Inspection on 07/12/09 for The Hollies Rest Home

This is the latest available inspection report for this service, carried out on 7th December 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Hollies Rest Home 04/02/08

The Hollies Rest Home 07/11/05

The Hollies Rest Home 21/06/05

The Hollies Rest Home 21/03/05

The Hollies Rest Home 23/11/04

The Hollies Rest Home 09/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for older people Name: Address: The Hollies Rest Home 14/16 Park Road Southborough Tunbridge Wells Kent TN4 0NX     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: Sarah Montgomery     Date: 0 9 1 2 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 Hollies Rest Home 14/16 Park Road Southborough Tunbridge Wells Kent TN4 0NX 01892535346 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): manager.hollies@regalcarehomes.com www.regalhomes.com Regal Care Homes Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 31 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users to be accommodated is 31 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Date of last inspection Brief description of the care home The Hollies is a care home providing personal care and accommodation for 31 older people who have a diagnosis of dementia. It is owned and operated by Regal Care Homes Ltd. The home employs a manager, deputy manager, senior carers and care staff. In addition to the care staff there are ancillary staff and a handyman. The home is located in Southborough, near Tunbridge Wells. It is close to shops and a bus route to the town centre of Tunbridge Wells or Tonbridge. The home provides Care Homes for Older People Page 4 of 31 Over 65 0 31 1 7 0 1 2 0 0 9 Brief description of the care home accommodation arranged on three floors. The premises are detached. There are three lounge/dining rooms on the lower ground floor and a conservatory. Bedrooms are on all three floors. There is a secure garden to the rear of the home and parking at the front. Please contact the home for up to date information regarding weekly fees. Extra charges are made for: - Hairdresser prices according to service; Chiropodist; Papers,magazines, toiletries at cost; Transport to and from hospital varies approx £7.50 per visit. 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 was conducted over two days - the 7th and 9th of December 2009. Two regulatory inspectors were in the home on the first day, and one inspector on the second day. The home does not have a registered manager. We were assisted by a manager from a sister home, and by the deputy manager of the home. During the inspection evidence was gathered by reading documents and by speaking to service users and staff. We also spoke to one relative. Some of the documents assessed included care plans, policies, risk assessments, medication files and staff files. The home returned their annual quality assurance assessment to the Commission. This document is filled in by the home and tells us what they are doing well, and what improvements they want to make. We used information from this document to inform the inspection process and report. Care Homes for Older People Page 6 of 31 The quality rating for this service is two star good. This means that people who use this service experience good quality outcomes. 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: 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 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 9 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users cannot be confident all their needs will be assessed prior to admission. Prospective service users can be assured they will receive sufficient information about the home to assist them in making an informed choice about where to live. Evidence: Standards 1, 3, and 6 were assessed. To assess these standards we looked at records which told us how prospective service users are supported in their choice of home. These records included the statement of purpose, service user guide and pre admission assessments. We spoke with members of the management team about these processes and documents, and spoke with some residents about their experiences of moving into the home. We also looked at information sent to us from the home in their annual quality assurance assessment. Standard 6 does not apply as the home does not offer intermediate care. Care Homes for Older People Page 10 of 31 Evidence: The homes statement of purpose and service user guide were inspected. They were then cross referenced with all evidence gathered throughout the inspection. This is because the statement of purpose and service user guide tells prospective and current service users, and their representatives what services are provided at the home. It is important that these documents are up to date and relevant as they serve as a benchmark for all service provision. The statement of purpose was a detailed document, providing good information about the home and about the services provided. Some parts of this document require updating, for example the manager position is currently vacant but the the previous manager is still recorded as being manager of the home. Also, the contact details of the Commission need to be updated in the complaints section. The current details are incorrect as this office is now closed. The home is a specialist service for people with dementia. Although the service user guide contains adequate information, it is not user friendly. Consideration needs to be given to developing a service user guide specific to the service user group. The statement of purpose and annual quality assurance assessment both detail the homes admission criteria and policy. Three pre admissions assessments for prospective service users were inspected. All demonstrated the home had gathered appropriate information on service users, and had done this in partnership with the multi disciplinary team. None of these service users had yet moved into the home and so their pre admission assessments could not be cross referenced with care planning documentation. We then looked at a pre admission assessment of a service user who moved into the home in January 2009. We found this assessment to have shortfalls, with many key areas of the form left blank. This was particularly the case in the mental health section of the assessment, where no information was recorded regarding confusion, anxiety, short term memory, past medical history and aggression. We cross referenced this pre admission assessment with care plans and risk assessments. The care plan did not contain sufficient details of support needs, and staff would be unable to ascertain what support needs the individual had. It was not apparent on either the assessment or care plans whether the home had sought the views or wishes of the service user. Care Homes for Older People Page 11 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. Service users can be confident they will be supported with their health and personal care needs. Service users would benefit if their care plans contained more detail and were more accessible to care staff. Evidence: Standards 7, 8, 9 and 10 were assessed. To assess these standards we looked at records which told us how the care home meets the health and personal care needs of service users. These records included care plans, risk assessments, daily notes, and medication records. We spoke to members of staff about how these records are used, and asked staff about how they used care plans in their day to day work with individuals. We wanted to see how the home ensures service users are treated with dignity and respect, and spent some time observing working practice. We also looked at information the home had sent to us in their annual quality assurance assessment. Care Homes for Older People Page 12 of 31 Evidence: The statement of purpose gives detailed information about individual care planning, and tells service users how the care plan is drawn up, and how often it will be reviewed. The annual quality assurance assessment tells us that it recognises a more person centred approach is required. We inspected four care plans in detail. We found that the home had started to develop a person centred approach to care planning. This means the views and wishes of service users had been sought and recorded. The home plans to ensure all care plans are reviewed and updated using a person centred approach. The majority of current care plans do have shortfalls, and the support needs of residents have not been adequately recorded. An example of this is two residents had been identified as having poor appetites, but their care plans did not highlight this enough. Although records indicated weights were being recorded, there was no care planning in place which suggested the home was supporting the individuals to eat, and no indication that nutritional supplements were being used. To compound this, the care planning system is complex, and information regarding the poor appetite example was recorded in four separate areas of the care plan. As well as information being recorded in different areas of the care plan, we also found that care planning files were very full, and this contributed to information being hard to find. We were concerned about the easy accessibility of care plan. When we spoke to care staff, they told us that they did not understand the care plans and they had nothing to do with them because the seniors do all that. When we spoke further with staff about specific service users, it was clear that they were aware of basic care support needs. However, care staff need to refer to and work with care plans on a daily basis, and have a good understanding of the care planning process. The home must ensure that care plans are clear and accessible documents, and that all care staff are knowledgeable about the care needs of all service users. We looked at records which told us how the home ensures service users health needs are met. We spoke with a visiting community nurse who told us the home communicates very well with us and gives us good information. She informed us that the management and prevention of pressure sores is good at the home, and that staff are aware of when to call the nurses in to provide treatment to service users and advice to staff. We could see from health care records that service users have access to GPs, specialist continence professionals, and other specialist health and medical professionals when required. For example hearing and sight tests and assessments for Care Homes for Older People Page 13 of 31 Evidence: mobility aids. We looked at how the home identifies and records risk on individual care plans. We could see that service users had been assessed for risks, but more detail regarding prevention of the risk is required. For example, one service user had a falls risk assessment which stated uses a zimmer, may fall. The action was recorded as supervision at all times. We asked if this happened, and was told it was not always practicable. The home must re visit this risk assessment and put steps in place to ensure the risk is managed appropriately. Overall, risk assessments inspected were well recorded, and when spoken with, the staff appeared to have a good understanding of their roles in identifying and managing risks. The home has good systems in place for administrating and storing information. We looked at medication administration records (MAR) for all service users. The front sheet has a photograph, name, allergies, date of birth and GP details. The back of this sheet includes all medication prescribed, and any possible side effects. We could see from further inspection of the MAR sheets that medication is signed for appropriately. The deputy manager described a robust system for medicine ordering. All medicines are kept in a locked cupboard and are stored correctly and at the right temperature. Controlled drugs are kept within the medication cupboard in a locked controlled drugs cabinet. Inspection of how controlled drugs are administered and signed for evidenced the home is failing to record appropriately in a controlled drugs register. The home was informed they must obtain a controlled drugs register without delay. Discussion with service users and staff, and observation over the course of the inspection evidenced that service users are treated with respect and their right to privacy is upheld. Service users told us that the staff are lovely and do so much for me and they always make sure I am comfortable. We saw that staff knock on bedroom doors and wait for an answer before entering. Staff engaged in conversations with service users, and spoke to them with respect and kindness. We saw that staff ensured the dignity of service users was upheld when assisting with drinking and eating. The home has good systems in place for laundry, and staff understand the importance of ensuring service users wear their own clothes at all times. Care Homes for Older People Page 14 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users can be confident they will be supported with their lifestyle choices but would benefit from increased activities. Evidence: Standards 12, 13, and 15 were assessed. To assess these standards we looked at records which told us how the home ensures service users are given social opportunities, and can make choices and decisions about their lives. We also looked at how the home supports service users to maintain contact with family and friends, and looked at records which told us how the home ensures service users receive a wholesome and nutritious diet. We spent time talking with service users about their life at the home, and talked to staff about how they support service users with their lifestyle choices. We referred to the homes annual quality assurance assessment and cross referenced this with evidence gathered. The home employs an activities coordinator. This is a part time post and activities are scheduled for afternoons. We spoke with the activities coordinator who gave us an overview of her role, and of the various activities she undertakes with residents. We saw that these activities were recorded in a file, but noted that many residents are only participating in activities at best once a month. Care Homes for Older People Page 15 of 31 Evidence: The homes statement of purpose lists a range of activities service users can participate in, including outings, flower arranging, sensory stimulation and reminiscence. Evidence gathered at the inspection tells us it is not currently possible for the home to ensure this list of activities takes place. The homes annual quality assurance assessment tells us that the home are planning to improve on activities over the next twelve months. The activities coordinator is new to the post, and is spending time getting to know the service users, particularly finding out information about hobbies and interests. To assist this process she is spending 1-1 time with individual service users recording their life histories. Activities are currently offered on an ad hoc basis. There is no information in the home to let service users know what activities are on offer on a daily basis. At present there are 27 service users living at the home. Inspection of activity records, observation during inspection, and discussion with staff and service users evidenced that there are not enough opportunities for all residents to participate in regular activities. This is a resource issue, and a part time role for an activity coordinator is not sufficient to ensure service users are offered choice and social opportunities. The home must give consideration to creating a full time position for this role. Service users are supported and enabled to maintain contact with family and friends. Visitors are made very welcome at the home, and are able to meet their relative in private, iether in the quiet lounge, conservatory or their bedroom. We spoke with a relative who told us the home and staff are wonderful, I cant praise them enough. Lunchtime was observed indirectly. Service users were seen to be given very good sized portions. Some clearly enjoyed this but others seemed to be put off by the large sized portions. There did not seem to be a system for allocating portion size. There appeared to be a number of service users who needed encouragement or direct assistance to eat their meal. Although staff did their best to support the residents, they seemed to be under pressure at this time. An example of this was when one resident began to wander, having only eaten half of her meal, as member of staff was heard to mutter Jesus under her breath. Staff told us that mealtimes are difficult and sometimes staff struggle to complete supporting service users in a timely manner. Care Homes for Older People Page 16 of 31 Evidence: Discussion with the cook evidenced meals are well planned, and dietary preferences and needs are known. However, systems for ensuring service users with diabetes get the right amount of food need improving. The cook makes diabetic cakes. There is one cake for each diabetic service user per day. When a service user is given a cake, this is not recorded, and staff have to rely on memory. We were told that on occasions some service users are given more than one, and some are given none. This could be a health concern, and also it is depriving some service users of a snack. The home needs to ensure that there are systems in place which ensure service users are given the correct food. Care Homes for Older People Page 17 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. Service users can be confident they will be listened to and their concerns acted up. Furthermore service users can be confident they will be protected from harm. Evidence: Standards 16 and 18 were assessed. To assess these standards we looked records which told us how the home ensures service users are protected from harm and abuse, and records which demonstrated that the home listens and responds to service users concerns or complaints. We spoke with service users about how they make a complaint, and talked with staff about how they respond to complaints and protection. We also looked at information provided in the statement of purpose, and information told to us by the home in their annual quality assurance assessment. We spent time talking with the deputy manager and senior staff about their roles in reporting alleged abuse and other significant events to the Commission and to other agencies. It was clear from their responses, and from information we have already received in the form of notifications, that the management team at the home are competent in protocols and systems for ensuring good and accurate reporting. We looked at how the home ensures service users are kept safe and protected from harm. The homes annual quality assurance assessment tells us that training has been provided for all staff on abuse prevention. We saw from the staff training records that the majority of staff had received recent training in adult protection. Care Homes for Older People Page 18 of 31 Evidence: However, there were gaps, and some staff had only received basic training during induction. The home must ensure that all staff undergo accredited training in adult protection. We inspected six staff files and looked at whether the home has robust recruitment protocols which ensure the protection of residents. Files evidenced that the home takes up appropriate references and ensures the necessary checks (for example criminal record bureau) are made prior to the prospective member of staff commencing employment at the home. We asked residents about how they might make a complaint or tell someone if they were unhappy. Of the residents we spoke with, none could tell us who they would talk to or what they would do. It was clear that residents need support in communicating their needs and feelings. We spoke with staff who told us they felt confident they knew the residents, and gave examples of when they realised a resident was unhappy or had a complaint. The home has a complaints procedure for residents. Consideration needs to be given to updating and reviewing this procedure to ensure it is accessible to all residents, and caters to the changing communication needs of people with dementia. Information in the homes annual quality assurance tells us that the home acknowledges this shortfall, as they state in the what we could do better section: make it okay for all our residents to complain, helping them to understand that this is a way of improving our service. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a comfortable home but would benefit if some improvements were made to the environment. Evidence: Standards 19 and 26 were assessed. To assess these standards we looked the communal areas in the home, and a number of bedrooms. We also looked at records which told us how the home ensures service users are kept safe, for example, certificates of electrical equipment testing. In addition, we looked at systems the home has in place to ensure the home is clean and hygienic, and looked at information supplied in the statement of purpose and annual quality assurance assessment. We inspected communal areas of the home, and looked at a number of bedrooms. We could see the home makes attempts at maintaining the environment, but more attention to detail is required. Several shortfalls were noted. In particular, we found the temperature in the home to be cold. Several radiators were checked. Of the four radiators in the main lounge, three were not working. The radiator in the conservatory was turned off, as was the radiator in the dining room. The conservatory was particularly cold, and the residents who were sitting in there told us they felt cold. We were told that there is a problem with the boiler which is being addressed, but also some radiators were turned off. We informed the home that service users need to be kept warm, particularly as many of them are not active, which can make a person feel Care Homes for Older People Page 20 of 31 Evidence: much colder. The two new shower rooms did not have any heating. We were informed new radiators were being installed. We saw that one of the downstairs toilets and a bathroom also had no radiators. We were concerned that service users were assisted with personal care in bathrooms which were very cold. We noticed a window in a downstairs toilet could not close, and the frame was rotting. This is causing a significant draft and is also a potential hazard. The home assured us the window would be replaced. In the same toilet there were very hot pipes running (and coming away from) down the wall. This is a burn hazard and these pipes must be boxed in and made safe. Our inspection of the environment evidenced some problems with management of incontinence. The conservatory carpet had an overwhelming odour of urine. We were told this would be replaced. A bedroom we looked at also had an overwhelming smell of urine. We were told the home were finding it difficult to manage some continence issues. The home must ensure that residents bedrooms and all communal areas are free from offensive odours. All of the bedrooms we looked at were cold. Windows were open and the heat was off. We were told bedrooms were aired during the day. This means bedrooms are cold, and should a service user choose to spend time in their room during the day, it could take some time to ensure the room is warm. Some bedrooms although occupied did not have names on. Some double bedrooms only had one name, although two people resided there. The home must ensure that residents are able to identify their room. The quiet lounge had a large amount of electrical wires coming from the television and stretching across the wall to the window. Staff told us that residents pull these wires. We informed the home that these wires must be made safe as a matter of urgency. We spoke with service users about their home. They told us I love it here, and I am happy with my bedroom. Two service users (in the conservatory) told us I am a bit cold. We spoke to the management team about all the shortfalls evidenced with the environment, and were assured they would be rectified. One of the shortfalls identified was a strong draught coming in through a (unused) cat flap. While we were there this was boarded up by the handyperson. We found furniture in the communal areas and bedrooms to be comfortable and of a good standard. Service users expressed satisfaction with their home, and appeared Care Homes for Older People Page 21 of 31 Evidence: relaxed and comfortable in the environment. 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. Service users can be confident they are supported by staff who are motivated and competent. Service users cannot be confident there are enough staff on shift to help them with their support needs. Evidence: Standards 27, 28, 29 and 30 were assessed. To assess these standards we looked at records which told us about the skills and competencies of staff. These records included recruitment processes, staff training and the homes rota. We also looked at information provided in the statement of purpose and at what the home has told us about in their annual quality assurance assessment. We spoke with six members of staff during the inspection. They told us that morale was good at the home, and the team works well together. Staff were motivated and enthusiastic, demonstrated competency and knowledge about their roles, and were caring towards the service users. All of the service users at the home require support with personal care tasks. Sixteen service users users require support with using the toilet, and a further seventeen are incontient. We saw that a high number of service users require assistance at mealtimes. Some service users have complex needs which require the support of two staff. The home is laid out over three floors. It is registered for 31, and currently has Care Homes for Older People Page 23 of 31 Evidence: 27 service users. The rota demonstrated that five care staff are on shift between the hours of 7am and 2pm. From 2pm to 7.30pm three care staff are on shift. The night staff come on duty at 7pm until 7am. Evidence gathered at this inspection tells us that staffing levels are not adequate to meet the needs of service users. The home must review staffing levels, and ensure that the needs of residents can be met, particularly at key times when service users require most support. When we looked at minutes of a recent staff meeting, we saw that concerns had been raised about residents not given enough time to eat and drink at lunchtimes. When we spoke with staff about this they said they were under pressure to get things done, and lunchtime was very rushed. The home must ensure that residents are supported to eat their meals in a calm environment, and at a pace which is comfortable for them. 50 of the staff team have national vocational qualifications. The home has a training programme which includes mandatory training and other specialist training, for example training in dementia and in loss. The training matrix was inspected. While it is clear that efforts have been made in enusring the staff team are regularly trained, we saw some gaps and noticed that over half of the team have not received training in dementia, and twelve out of twenty six staff have not been trained in adult protection. The deputy manager described a thorough induction process. This was evidenced by inspection of a staff members induction file, and discussion with staff. All staff are inducted into the home over a flexible period of time until the manager is satisfied with their performance, and until they have been given all appropriate information on the home and individual service users. The home must ensure that entries in staff induction files are signed and dated. Inspection of six staff files evidenced the home operates a robust recruitment procedure. Prospective staff are interviewed after completion of an application form, and references, criminal record bureau checks and protection of vulnerable adults checks are made prior to appointment. 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. Service users benefit from living in an open, positive and inclusive atmosphere. Service users would benefit from a manager being recruited. Evidence: Standards 31, 32, 33, and 36 were assessed. To assess these standards we looked at information and records which tell us how well the home is run, and records which tells us how the home self-monitors their performance. These records include the experience and qualifications of the manager, the homes annual quality assurance assessment, systems in place for supervising staff, and all records relating to meeting support needs of service users, for example care plans. The home does not have a registered manager. Day to day management of the home is undertaken by the deputy manager. The deputy manager was present during the second day of inspection. Discussion with him regarding policies, protocols and working practices at the home evidenced he has the competence, skills and Care Homes for Older People Page 25 of 31 Evidence: experience to run the home. He spoke of innovative ideas, and was enthusiastic and motivated about the continued development of the home. We could see that his management style was open, positive and inclusive, and both staff and residents spoke highly of him. Information gathered during the inspection evidenced shortfalls. Most notably staffing numbers and issues with the environment. The registered provider must ensure a manager is recruited. Overall management must be in effect so these shortfalls can be adequately addressed. Inspection of the staff supervision matrix demonstrated that at present supervision of staff is sporadic. We can see that the senior team at the home do not currently have time to ensure all processes are followed. The home has introduced good quality assurance systems, and provide questionnaires to service users, families and other stakeholders. Self monitoring in the form of monthly visits from a Regal Care Homes representative and ccompletion of the annual quality assurance assessement assists the home in shaping the service and planning improvements. Care Homes for Older People Page 26 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 27 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 3 14 The registered person must ensure that pre assessment documentation is fully completed. This will ensure the home is aware of all the support needs of individuals and will assist in informing all care planning. 31/03/2010 2 7 15 The registered person must ensure that all care plans contain detailed information regarding support needs. Care plans must be accessible to staff, and presented in a clear format. All staff must use care plans as part of their day to day work with service users. To ensure service users needs are met. 31/03/2010 Care Homes for Older People Page 28 of 31 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 9 13 The home must ensure that receipt, administration and disposal of controlled drugs are recorded in a controlled drugs register. To ensure the home meets their legal responsibilities. 04/01/2010 4 19 23 The registered person must ensure that the home is heated appropriately, including radiators being fitted in all areas including toilets and bathrooms. The registered person must also ensure that all hazards are made safe, and that carpets which are soiled are replaced and the home is free from offensive odours. To ensure the health, welfare and safety of service users is met. 31/03/2010 5 27 18 The registered person must ensure there are sufficient staff on shift to meet all assessed support needs of service users. To ensure service users assessed needs are met. 31/03/2010 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 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!