were planned each day of the week and they included a wide and varied range of organised activities that people could join in e.g. discussion groups; board games; quizzes; birthday socials; clubs (gardening and arts) Care Homes for Older People Page 15 of 32 Evidence: arts and crafts; bingo; baking; mini bus outings; and computer games i.e.Wii During the first part of the site visit we saw staff accompanying two people from the reminiscence neighbourhood to another part of the building where they were going to take part in a quiz, have coffee and biscuits and then benefit from exercise to music. We later saw 8 people being taken out on a mini bus trip and a number of people enjoying a musical entertainment session. At all times they were accompanied and supported by care staff from the reminiscence neighbourhood. Local clergy visits the home regularly. One person living in the home who was spoken to said. There is all sorts of entertainment. They tried to persuade me to go out on a bus trip just now. I have been on one or two. Observation of the homes routines and discussion with care staff indicated that individuals life styles and preferences were respected, that routines were flexible and relationships between people living and working in the home were friendly, relaxed and informal. One visiting relative in summarising her opinion of the home said. Overall the place is excellent. The staff should be made into Saints they are very attentive. They let me know if they have any concerns about Mum. Mum seems happy and content. She has a great quality of life. When one of the care staff was asked about a person who was eating their breakfast in the dining room later than anyone else and was consequently on her own he said. Z likes her lie-in in the morning with her cup of tea and comes to breakfast later. People living in the home and visitors that were spoken to during the site visit confirmed that there were no restrictions concerned with visiting the home. Individuals visiting the home also said that that they were always made welcome. Individuals were able to bring personal items into the home including furniture and it was apparent from discussion and observation during a tour of the building that some people had taken some trouble to personalise their bedroom accommodation. Discussion with people living in the home and catering and other staff observation of the main meal of the day and the kitchen facilities and areas indicated that the food provided was nutritious and there was a wide range of meals provided with a selection of choices every day. In addition special needs and individual preferences and needs were catered for e.g. soft and diabetic diets. Fresh ingredients were used in the preparation of meals and the ready availability of fresh fruit fluids was noted. Individuals could choose where to eat and the menu for the day was on display in the kitchen/dining area. Care Homes for Older People Page 16 of 32 Evidence: Individuals food preferences, dislikes, food related allergies and their nutritional and dietary requirements were recorded in their care plan documents and the information was also readily available to catering staff in the kitchen. When asked about the choices that individuals made about food the chef said. They can have whatever they want and if we have not got what they want we will get it for them. One of the people living in the home when asked their view about the food provided said. The food is endless it is a struggle not to eat too much and the quality is good. Care Homes for Older People Page 17 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are policies and procedures in place in respect of concerns and complaints but the response of the service needs to be more robust to protect service users. The rights of service users are upheld. The protection of service users from the risk of harm and neglect could be enhanced by further staff training. Evidence: A visitor spoken to during the site visit was confident about raising any concerns with the homes manager or any of the senior staff working in the home. She said. The complaints procedure was in all the information they gave us and they were meticulous in taking us through it. I would have no hesitation in speaking to the manager. As mentioned earlier in this report concerns expressed by a relative of a temporary service user should have been dealt with as a formal complaint under the organisations own procedures. No complaints were recorded in the service maintained complaints record. However, as mentioned previously in this report it was noted that the home had not responded by recording a formal complaint when a family member had expressed concern about their relatives care. Plans of care examined included reference to ensuring any decisions that were made on behalf of an individual unable to do so because of their mental frailty would be made in accordance with the best interest principles of the Mental Capacity Act 2005. Following an incident involving two people living in the home the Registered Manager had been advised by a health care professional to apply to the Local Authority for an Care Homes for Older People Page 18 of 32 Evidence: urgent authorisation in accordance with the Deprivation of Liberty Safeguards (DOLs) under the Mental Capacity Act. A DOLs assessor from the Local Authority was evaluating the situation at the time of the site visit and she indicated that the arrangements made by the manager in consultation with relatives of the individuals concerned were satisfactory and did not constitute a deprivation of liberty. She said. The degree of restriction of a particular activity is not significant or sufficient enough to be considered as depriving the person of their liberty and he is reluctantly accepting of the situation and cooperating with the arrangements. There is a risk assessment in place following the incident, which I think is good. The manager made the decision about the arrangements in consultation with the relatives and the daughter is very pleased with the home and the way things have been managed. There was information in the staff office about the Local Authoritys safeguarding vulnerable adults procedures and also in the registered managers office as well as information about DOLs. Staff spoken to had a good understanding of what constituted abuse and the need to bring concerns to the attention of someone as a safeguarding matter and also of their ability to whistle blow if necessary. However no one spoken to seemed aware of the essential role of the local authority in the safeguarding of vulnerable adults. It was noted from staff training records and from discussion with the manager that protection of vulnerable adults is undertaken within the organisation and Local Authority safeguarding training is not accessed. It is considered that it is likely that these arrangements have led to staff not understanding and lacking in knowledge in relation to the role of the Local Authority in taking the lead on safeguarding matters. It is recommended that the service give serious consideration to accessing the Local Authority safeguarding training to ensure that staff fully understand the responsibilities of all agencies involved. The home is subject to safeguarding concerns, which are being monitored by the Local Social Services Department. This has involved regular meetings with Management personnel responsible for the day to day running of the home. The Regional Manager said that the homes administrator arranged to have the details of people who moved into the home included on the local electoral roll to ensure that they would have the opportunity to exercise their right to vote if they wished to do so. The Manager confirmed that it is not the role of the home to provide any physical intervention with service users who may be distressed or exhibiting challenging behaviour. In these instances distraction techniques are used, which staff have received some training in applying. Given the concerns about the ability of the home to appropriately manage challenging behaviour consideration should be given to Care Homes for Older People Page 19 of 32 Evidence: providing more detailed and informative training for staff. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes environment was comfortable, safe and well maintained. The homes procedures and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. Evidence: At the time of the site visit the home had only been operating for six months and exterior and interior of the premises, its decor, furnishings, fittings and equipment were in excellent repair. The site visit was part of the key inspection of the reminiscence neighborhood which comprised the top floor of a three story building the other two floors provided a separate and different service. There was also no unpleasant odour anywhere in the reminiscence neighbourhood. Lighting and the temperature levels throughout the building were good. Access to other parts of the building and to the outside by people who lived in the reminiscence neighbourhood was made available by two passenger lifts as well as stairs. Entry to the lift area and stairwell was controlled by a keypad system in order to prevent accidental injury or harm being suffered by people living in this part of the Care Homes for Older People Page 21 of 32 Evidence: building. Bedrooms were spacious and all single rooms of which there were 10 had their own en-suite shower and toilet. Mews/Companion suites comprised two rooms that shared a kitchenette area and a room with a shower and toilet and there were 13 of these. There were three communal assisted spa baths provided as well as a number of communal WCs throughout the neighborhood area. The communal WCs were provided with liquid soap and paper hand towels in order to promote infection control. In toilet and bath areas the fittings contrasted with the decoration in order to assist people with a visual impairment. The temperature of the delivery at all hot-water outlets was checked regularly to ensure that it was being delivered at a safe level in order to prevent scalding. Restrictors were fitted to all windows as a safety precaution and high railings were fitted to a large balcony that provided views of the garden and surrounding area that was readily accessible from the main lounge area. Other communal facilities comprised dining and lounge areas that were provided with comfortable furniture. In addition there was a multi-sensory (snoezelen) room that was fitted with a range of equipment designed to stimulate a persons various senses for therapeutic purposes. The corridors throughout the neighbourhood were very wide and could easily accommodate wheelchairs and were fitted with railings. There were also small areas in the corridors where people could sit and have some privacy away from others if they wanted peace and quiet. Memory boxes were located outside bedrooms in which items personal to the individual using the room could be placed as an orientation aide. There was signage throughout the neighbourhood to indicate the use of communal facilities or the purpose of the room and a Braille version was included on them. While they were not particularly large or in a style or colour that research suggests is helpful with perceptual problems or visual impairment the intention was to promote the independence of people living there. There was some discussion with the management staff about the pattern on the floor covering and the colour schemes throughout the neighbourhood which again research indicates may not be helpful to people with dementia. The home employed maintenance personnel to undertake minor repairs and redecoration and to monitor the homes utilities and services as well as to ensure that Care Homes for Older People Page 22 of 32 Evidence: there were contracts in place for the servicing of systems and to promote the health and safety of everyone living and working in the home. There was a laundry located in the neighbourhood that dealt with items of personal clothing and a facility elsewhere in the building that laundered bed linen. There were procedures in place for dealing with soiled items. The cleaning of bedrooms and communal areas was carried out by house-keeping staff and they had clear guidance and procedures available to them about the work that they carried out. Care staff carried a small bag around their waists in which they carried equipment essential to promote infection control. One of the care staff said. In my pouch I carry a hand sanitizer and gloves. We discard them every time we use them and replace them with a new pair. We have received instruction in the 6 steps for washing hands properly. We have plastic disposable aprons. Comments from people living in the home and visitors about the accommodation and the condition and cleanliness of the home included the following. I have a nice big room it is very comfortable. Overall the place is excellent. I think the accommodation is really good Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment, training, deployment, level and skill mix of staff ensures that the needs of people living in the home are met and their safety is promoted. Evidence: The number of staff on duty in the home at the time of the site visit comprised three care staff and two senior staff (care managers and lead care managers) from 06:45 to 14:15 hours and three care staff and one senior from 14:15 to 21:15 hours. All staff spoken to and a visiting relative indicated that they thought the number of staff on duty was enough to meet the needs of the people accommodated at the time of the visit i.e. 14. One of the care staff said. There were 4 staff on duty this morning including the coordinator. I believe it is enough. We have enough people available if we need to double up to help someone or to accompany someone downstairs. The manager confirmed that it was her view that staffing was currently adequate to meet the needs of the current service users. However, staffing would be continually reviewed as more service users moved into the home. All staff spoken to whatever their role in the home including maintenance personnel and house keepers receive two week corporate induction training that includes two days about dementia care and also training about safeguarding vulnerable adults. Confirmation in the form of completed and partially completed induction folders were in evidence in the managers office. A lead care manager stated that for staff providing Care Homes for Older People Page 24 of 32 Evidence: personal care they received training following their initial induction that covered topics such as the fundamental principles that underpin social care i.e. privacy, dignity, choice, independence and rights, etc. Individuals spend a minimum of 3 days shadowing experienced staff and then if necessary will double up with another member of staff until they can demonstrate they are competent. It is the intention of the service to provide National Vocational Qualifications for those eligble staff from late June 2009 onwards. There are a range of regular staff meetings to which staff can attend. These include monthly care staff meetings that excludes the Registered Manager. The Manager also has the opportunity to meet with other managers in the region on a regular basis. All staff spoken to indicated that they did not start working in the home until references that they had provided had been followed up by the home and police checks had been carried out ensuring that they were suitable to work with vulnerable people. The massage therapist said. They insisted that I was CRB checked. All care staff spoken to knew what help and support the individuals that they were designated to look after required in great detail. They all described how they provided care for individuals that was set out in care plans that were later examined. They all expressed enthusiasm about their work and also being part of a team with supportive management and colleagues. Comments from them included the following. I enjoy working with my colleagues. It is a place where you have to and can create a nice atmosphere. I love it here. It is good and will become excellent when the team is fully developed. I had not done this sort of work before and I love it. I had a relative with Alzheimers disease. I hope to start NVQ 3 soon. Four staff files were seen. They followed a uniform format and included all the documentation required by regulation. It was noted that all references are obtained in writing and then the last employer is contacted by telephone whereupon their responses are recorded. All providers of service such as the hairdresser, chirpodist and a beauty therapitst have provided application forms and have been Criminal Records Bureau and Protection of Vulnerable Adults checked. A staff training record was provided by the administrator. The majority of staff training is provided in house. With the exception of First Aid, Risk Assessments and currently Moving and Handling, although this will be provided in house once a Train the Trainer qualification had been obtained. Additional practice related training is provided by the Manager and forms an ongoing programme and is applied according to individual need. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from a manager who is gaining in experience and is described as fair and approachable. There are systems in place to ensure that the views of service users is taken into account in the running of the home. There are robust financial procedures to protect service users and staff and service users are protected by the homes policies and procedures on health and safety. Evidence: The Registered Manager is a qualified nurse and has extensive management experience although this is her first appointment to a registered service. She advised that she felt well supported by her clinical line manager but recognised that the position of manager was very demanding and although she had learnt a great deal there was still considerable work to be undertaken. Care staff veiws about the Registered manager were all very positive and included the following. Debbie is knowledgeable about dementia. It is difficult for her to cover both homes. She is very approachable and does not discrinate against anyone in any way. Care Homes for Older People Page 26 of 32 Evidence: She puts the residents first. Debbie is the manager she is open and encourages us and is approachable. It was noted that since March the manager has been overseeing the Assisted Living service located on the ground floor in addition to her duties and responsibilities for the Reminiscence Neighbourhood. A manager has now been appointed to the Assisted Living service and is due to take up the position imminently. The Manager has not been entirely clear of her responsibilities to notify the Commission of incidents effecting the health and well being of service users. Some previous incidents had not been notified. At the time of the visit the Manager was able to demonstrate from copies of 7 notifications made since the end of April that she now understands this duty. The organisation provides a range of monitoring systems to evaluate the service provided and the outcomes for service users. In addition to proprietor visits under Regulation 26 of the Care Home Regulations a full quarterly audit takes place covering all aspects of the home and further annual audits to monitor progress. An external annual audit is also undertaken. A periodic audit of medication is also undertaken by the Regional Director. It is company policy that an annual satisfaction survey is undertaken that seeks the views of service users, their relatives and Representatives and other professionals with an interest in the home. Records of regulation 26 visits were seen together with one quarterly audit already undertaken. The manager was able to provide information on the improvements made to areas identified in the report falling short of the standard required. All monies held on behalf of service users and associated records are kept separately and securely within the homes office safe. These arrangements were seen but a full audit was not undertaken. There was evidence from discussion with the manager and from records of booked appointments that the home is providing regular one to one supervision for staff. Staff spoken to indicated that they received regular supervision and appraisal from senior staff in order to discuss their personal and professional development and all said that they hoped to gain relevant qualifications. There are policies and procedures in place in relation to the keeping and maintenance of written records within the home. Records examined indicated that the homes equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment portable electrical equipment; hot water system; etc. Care Homes for Older People Page 27 of 32 Evidence: There were contracts in place for the disposal of clinical and household waste. Records were kept of accidents. Staff spoken to said and records examined confirmed that that they attended regular and compulsory fire and other health and safety training. There was a fire risk assessment for the premises and regular risk assessments of the premises and working practises were undertaken and hazardous chemicals were handled, stored appropriately and information was kept about them. Guards covered all radiators in the home and all windows above the ground floor were fitted with restrict ors. There was an accredited moving and handling trainer on the staff team and there were hoists, and other equipment in the home to promote safe working practises. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 13 To ensure that all risk assessments are relevant to individuals and are accessible to staff. So that staff are familiar with the risks associated with individual service users and can actively minimize them. 31/07/2010 2 9 13 To have clear, person centered care plan on the use of medicines that are to be taken only when needed. so that all care staff follow a consistent approach in the use of this medicine 31/07/2009 3 16 22 Ensure that when significant 31/07/2009 concerns are expressed they are recorded appropriately and demonstrate the outcome of any investigations. Care Homes for Older People Page 30 of 32 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 To ensure that the home operates in a transparent manner. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 To reserve the controlled drugs cupboard for storage of controlled drugs only. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. 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