Inspection on 30/12/09 for The Lilacs

This is the latest available inspection report for this service, carried out on 30th 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 1 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 14/03/2010.

Key inspection report Care homes for older people Name: Address: The Lilacs 42-44 Old Tiverton Road Exeter Devon EX4 6NG     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: Louise Delacroix     Date: 3 0 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 30 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 30 Information about the care home Name of care home: Address: The Lilacs 42-44 Old Tiverton Road Exeter Devon EX4 6NG 01392435271 01392435271 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Lilacs Care Ltd Name of registered manager (if applicable) Mrs Patricia Jean Hall Type of registration: Number of places registered: care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only (code PC) to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (code OP) maximum of 29 places Dementia (code DE) maximum of 29 places Mental disorder (code MD) maximum of 29 places The maximum number of service users who can be accommodated is 29 Date of last inspection 0 0 0 Over 65 29 29 29 Care Homes for Older People Page 4 of 30 Brief description of the care home The home was registered as a limited company in October 2009. As part of the registration, the service increased its bedrooms to twenty nine. Some of these are ensuite. There are bedrooms on the ground floor, as well as bedrooms on the first and second floor of the home, which can be accessed via a through lift. The home has two lounges, a conservatory and dining area. There are gardens at the rear of the building and parking for visitors. The home has an experienced registered manager. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: 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: The inspection was unannounced and took place over ten hours at the home, and we spoke with the deputy manager the next day to confirm further details. Four people living at the home contributed in detail to the inspection, as did the deputy manager and five staff members. The manager on the home was on holiday at the time of the inspection so feedback was given to the deputy manager. We also met with other people living at the home as we looked around the home and spent time talking with them about their chosen topics. Many people living at the home are not able to comment directly on the service itself so we spent time in communal areas to observe the type of care they receive and their responses to the world around them. Time was spent observing lunch and tea time meals. Prior to the inspection, surveys were sent to people living, working and visiting the home, which have been incorporated into this report. Many of the people living at the home had been supported by their relatives, so their views have also been captured in Care Homes for Older People Page 6 of 30 some of the comments. As part of the inspection, three people were case tracked, this means that where possible we met with these people, and the records linked to their care and stay were inspected. During the inspection, a tour of the building took place and records including care plans, staff recruitment, training and medication were looked at. Prior to the inspection, the home completed an Annual Quality Assurance Assessment (AQAA), which provides the Care Quality Commission (CQC) with current information about the service, staff and people living at the home. The Lilacs has been running as a care home for people with dementia for a number of years but were registered as a limited company in October 2009 and a new registered managers application was approved, as well as an increase to the number of bedrooms. Under CQCs current policy, this means that they are inspected as a new service. As a new service, prior to this inspection the home had no overall rating but was rated as new. Care Homes for Older People Page 7 of 30 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. Care Homes for Older People Page 8 of 30 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 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their care needs will be assessed to help ensure that the home is the right place for them. However, the statement of purpose would benefit from minor improvements to make it more accurate and user friendly. Evidence: The homes AQAA states that the management visit every prospective resident and/or their families in their own home or hospital, and that people are encouraged to visit prior to moving in and to ask questions. Staff told us about the visits they had undertaken prior to three people moving to the home. This has happened since it has been registered as a new service and we saw the paperwork to support these assessments. People in their surveys told us that they had received enough information about the home to decide that it was the right place for them. We met several people who had moved to the home since the home has become re-registered but they could not remember if they had visited before moving in but commented positively on the home. Staff were positive about meeting the needs of people who Care Homes for Older People Page 11 of 30 Evidence: had recently moved to the home, and felt that they had fitted in well. The homes statement of purpose provides a section entitled admission criteria but does not detail people visiting the home before moving in. The statement of purpose provides basic information about the service but could benefit from being written in a more user friendly manner and could promote the role of the person moving to the home in influencing the service. For example, their role in the pre-admission assessment. There is also an inaccuracy regarding the number of communal areas that needs to be addressed. We visited one of the lounges in the communal areas but we were told by several staff members that it was no currently in use. One person told us it could be used for people to meet with families but when we visited this would not have been appropriate as there were boxes and unused Christmas decorations left out. The home does not provide intermediate care. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from well planned care by staff who monitor changes and promote choice. Evidence: We looked at three care plans, which included one for someone who had moved to the home since its new registration. They were up to date, which included risk assessments, personal preferences and provides guidance to staff. There are monthly reviews but these are recorded in a basic manner i.e. no change rather than a holistic overview of peoples lives at the home, and therefore would benefit from improvement. During the day, we saw plans being updated to reflect changes. For example someone was observed eating a paper serviette at lunchtime and we saw this information being added to a risk assessment in their care plan, which included brief guidance for staff. We also heard staff being verbally updated about changes that had occurred in peoples care and health needs, and staff told us that there were handovers at the start of their shifts to update them. We observed one of these handovers. Staff were Care Homes for Older People Page 13 of 30 Evidence: positive about the new layout for care plans, and the work undertaken by the deputy manager in making information more accessible and less repetitive. Care records that we looked at showed that peoples changing health needs are recognised, and conversations between staff and calls to GPs confirmed this. The one health professional who returned a survey told us that usually the home properly monitored, reviewed and met the health and social needs of people living at the home. They also told us that the care service usually sought advice and acted upon on it to meet peoples social and health care needs. Staff showed us a room for someone who was in hospital, we were told they had been provided with a larger room on the ground floor to provide space for equipment as their health needs had increased. Staff told us that nobody at the home has a pressure sore, which reflected the information in the homes AQQA. We saw that there is guidance to reduce peoples risk of pressure sores, and we saw cream in peoples room to help prevent this. We also saw a two hourly turning regime for someone assessed as at risk, and saw in their room that they had been provided with a pressure relieving mattress. Daily records showed increased level of detail when people become ill to help monitor their health and well-being, and care plans identified the need to monitor peoples pain. Records show that people have access to the services from chiropodists, opticians and dentists, when needed. We looked at how weights are recorded, staff told us that the home has seated scales, and records for the three people we case tracked showed that peoples weight is monitored regularly. And for one person who was assessed as needing supplements, we saw that their weight had increased since their move to the home, while a staff member who cooks for the home was clear about who needed additional monitoring and the supplements that people had been prescribed. We noticed that one person we were case-tracking took a long time to eat their meals, and staff told us that this was always the case, but given time the person did finish their meal, which we observed for one meal. However, at one time they were trying to eat the pattern on their place mat as staff were not always able to give them their full attention. A staff member sat at the same table to eat their meal with people who needed encouragement, which is good practice, although they were called away to deal with others matters, which prevented it from always being a relaxed style of support. We saw good examples of the home recognising when they can no longer meet peoples needs, and the manager has contacted us in the past, to advise us of changes and what they plan to do to address these issues. However, in one persons Care Homes for Older People Page 14 of 30 Evidence: case we saw that there has been a delay in the commissioning service in responding to their request for a person to be reviewed and moved to a more suitable home. Unfortunately, we saw that this persons behaviour had a negative impact on the wellbeing of other people living at the home. A person told us that it got them down listening to people who are unhappy. Staff also told us that some peoples behaviour was impacting on their capacity to spend time with other people at the home, which we observed. During the inspection, an ambulance crew was called and staff said that they had praised the quality of the information that was provided. Another person was also admitted to hospital and we saw staff preparing the written information that the hospital would need regarding their care needs and medication. We saw that medication was well managed at the home and that it was stored in a safe and appropriate manner. Records were generally completed appropriately, including the controlled drugs book, although hand-written changes to the medical administrations records (MARs) are not currently double-signed, which is not best practice. We saw medication being safely administered, with the staff member checking that people had taken their medication. Staff told us that they had recently received an update on their medication practice. We saw reminders to staff to date creams once opened, which shows that the home is trying to promote good practice. As part of the inspection, we looked to see how peoples dignity and privacy is maintained at the home. People told us in their surveys that staff listened to them, and we observed this to be the case during the inspection. Staff generally took time to make eye contact and be at the same level as the person they spoke with. We saw staff explaining to people what they were going to do before they carried out a care task, for example explaining how they were going to help someone move. We saw staff knocking on doors before entering and saw that some people have chosen to have locks on their doors to keep their rooms private when they are not using them. People told us that their clothes were well cared for, and we heard people being addressed by their preferred name as stated on their care plans. We saw that incontinence pads were discretely stored and that in their rooms peoples belongings were carefully displayed and clothes well cared for. We saw staff discreetly adjusting peoples clothes to maintain their dignity during transfers from a chair to a wheelchair and staff ensured that nobody was left wearing a protective apron after they had finished their meal. We saw instructions in a memo to staff about preparing people for a bath, which refers to an option of bringing people to the conservatory in their dressing gown or people staying in their room until their bath. This memo would Care Homes for Older People Page 15 of 30 Evidence: benefit from reminding staff that the person should be given a choice in order to maintain their dignity. We heard people discreetly being offered help with maintaining their continence. However, we did see some people who were looking for the toilet and were unable to find it, changes to the environment through improved signage might help increase peoples dignity and independence. This would also include ensuring that everybodys room is appropriately signed, as for some people who have recently moved to the home this has not been happened. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from their visitors being made welcome, cooking that meets their tastes and a home where choice is promoted. However, there is still further work needed to improve the quality, variety and quantity of activities available to the people living there. Evidence: The homes AQAA states that there is a full range of activities is carried out with individual and group activity taking place each morning and afternoon. In the morning of our inspection, we saw that there was an art group taking place. The organiser confirmed that this took place once a week, and that people chose to attend. We saw a group of four people enjoying the session and receiving praise and encouragement with their work. In the conservatory area, people were listening to music, which some people commented positively on, although one person said it was too loud. A few people looked at newspapers and throughout the day staff encouraged people to look at magazines, which people responded positively too. One person said they would like to go out, and said they hoped to able to use the garden once the weather improved. People in their surveys said there was always or usually activities that they could take part in. Care Homes for Older People Page 17 of 30 Evidence: However, in the afternoon there was less to occupy people, both on a one to one and group basis. There were a number of occasions where staff started a conversation with people but were interrupted by the needs of others so some people experienced limited meaningful interaction. We heard people talking among themselves about there being nothing to do, and one person said to another they dont make any effort to entertain us. This level of discontent increased during the day for some people, while others seemed to be more content once they had moved to the TV lounge in the evening. When we spoke with staff, they acknowledged that some peoples behaviour could be more challenging from the late afternoon and that this could be time consuming. However, if there was more stimulation for people this could perhaps reduce some of the behaviour we witnessed. We saw that some people who were physically frail appeared to have less verbal interaction from staff than other people who were more physically and mentally able. A person that we spoke to said that they needed more to stimulate their mind and that they became bored by the lack of stimulation. We saw that peoples religious beliefs are recorded, and that recognition and respect is shown in the recording of how this should be supported by staff. When we spoke with staff, they were aware of peoples religious preferences. We looked at the records for three peoples activities; these are generally well recorded and we saw that seasonal events had been organised to celebrate Christmas. However, they show gaps between activities, such as gaps of six days and four days for one person. Activities include massage, manicure, skittles, quizzes, Tranquil Moments and singing. One person that we case tracked had a comment in their care plan that they liked to feel helpful but we could see no evidence as to how this need had been met, although another person appeared from their body language and discussion with staff to enjoy laying the table for lunch. There is potential for the home to explore more opportunities for people to take part in the life of the home, as well as accessing the local community, and varying the types of activities offered. We saw people visiting the home, and they seemed relaxed in their interactions with staff who welcomed them. One person told us they could visit at anytime and that they were welcomed and that they could always speak to staff about their relatives care. Throughout the day, we saw people making choices about where they sat and who they mixed with, and we saw that the staff handbook promotes choice. For example, in the evening we saw a group of people making a choice to sit together and watch Care Homes for Older People Page 18 of 30 Evidence: the television in one of the lounges. People chose whether they participated in an art class that was taking place and we saw someone choosing to eat their meal in the lounge rather than moving to a table, which staff respected. There is a whiteboard on the dining room wall that states what the main meal is, although choices are not listed. However, when we spoke to staff, they could tell us about individual likes and dislikes are known, and that choices are provided when the main meal is not suitable. which are recorded. We saw during the main meal that some people had a different desert, for example one person chose to have fruit rather than a cooked pudding. Care plans record peoples choice of a bath or a shower, and we heard people discussing with staff when they would like their bath and staff listening to them. People told us that they chose when to go to bed. A sign in the office reminds staff that people must be offered a choice as to when they get up. A staff group told us that peoples preferences were always respected, and on the day of the inspection we saw someone choosing to get up later in the morning, which staff confirmed was their usual routine. Staff working in the kitchen were enthusiastic about their role, and knowledgeable about the people they cooked for. They were happy with the quality of the food they cooked with, and said that they spoke to people individually to gather feedback about the meals. People told us in their survey that they either usually or always liked the food served. Most people that we spoke to on the day of the inspection said the food was good and people seemed satisfied when they were eating their meal, although one felt the quality was variable. However, for one person the meal took a long time to finish, especially as they sometimes did not manage to place the food on their cutlery, which meant that the food was likely to be cold by the time they finished. We saw that the group of people who needed encouragement with their meals would have benefited from a staff member who was not involved in other care tasks as well. Care Homes for Older People Page 19 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a staff group who listen to them and who are clear about their responsibilites to protect the people in their care. Evidence: The homes AQAA states that no complaints have been received by the home. None have been received by CQC since the home has been registered as a new service. Five people told us in their surveys that there was someone they could speak to informally if they were not happy and all of these people knew who to make a formal complaint. People that we spoke to during the day, seemed contented apart from some people saying they wanted more to do. Staff are instructed what to do in response to a complaint in their handbook. People in their surveys said that staff listened to them which we observed during the inspection. Staff were able to tell us about their role in safeguarding vulnerable adults. All were clear about their responsibilities to report poor practice to their manager and knew who they would contact externally and we saw that the contact numbers had been updated by the time we left the home. Staff are given information in their handbook about how to recognise abuse, and are referred to the homes policy in this area of care, which we suggested had local numbers included for the police. We saw staff monitoring the influence of one person living at the home over another resident, who they felt could be vulnerable, and intervening when necessary. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well maintained and kept clean. Minor changes to the homes infection control procedure will improve this area of care and help keep people well. Evidence: As part of the inspection, we looked to see how the building is maintained and if it is a homely place to live. The communal areas are clean and staff commented that it was lovely to see fresh flowers, attractive tablecloths and place settings. One person commented that more thought was now being put into making the home look more homely, which includes fresh flowers. The home has a level garden with raised flowerbeds, although because of the time of year it was difficult to judge its overall appearance because of the lack of flowering plants. One person said to us that they had been told there was a garden but they had not gone outside yet but liked the look of it. We looked to see if peoples rooms are kept clean, and spot checked ten rooms. People we spoke with said they were satisfied with their room and its facilities, and the cleanliness. All rooms were clean and had tidy wardrobes, satisfactory beds and bedding. Lockable storage is available and some rooms have en suite toilets. All the rooms, we visited, were warm. Some bedroom doors display a photo of the rooms occupant, to help people identify their own room. However, signage for other areas of the home could be clearer to help promote peoples independence. Care Homes for Older People Page 21 of 30 Evidence: There is one bathroom on the upper floor that is currently unusable due to water leaking, staff confirmed it was not used, but it had not been shut off. The home has several other bathrooms that can be used in the meantime, including an attractive shower room. Different staff confirmed that the work was due to start to correct the leak and that a new window was to be fitted. The AQAA also states that in early 2010 the external decoration for the home will be updated, which is particularly needed at the back of the building. We looked to see how infection control is managed within the home to help keep people safe. We saw disposable gloves were available. Staff were able to tell us about the infection control measures within the home i.e. how soiled laundry is transported and washed appropriately. The home has invested in an industrial washing machine and now has a sluice room. Special bags are available for processing soiled items, which staff confirmed they used. Commodes in bedrooms were clean and in a good state. However, liquid soap and disposable paper towels are not provided in bedrooms, despite the staff handbook promoting hand washing by staff. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have their needs met by a caring and skilled team of staff, who are recruited appropriately to help keep people safe. Evidence: On the day of the inspection, there was a suitable level of staffing, which matched the rota, and we saw that people were generally not kept waiting and that staff were attentive. (See daily living section). People that we spoke to were generally happy with the support given by staff, although one said they would like more one to one time with staff. People said that staff were obliging and very helpful. One person told us that staff had helped them in the morning because they had not been feeling well and that a GP had been called, and that they felt looked after. Staff told us that the staff group had been more stable recently, although sometimes agency was used to cover. The homes AQQA states that agency staff have not been used in the last three months and that they aim to recruit the right person for the job and check their suitability through their induction period. A cleaner is employed, leaving care staff more time for care duties. There is a cook on duty daily until after lunch, preparing any hot dishes planned for teatime that can be made in advance; we were told that care staff are responsible for any catering and kitchen duties thereafter i.e. from mid-afternoon, which we observed. Care Homes for Older People Page 23 of 30 Evidence: The owner confirmed that of the twenty care staff, fifteen have a recognised care qualification [NVQ2 in Care or higher, or an equivalent]. This is a good achievement as the accepted minimum limit is half of the workforce. We were also told that eleven of the care staff have had training in food hygiene. Three carers that we spoke to confirmed their NVQ qualifications, and they confirmed that they had food hygiene training. We checked the personnel files for three new care staff who had been employed since our last inspection. Each file contained information on the persons employment history with no gaps which is good practice, as well as health declarations, two positive references and an appropriate POVA First check and police check (CRB). As part of the inspection, we looked to see how staff are supported to carry out their jobs by the training provided. The homes AQQA states that there is induction for new staff, and discussion with staff and three records for new staff confirmed this. We talked to staff about their training needs, and they told us about courses they had been gone on, including food hygiene, dementia awareness, first aid and fire training. The homes induction policy says that new staff members will be trained in house for moving and handling, we talked to staff about the training that was provided, but it was not clear if the trainer was appropriately qualified. Staff told us that further training is planned from an external company, which will include health and safety, and an introduction to dementia awareness. A member of the management team said that it was taking time to ensure that staff all had the correct training as some records had not been kept appropriately. Another of the management team told us that they were trying to encourage staff to take on different shifts to broaden their experience and gain a fuller picture of the needs of the people throughout the day. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from an experienced manager. Further work is needed to involve people living, working and visiting the home in the development of the service, and minor changes will make the home a safer place. Evidence: The home has a registered manager who is experienced. In our discussions with staff, they appreciated the manager and the deputy managers support and their commitment. We were told that communication was good, including handovers, and staff meetings. We saw that the manager circulates memos to staff, which they sign when read, in order to address any issues quickly with the whole team. We saw these had recently included promoting choice and improved medication practice. Staff also confirmed that regular staff meetings take place with minutes produced which they have to sign once theyve read them, and that supervision takes place. Care Homes for Older People Page 25 of 30 Evidence: Quality assurance could not be looked at in detail as the service is new, although we saw records relating to monitoring of the home for the previous service prior to the new registration. During our inspection there were a number of people who could verbally express their views and therefore, could with support, contribute their views and ideas. The homes statement of purpose states that there are service users relatives and representatives meetings but when we spoke to a staff member they said this was not the case. As part of the new registration, the home had to appoint a responsible individual, to complete regulation 26 visits to contribute to the monitoring of the service. The homes statement of purpose recognises this fact. We spoke with the manager after the inspection, and they confirmed with us the arrangements in place, including how quality assurance monthly visits will take place. We were told that the home does not become involved in peoples finances, instead a bill is sent for additional costs. We were able to audit the way people are invoiced for extra charges. As part of the inspection, we looked to see if the home is maintained in a way which keeps people who live there safe. When we checked bedrooms, we saw that windows have been restricted to try and prevent people from failing out of them. Bedrooms have covered radiators, and radiators in most communal areas have been covered. However, a small radiator in a toilet on the top floor has not yet been covered. There are hot water signs above the sinks, although on the day of the inspection, the running water was an appropriate temperature when we checked it. The kitchen looked clean, and had hand washing facilities, although some cupboard doors are missing. The home has notified us appropriately about an incident when a person left the building without staff knowledge. The safeguarding team were also involved in monitoring the situation. We have been provided with information about what steps have been taken to prevent this from happening again. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 12 16 Arrangements must be made to ensure that there are a range of activities available to meet the needs of all people living at the home, including accessing the community. This action will help ensure that peoples well-being is maintained. 26/03/2010 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 1 The statement of purpose would benefit from being written in a more user friendly manner. Communal areas should be reflected more accurately as there are currently two lounges, a dining room and a conservatory area rather than three lounges. If the second lounge is described in the statement of purpose as part of the communal areas it should be available for use. 2 9 Handwritten alterations to medication administration Page 28 of 30 Care Homes for Older People 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 records should be checked by two staff and double-signed by staff to promote safer practice. 3 15 The home should contact their local Speech and Language Team for advice on good practice regarding supporting people with dementia with their meals. All bedroom should have liquid soap and paper towels in place to promote good infection control procedures, The manager should ensure that any in house training is delivered by people whose training qualifies them to be a trainer i.e. in moving and handling. This is to ensure that peoples practice is up to date. The temperature of water should be regularly monitored and recorded as part of a risk assessment. If the risk is assessed as high then appropriate action should be taken. The radiator in the upstairs toilet must be covered to help keep people safe. 4 5 26 30 6 38 7 38 Care Homes for Older People Page 29 of 30 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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