Inspection on 15/09/09 for The Downs Care Centre

This is the latest available inspection report for this service, carried out on 15th September 2009.

CQC found this care home to be providing an Good 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.

Other inspections for this house

The Downs Care Centre 28/05/08

The Downs Care Centre 23/08/06

The Downs Care Centre 05/10/05

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

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: The Downs Care Centre Laburnum Avenue Hove East Sussex BN3 7JW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Elizabeth Dudley     Date: 1 5 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Downs Care Centre Laburnum Avenue Hove East Sussex BN3 7JW 01273746611 01273737314 thedowns@schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Trinity Care (Hove) Limited care home 25 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 who can be accommodated is: 25 The registered person may provide the following category/ies of service only: 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 categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home The Downs Christian Nursing Home is situated in a residential area of Hove. The entrance is shared with the South Downs Health Trust, which provides an inpatient facility in a separate area of the building. The home, which was purpose built in 1999, is set out over three floors and a passenger lift enables access to each floor. Nursing and personal care are provided in single room accommodation for up to twenty five residents. All rooms have ensuite facilities and there is a lounge and dining room on the two floors where there is resident accommodation. All areas are accessible for those with limited mobility and the home has hoists and bath hoists for those who are less mobile. There are also grab rails and disability aids in the bathrooms and toilets. Care Homes for Older People Page 4 of 31 Over 65 25 0 2 0 1 1 2 0 0 8 Brief description of the care home Well maintained gardens surround the building and the relatives room and garden room provide additional relaxation areas for residents and their visitors. There is a large parking area to the front and side of the building. The home welcomes prospective residents or their representatives to view the premises, discuss their needs with the Registered Manager and spend time with the staff and residents. Current fees range between £430.70 and £842 per week. these do not include extra services such as chiropody and hair dressing and details of these can be obtained from the home. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection took place on the 15th September 2009 from 09.45 to 18:00 and was facilitated by the appointed manager. The manager who has been appointed by the company, is not yet registered with the Care Quality Commission, but for the purposes of this report will be referred to as The Manager. Prior to the inspection the commission sent out ten questionnaires to residents, ten to staff and three health care professionals, to gain views of what it was like to live and work in the home.Of these, three were returned from residents and five from staff. These gave information which has helped in forming the judgements made in this report. Thanks are extended to those who took the time to complete the questionnaires. Care Homes for Older People Page 6 of 31 The Annual Quality Assurance Assessment (AQAA), a document which is required by regulation, and requires the provider or manager to show us what is happening in the home, what has been achieved in the past twelve months and what is planned for the next twelve months, was received when we asked for it. The information we received was accurate and reflected what was occurring in the home.This document also gives us some numerical information which is used in the formation of the report. During the inspection documents relating to admission procedures, care planning, medication, health and safety and catering were examined. Other documents which are required to ensure the smooth running of the home were also looked at. Six residents were involved in the inspection, discussions were held with them in order to find out about the life in the home and whether this met their needs and provided a quality of life which conformed with their expectations. We met two visitors to the home and conversations were held about their views on the care given to the residents. Seven members of staff gave their views on their home, on their understanding of what was required of them and the training available to them. Thanks are extended to the residents, visitors, staff and management for their help, courtesy and hospitality during the day. The last key inspection for this service took place on the 20th November 2008. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Whilst there have been improvements made over the last year, some shortfalls were noted at this inspection and requirements have been made. The manager has not yet been registered with the Commission for Social Care and this is a requirement under the Care Standards Act. The home has not ensured that all new staff have all the documentation required by regulation prior to starting work at the home. On this occasion two members of staff had not had the full requirement of written references prior to commencing employment. Care Homes for Older People Page 8 of 31 The standard and provision of risk assessments were not robust and this could put residents at risk. There were some issues found during the inspection on which requirements have not been made, the manager gave assurances that these would be followed up and this will be checked at the next inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents receive sufficient information about the home prior to their admission, this ensures that they can make an informed decision over whether they wish to live there. Following assessment of the prospective resident, the home informs them in writing about whether the home has the facilities to meet the individuals needs. Evidence: The home provides a range of information for prospective and existing residents about the services provided. These include a brochure and a Statement of Purpose and Service User Guide. Both the Service User Guide and Statement of Purpose were up to date and give accurate information to the reader other than the current address of the Care Quality Commission. Prospective residents are assessed by either the manager or the deputy manager prior Care Homes for Older People Page 11 of 31 Evidence: to admission. Three preadmission assessments seen showed that this is undertaken in a thorough manner with the assessments providing sufficient information to inform staff about the individuals needs. The home then responds in writing to the individual to inform them of whether the home can meet their needs. Contracts and statements of Terms and conditions are given to all residents following their admission to the home. The content of these complies with the National Minimum Standards and associated regulations. A discussion about the admission process was held with two residents, both of whom have been recently admitted to the home. Both residents said that their relatives or representatives had visited the home to look around and been given information to take to them, when the manager or deputy manager had come to assess them, they had brought them more information. The residents said that they thought that the admission process had gone smoothly and that when they arrived at the home staff had introduced themselves,ensured that they were comfortable and answered any questions they had. The home admits residents for respite, continuing and permanent care but does not admit residents for either transitional or intermediate care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individual care plans are of a sufficient standard to ensure that residents receive the care that they require to meet their assessed needs. Comprehensive instructions for the staff giving the care are included in the care plans. Whilst the standard of medication administration, recording and storage ensures the safety of the residents, additional information is required to ensure that the administration of medication is personalised to the needs of the individual Evidence: In order to assess whether care planning related to the care needs assessments of the residents, six care plans were examined. Whilst the standard of care planning was variable insomuch as some care plans had more detail and instructions for care staff, care plans addressed the assessed needs of the individual. Risk assessments require more detail to ensure that all risks relating to the use of equipment are fully identified and that they ensure residents safety.ie where the use of hoists are required, type of hoist and hoist sling size must be shown and also this should be included in the care planning. Care Homes for Older People Page 13 of 31 Evidence: The manager must ensure that when bucket chairs or other equipment is used that could be seen as restraint, full risk assessments including a rationale for use must be included in the care plan, and the use of electric wheelchairs by residents in the home must be fully risk assessed. Whilst daily records showed the care given and that this related to the planned care, they were task orientated as opposed to being written with the individual person in mind. There was evidence of involvement of General Practitioners, wound care specialist nurses and other health care professionals and residents spoken with said that staff were proactive in addressing any health care needs which could not be met by the home. Residents were well groomed and dressed appropriately for the temperature in the home, wheelchairs and other equipment were being used correctly and residents seated in the lounges and in their rooms appeared comfortable, with foot rests, cushions and any other requirements attended to. The manager said that the home has two Dignity champions, these are members of staff who ensure that care staff are aware of the need to complete personal care in a manner that meets the residents preferences and maintains their dignity. Ongoing training in this is taking place. Concerns were raised with senior staff regarding the absence of staff in the lounges at specific times of day and that individual residents in the lounges were unable to summon staff due to few call bells being available. The manager said that this will be addressed. Fluid charts and other records of care and nursing interventions in residents rooms were up to date and whilst most turning and food charts were as far as could be ascertained, accurate, there were some discussions with the manager regarding the fluid charts which are used for the majority of residents as a nutritional record. Some of these showed that residents were receiving very little fluid over the twenty four hour period, but residents did not appear dehydrated and it was queried whether the amounts were always recorded, or in some cases where problems with fluid intake were not identified, whether it needed to be recorded. Eight residents and two visitors were spoken with, comments received included: Bells Care Homes for Older People Page 14 of 31 Evidence: are answered quite quickly, we dont have to wait for long. I think we get looked after very well, most of the staff are very good. I am very happy with the care my (resident) receives, she always looks nice and she is happy here. A survey received stated The staff are very friendly and welcoming and good care is a high priority. One resident said that although the Primary Care Trust had supplied them with a wheelchair for personal use, staff were using this for other residents. The manager should ensure that wheelchairs supplied to individual residents are used specifically for them. The administration, recording and storage of medication safeguards the residents and regular medication audits are now undertaken. Senior staff must ensure that the recording of PRN (as required) medications identifies the specific reasons why a resident would need this medication, this is part of ensuring personalised care. The home must also ensure that the administration of homely medications such as cough linctus, is supported by permission from the general practitioner for each resident. The manager gave assurances that these issues would be addressed. The home admits residents for continuing care and is in the process of arranging for senior staff to attend a course in end of life care. End of life care planning is still ongoing, but although the home is arranging for consultations between general practitioners and residents regarding their wishes for resuscitation, many of the care plans already show where the resident would prefer to receive their care at the end of their lives. Registered nurses are up to date and proficient with the use of syringe drivers and other methods of pain relief. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines around the home are sufficiently flexible to enable residents to make decisions about the activities of daily living. A programme of leisure activities is provided on week days although staff said that there is not much going on at weekends. Comments from residents showed that they enjoyed the activities. The home provides a varied and nutritious menu which provides a choice at all meals. Food is well presented and served at a temperature according to the type of food served and the preferences of the individual. It may be difficult for residents who stay in their rooms or who are immobile to access the fresh fruit available. Evidence: The activities coordinator works for thirty hours over five days a week and whilst relatively new in post has implemented an activities programme. All residents receive a copy of the weekly activities programme which shows that activities provided include music, card making, exercise, cooking and one to one sessions. Some outings have taken place in the summer. The activities coordinator is not currently involved in the Care Homes for Older People Page 16 of 31 Evidence: social care planning although she keeps records of which residents enjoy which activities. The manager said that they are hoping to employ a second activities coordinator to work weekends. Staff stated that nothing much happens at weekends. The home produces a monthly newsletter, copies of this are given to all residents. Residents spoken with and surveys received included the following comments: I really enjoy the activities, it gives you a chance to all get together. Activities are varied and there is something for most people. Residents said that the routines of the home were sufficiently flexible to allow them to maintain their previous lifestyle decisions regarding times of rising and retiring, choice of when they wished to have personal care and the way in which they spent their day. The home has an open visiting policy and visitors spoken with said that they are made welcome. A visitor spoken with said Since the new manager came to the home, I find that the senior staff are more willing to include us in the care planning and generally to keep us more informed. All staff have always made us very welcome. Ministers of religion visit the home twice a week, and services are held. Although these are currently of Christian faith, the manager said that ministers of other faiths would be contacted as the need arises. The menus and presentation of food has much improved over the past year. The menu is varied and in line with the companies Nutmeg scheme which ensures that residents get a well balanced and nutritious diet. Residents have choices at each meal, these are detailed on the menu, and residents spoken with verified that they were being offered these. However it was noted that although fruit was available in the dining rooms and lounges, this was not as readily available to residents who stayed in their rooms or were immobile. The presentation of food has improved, with pureed meals appearing attractive and tables and care being taken with the setting up of tables and most trays. it was noted that residents clothes are protected with linen napkins instead of aprons which ensures their dignity is maintained. Staff assisting residents with meals were doing so with empathy and engaging in conversation with the residents whilst this was taking place. Care Homes for Older People Page 17 of 31 Evidence: Residents spoken with said that the food is always hot and well presented and that they have a good choice of meals. Comments received included: The food is very good, always good food. very nice meals, always a good choice. The kitchen was clean and any visitors or staff members entering the kitchen now wear protective clothing. The home has gained five stars in the Environmental Health Authoritys scores on doors initiative. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home deals with any complaints or concerns it receives in an open and transparent manner and residents said that they would feel comfortable talking to the manager about any concerns they may have. Staff have received recent training in the safeguarding of those in their care and the home has introduced a new adult safeguarding policy which conforms with national guidelines. Evidence: The complaints policy is displayed in the home and also included in the Service User Guide and whilst the majority of residents were aware of how to make a formal complaint, they said that they would first approach the manager or a senior staff member prior to going down the written complaints route. Residents said that any concerns they had brought to the manager had been dealt with in an open and fair manner and had been resolved. The manager keeps records of any complaints or adult safeguarding issues received but it would be good practice to keep records of minor concerns and how these were resolved, this may be needed for future reference. Care Homes for Older People Page 19 of 31 Evidence: There have been no complaints made since the last inspection. During the past six months the home instigated an adult safeguarding alert where there were concerns about a resident, which is still ongoing, and also have had one adult safeguarding alert made against the home, this was not substantiated in any part. The majority of the staff have received recent adult safeguarding training and the home has training planned for the few that have not yet received this. There is a new adult safeguarding policy in the home which conforms with the national guidelines, some staff received their training prior to the new policy being introduced to the home and therefore may not be familiar with this. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a well maintained and pleasant home. Evidence: The home is set out over two floors, lower ground and ground floor, with the lounge on the lower ground floor giving access to a well maintained garden. Communal space, in the form of a lounge and dining room, is provided on each floor. All areas of the home are pleasantly decorated and well maintained. Residents accommodation is provided in single rooms over both floors, which are accessible by a shaft lift. All residents rooms have an en suite facility, but assisted bathrooms are provided on each floor. Residents have a lockable drawer for their personal possessions and all windows on the upper floors have window restrictors which have been maintained in good order.Water temperatures to residents outlets have been monitored and recorded on a regular basis and records showed that these were within recommended parameters. The home provides sufficient moving and handling aids and pressure relieving equipment to ensure that residents are able to maximise their independence. All areas of the home were clean and free from offensive odours and the deputy Care Homes for Older People Page 21 of 31 Evidence: manager is currently undertaking infection control training with the Health Protection Agency, participation in this course may be extended to other members of staff. Comments received when talking to residents and from surveys included I find it a very clean home with lovely furnishings and curtains. Its kept very clean and very fresh here. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels have improved since the last inspection, therefore ensuring that there are sufficient members of staff on duty over the twenty four hour period to enable residents to receive standards of care which meet their needs and expectations. However few staff have attained the National Vocational Qualification in Care at level 2 which may result in residents receiving care from staff who do not have the necessary skills and knowledge. The home is not ensuring that newly employed staff have a basic training in moving and handling, or how to act in the case of fire. This could put both residents and staff at risk. Some staff are being employed prior to written references being received, this may put residents at risk Evidence: The duty rotas show that the manager has increased the staffing levels to include an extra member of care staff who works between the two floors in the morning. Staff comments about staffing levels were divided, with some saying that there were sufficient staff, and others stating that on days when there was no extra member of staff it was very difficult. There was no evidence on the duty rota that staffing levels had dropped on any day during the past two months, and therefore this was discussed Care Homes for Older People Page 23 of 31 Evidence: with the manager. Although at the last inspection the manager said that she intended to commence the Skills for Care induction course, the home is still using the Southern Cross induction course, which does not address issues in any depth. Surveys received and discussion with staff showed that staff did not think that the course covered everything they needed to know, and concentrated mainly on the policies and procedures, staff said It could be better; Not as good as it should be. On examining the training matrix it was seen that some new staff have not completed moving and handling, fire training or safeguarding adults training. The manager should be aware of the homes responsibility towards both the residents and the staff. Some staff previously employed have not updated mandatory moving and handling training. Whilst this was a requirement at the last inspection, the training records show that the home has been working to ensure that all staff receive this training, and also records show that the parent company is auditing training on a monthly basis, therefore the commission will not be taking any further action to ensure full compliance at this time. Out of the twenty six care staff employed, five (20 ) of the staff have the National Vocational Qualification level 2 in care , the National Minimum Standards asks that 50 of staff achieve this qualification. Six staff personnel files were examined, these showed that whilst the majority of the members of staff had all documentation in place, one member of staff had been employed without two written references and the evidence available showed that references for another member of staff had not been received until after the date they started work at the home. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There have been considerable improvements in the quality of life available to residents in the home over the past year, and the manager is aware of further improvements required. However the home is underestimating the contribution of staff training, formal staff supervision and risk assessment in ensuring the home is of a standard to ensure the safety and the rights of the residents living there. Evidence: The appointed manager commenced in post in September 2008. She is a registered nurse with with past experience in management of nursing homes. Although at the last inspection she stated that she intended to apply for registration with the commission, this has taken not place and is a requirement under the Care Standards Act. Several of the surveys received by the commission from staff commented on the improvements in both staff morale and communication in the home The home is Care Homes for Older People Page 25 of 31 Evidence: better since we got the new manager and the deputy, we are now involved in the care planning and communication has improved. Since being involved in care plan reviews the team work has improved so has staff morale. Communication between all levels of management and staff has improved and frequent staff meetings allow us to make our views known. Residents and visitors spoken with were positive about the home. The AQAA was received when we asked for it and gave comprehensive and accurate information about what the home has achieved and what it hopes to achieve in the next year. Neither the manager nor the deputy manager have undertaken training in Deprivation of Liberty Safeguarding (DoLs) or the mental capacity act. Training has been arranged and the manager is aware that there may be residents in the home that will need assessing in relation to the Deprivation of Liberty safeguarding. Whilst the parent company undertakes quality monitoring at a corporate level for the individual homes, there were no results of this seen at this inspection. The home has commenced some quality monitoring in the form of surveys, these have only been given to residents at present and have not yet been collated. The manager intends to extend this process. The home holds the corporate policies and procedures which are generic and not relevant to the individual homes, discussions were held with the manager regarding policies specific to the home. The generic policies seen in the home had not all been reviewed regularly although the manager said that there may be updated copies on the computer. These updated copies should be made available in the home and preferably supplemented with policies regarding local practices in the home. Regulation 26 visits (monthly visits and reports which regulation requires the provider or an appointed person to do), have taken place monthly and were comprehensive and addressed any issues found in the home. The home holds residents monies in individual interest bearing bank accounts, receipts for money added or withdrawn for services were available and those examined were accurate. Whilst staff are now having formal supervision, this is not being done as regularly as directed by the National Minimum Standards; and the manager gave assurances that this would improve, she is in the process of sending senior staff on training courses to enable them to undertake supervision of staff. The manager gave assurances that the Care Homes for Older People Page 26 of 31 Evidence: frequency of supervision sessions would be addressed, therefore the commission will not take further action on this occasion. Risk assessments need to be further developed to ensure that they address all the risks to the residents and the actions required to be taken to address these risks. The kettles and microwave ovens used by the staff in the dining rooms may pose a risk to residents and risk assessments should be put in place. The home and the company have been addressing mandatory training for staff and are aware of their shortfalls in this, not all staff have completed or updated this. The manager has given assurances that this will be completed Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 19 That the home does not permit staff to commence work at the home until all documentation required by regulation including two written references have been received. To ensure the safety of service users and staff. 30/10/2009 2 31 8 That the manager applies for 23/12/2009 registration with the Care Quality Commission. To comply with the Care Standards Act 3 38 13 That robust risk 28/10/2009 assessments are put in place to address all the issues identified in the main body of the report. To ensure service user safety Care Homes for Older People Page 29 of 31 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 2 16 28 That the manager keeps records of minor concerns and how these were addressed for future reference. That the home ensures that staff undertake the National Vocational Qualification in care to enable service users to receive care from suitably trained staff. Care Homes for Older People Page 30 of 31 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). 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