Inspection on 08/03/10 for The Limes Residential Care Home

This is the latest available inspection report for this service, carried out on 8th March 2010.

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

The inspector found no outstanding requirements from the previous inspection report, but made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Similar services:

Henry Nihill House

Birchwood

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Orchard House Nursing Home

St Josephs Rest Home

Freshfields Residential Home

Red Court Nursing Home

Heritage Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 16/05/2010.

Key inspection report Care homes for older people Name: Address: The Limes Residential Care Home 11-15 Fenstanton Avenue London London N12 9HA     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: Julie Schofield     Date: 0 8 0 3 2 0 1 0 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 37 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: The Limes Residential Care Home 11-15 Fenstanton Avenue London London N12 9HA 02084466609 02084463474 rajgunputh@hotmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Munundev Gunputh Name of registered manager (if applicable) Type of registration: Number of places registered: care home 26 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 26 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home The Limes is a private residential home, which is registered to provide personal care for a maximum of 26 older people, some of whom may have dementia. Although there has been a recent change in the ownership of the home, there is now a sole owner after one of the partners retired, the home continues to provide a service. Care Homes for Older People Page 4 of 37 Over 65 0 26 26 0 Brief description of the care home The home is a combination of 3 houses, which have been joined together and adapted to its current use. There are 22 single and 2 double bedrooms. All but 3 of the bedrooms have en suite facilities. The open plan lounge and dining area, kitchen, laundry, 2 communal showers, toilets, residents bedrooms and a conservatory are located on the ground floor. There are further bedrooms and 2 commual bathrooms, with toilets, located on the first floor. A passenger lift links ground and first floor. There is a small parking area at the front of the house and a large garden at the rear. The stated aim of the home is to provide a safe and homely environment where the unique needs of each individual are recognised and skilled staff are available to provide care and support in a way which encourages self determination and enable each person to achieve their potential. The home is located in a residential street and is close to shops, public transport and other community facilities in North Finchley. Information about the current level of fees and the service provided may be obtained, on request, from the manager of the home. Care Homes for Older People Page 5 of 37 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: We inspected the home on the 8th March 2010. The inspection began at 8.35 am and finished at 5.40 pm. During the inspection the area manager assisted with the inspection as the post of registered manager is vacant. The provider also called to the home during the inspection. We case tracked the care of a selection of residents, we studied records (including residents records, staff records and records relating to the running of the home), we looked at key policies and procedures and we saw the preparation and serving of the midday meal. We spoke with the area manager, the provider, members of staff and with residents. We observed care practices. We checked compliance with statutory requirements identified during the last key inspection and we carried out a site visit. Prior to the inspection we surveyed a selection of residents and members of staff. We noted that some residents completing a survey form had been assisted by one of their relatives. We also received an Annual Quality Assurance Assessment (AQAA) from the Care Homes for Older People Page 6 of 37 home. We would like to thank everyone for their assistance and feedback during the inspection. Care Homes for Older People Page 7 of 37 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. Care Homes for Older People Page 8 of 37 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 37 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 37 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. Carrying out an assessment of the resident, prior to admission, ensures that the needs of the resident are identified and that the home is able to determine whether these can be met. Evidence: We selected 8 case files to review the admission procedure and process. Two of the files belonged to residents that had been recently admitted to the home. We noted that in each case a pre-admission assessment form had been completed by a manager of the home, who went to meet the prospective resident after receiving the referral. The completed form demonstrates a comprehensive assessment and includes cultural needs, physical and health care needs and social needs. The assessment takes place after the home has received copies of relevant supporting documents from the placing authority. We noted from the files that among the documents provided to the home were copies of the transfer forms and discharge letters from hospital, the FACE overview assessment, a statement of need and care plan and reports from health care Care Homes for Older People Page 11 of 37 Evidence: professionals. One file contained a capacity recording form. The assessment form was then used as a basis for developing a care plan for the resident. As part of the admission process the resident and/or their relatives or representative are encouraged to visit the home to view the accommodation, meet the residents and members of staff and to see what life is like in the home. This would help the prospective resident to decide if they were satisfied with the choice of placement. We observed that there is a notice in the entrance hall advising visitors of where a copy of the most recent CQC inspection report is held. After the pre-admission form is completed the manager contacts the placing authority to confirm whether the home can meet the needs of the prospective resident and if so the placing authority informs the person in writing. When we surveyed residents living in the home we asked them if they had received enough information to help them decide if this home was the right place for them, before they moved in. Five of the 6 residents that completed a survey form ticked yes. The home does not provide an intermediate care service. Care Homes for Older People Page 12 of 37 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. Care plans lack an assessment of capacity and not all have risk assessments or detailed risk assessments. A full assessment is needed for a resident to receive a service tailored to meet their individual needs. The health and well being of residents is promoted through regular health care checks and appointments. Residents are supported in taking their medication, as prescribed by their GP, in order to maintain their general health. Discreet and caring support is given to residents by staff so that the privacy and dignity of the resident is respected. Detailed information is needed in respect of end of life care so that plans are in accordance with the residents wishes. Evidence: In addition to the 2 case files belonging to residents recently admitted to the home, we case tracked the care of 6 other residents. When we examined their case files we noted that they contained a care plan and a life history and background. There was evidence that the care plan was reviewed on a regular basis, both by the home and by the placing authority. However, one file that we viewed did not contain any risk assessments and another file belonging to a resident that was bed bound had a very Care Homes for Older People Page 13 of 37 Evidence: brief risk assessment in respect of falls. When we surveyed members of staff we asked whether they were given up to date information about the needs of the people they cared for and each of the 4 members of staff ticked always. We discussed the impact of the Mental Capacity Act and the Deprivation of Liberty Safeguards. The area manager confirmed that some members of staff have begun this training and that the company is working to produce a template for capacity assessments, to be incorporated into the care plan. When sampling case files we noted that there was evidence of access to health care provision in the community. We saw that files contained a medication profile and medical history. Visits by health care professionals were recorded and these included visits by the GP, chiropodist, optician, physiotherapist, District Nurse and dentist. Residents had been able to have the flu vaccine, if they wished. Support was given for residents to attend out patient appointments at the hospital e.g. at the opthalmology clinic, the cardiology clinic, the trauma clinic etc. We asked about pressure care and were told that 1 resident has a pressure sore that is being treated by the District Nurses. Their case file included an up to date record of turning the resident every 2 hours, a food and fluid record chart and a continence record chart. The resident has been provided with a special mattress and cushion to make them more comfortable and to assist the healing process. When we surveyed residents we asked whether the home makes sure that the resident gets the medical care that they need and 5 residents ticked always and 1 resident ticked usually. There are no controlled drugs being administered in the home at present and none of the residents self-administer. The home uses the blister pack system for administering medication. We noted that the storage was safe and secure and that the popped blisters were in accordance with the time of day and with the day of the week that we inspected the cassettes. Records were up to date and complete. When we spoke with residents in the home we asked about respect for the residents privacy and dignity. A resident that required assistance with personal care confirmed that the members of staff made her feel at ease when they were helping her. We noted that assistance with personal care was offered discreetly and that residents are addressed by the name or title that they prefer. Although there are 2 rooms that may Care Homes for Older People Page 14 of 37 Evidence: be shared in the care home, and screening is available in these rooms, they have been occupied on a single basis as residents have preferred not to share. The area manager confirmed that any medical examinations or treatment are carried out in the residents bedroom. We discussed end of life care. We had noted that not every case file seen included details of funeral arrangements. When this section had been completed it included cultural or religious needs before or after death. Residents have been able to choose to remain in the home during their final days and Macmillan nurses have in the past provided support. We were told that the care home is looking to apply for Gold Standards accreditation for end of life care with the local authority. Care Homes for Older People Page 15 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A program of activities provides residents with opportunities for stimulation and enjoyment and this must be tailored to the needs of all residents, including those with dementia. Residents said that they enjoyed the company of their visitors, who were made welcome by the staff when they visited the home. Residents have opportunities to exercise choice in their daily lives. Residents nutritional needs are met through the provision of a diet that is wholesome and varied and which meets their needs. Evidence: There is a white board in the open plan communal area that lists the names of the staff on duty during that day and the activities being offered. However, on the day of the inspection, which was a Monday, the details related to the previous Saturday. We were told that the home did not have an activities co-coordinator and that all members of staff shared a responsibility for enabling residents to take part in activities. Two of the more active residents enjoy going out to the shops etc and a member of staff is provided to escort them. Within the care home there are puzzles, art work, board games and DVDs to take part in or to watch. During the inspection we saw a game of dominoes taking place. Outings are arranged during the good weather and entertainers visit the home. We were told that seasonal celebrations take place. When we surveyed residents we asked whether the home arranges activities that they Care Homes for Older People Page 16 of 37 Evidence: can take part in if they wish. Two residents ticked always, 2 residents ticked usually and 1 resident ticked sometimes. A record of activities that residents had participated in is kept. Residents are able to choose whether to take part in any arranged activities or whether they wish to associate with other residents. There is respect for residents religious beliefs and members of a local church visit the home to conduct an interdenominational service. Visitors are welcome in the care home at all reasonable times, although when meals are being taken the privacy of other residents must be respected. Residents confirmed that they are able to entertain their visitors in the privacy of their own room, if they wish. They also confirmed that their visitors were made welcome when they called to the home by the members of staff on duty. Residents have the right to refuse to see a visitor if this is their wish. The only time that visitors are not encouraged to call to the home is when the visitor is ill and there is a risk that they may pass on an illness to the resident(s). We noted on our arrival at the care home that there were copies of the Deprivation of Liberty booklet and the Mental Capacity Act booklet produced by the Department of Health, available in the entrance hall. The home has also been able to advise relatives when an advocate is needed or when the support of Age Concern is required. Residents are encouraged to remain as independent as possible and to make decisions about their daily lives, as far as this is possible. Residents are assisted in handling their financial affairs by a relative etc and no one working for the company is an appointee for any resident. During a site visit we saw that residents have the opportunity to bring with them personal items, on admission to the home and residents are encouraged to personalise their room with photographs, ornaments and small items of furniture. To assist residents in purchasing their own new clothes there are arrangements for clothes parties to be held in the home where residents are able to see, select and try on new clothing before a purchase is made. We noted on our arrival at the care home that the home had achieved a 5 star (excellent) score on the door from the environmental health department for its kitchen and food handling arrangements. When we arrived at breakfast time the carers were offering a choice of cereals, toast, sandwiches and hard boiled eggs to residents. When lunch was prepared it consisted of a pork chop (with any bones removed), mashed potato, broccoli and mixed vegetables. Residents are asked if they would like an alternative. When the meal was served we noted that it looked and smelt appetising and that portion sizes were generous. A choice of desserts was available and the diabetic residents had access to low fat yogurts and fresh fruit. The Care Homes for Older People Page 17 of 37 Evidence: cook informed us that most residents prefer their food to be well cooked and soft. Three residents have a pureed diet and the cook uses a blender to ensure that each item is served separately on the plate. Where necessary assistance with feeding is discreetly provided to residents. We looked at the diary and saw that the record of meals consumed by residents was up to date and complete and that where residents had alternative meals a record had been kept. Cleaning records for the kitchen, records of fridge and freezer temperatures and records of the temperature of food being served to residents were also available. There was a 4 week menu cycle and menus were varied and wholesome. The evening meal offered a choice of a cooked snack or a cold meal. When we surveyed residents we asked whether they liked the meals at the home and 4 residents ticked always and 2 residents ticked usually. Care Homes for Older People Page 18 of 37 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. A complaints procedure was in place to protect the interests of the residents. Protection of vulnerable adults training for staff and familiarity with the homes procedure and with the whistle blowing procedure contribute towards the safety of residents. Evidence: We noted on arrival at the care home that a copy of the complaints procedure was on display in the entrance hall. The procedure outlined the various stages of the procedure and attached timescales to each individual stage. However, the contact details for the regulatory authority were out of date. The provider contacted the CQC following the inspection to confirm that the amendment to the policy had been made. A summary of the procedure is also included in the service user guide and a copy of this is provided in each of the residents bedrooms. The area manager informed us that they were in the process of producing a shorter, more user friendly version of the procedure for residents and that a copy of this would be placed in each of the bedrooms. When we surveyed residents we asked if there was someone they could speak to informally if they were not happy and they each ticked yes. We went on to ask if they knew how to make a formal complaint and 4 of the 6 residents ticked yes. When we surveyed members of staff and asked them if they knew what to do if someone had concerns about the home they all ticked yes. We examined the records relating to complaints received since the last key inspection. Care Homes for Older People Page 19 of 37 Evidence: Of the 3 complaints recorded, all had been dealt with appropriately and resolved. The records included a summary of the investigation carried out, the actions taken and details of feedback to the complainant. This addressed a statutory requirement that had been identified during the previous key inspection and we were satisfied that compliance had been achieved. A copy of the homes adult protection policy and procedure was available for inspection but as this was in the process of being amended the provider forwarded a copy of the new procedure to the CQC following the inspection. The procedure addressed a statutory requirement that had been identified during the previous key inspection and we were satisfied that compliance had been achieved. We noted that the the procedure includes guidance about reporting incidents to the local authority and about the role of the lead authority and its responsible for carrying out investigations. The home also has a whistle blowing procedure. When we spoke with members of staff they were able to demonstrate their understanding of adult protection procedures and confirmed attendance at training sessions. The home has not made any safeguarding alerts in this period. We saw that a copy of the local authoritys inter agency guidelines in the event of abuse was available in the office for reference. We noted when reviewing staff personnel files that the homes recruitment policy included obtaining the necessary checks (CRB and pova first) and references etc prior to employment. These documents were in place. We also noted that the home has policies and procedures for handling residents monies. Care Homes for Older People Page 20 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy a homely environment with comfortable communal and private facilities in which to relax. Residents live in a care home that is clean and tidy. Infection control procedures and training for members of staff assures residents that the risk of cross infection is minimised. Evidence: The location of the care home is peaceful and there is a garden at the back of the property that has a ramp giving access to the area furthest away from the house. The garden is attractively set out and includes a paved area and seating for residents. The care home has been formed from 3 houses and the garden area retains 3 different themes. Communal space consists of an open plan lounge and dining area and a conservatory. We were told that the conservatory is not used during the winter months as there is no heating there. We noted that the roof of the conservatory appears to be transparent and without blinds. A lack of protection from the sun during the summer may cause the temperature in this room to rise. The decor and furniture in the communal areas provides a comfortable and homely environment for residents. While we were present in the home we conducted a site visit. We discussed 2 statutory requirements in relation to the physical environment that had been identified Care Homes for Older People Page 21 of 37 Evidence: during the previous key inspection and noted that these have now been addressed and compliance achieved. We saw that the program of maintenance for the home was ongoing. New carpet had been provided for the open plan lounge/dining area and in the conservatory. Part of the lounge area had been redecorated to match the new chairs that had been purchased. The hallway had also been redecorated. The program of refurbishing residents bedrooms has continued with redecoration and new carpets. There were a number of minor repairs/redecoration that are needed. We pointed these out to the area manager during the site visit. The walls in the upstairs corridor need repainting, the light fitting in Room 20 needs a cover, the wardrobe door needs repairing in Room 21, the holes left by rawl plugs in Room 23 need filling, the en suite door in Room 1 needs repairing and curtains in 2 of the ground floor bedrooms need to be firmly attached to the curtain rail. While walking around the care home we saw that it was clean and tidy and noted an absence of offensive odours. When we surveyed residents we asked if the home was clean and fresh and 3 residents ticked always and 3 residents ticked usually. We discussed infection control with the area manager who informed us that they have a copy of the Department of Healths guidelines for care homes and that training is provided to members of staff in respect of infection control procedures. Laundry facilities are situated in a building to the rear of the care home but access to this is through the open plan lounge/dining area and then the conservatory. We discussed their plans to open up an area at the side of the house and to utilise a door in this area so that the route to the laundry would not involve walking through the open plan lounge/dining area. We looked in the laundry room. Facilities consist of commercial appliances and the washing machine has a sluicing cycle. Care Homes for Older People Page 22 of 37 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. Staffing levels were sufficient to meet the current needs of residents. Residents benefit from support from members of staff that have developed their understanding and awareness through NVQ training. Recruitment procedures are generally good and this promotes the safety and welfare of residents, although a change is needed in the policy relating to references. Members of staff have access to training that develops their understanding and skills. Keeping training records up to date would allow the home to demonstrate that care staff have refreshed their training at the recommended intervals. Evidence: We reviewed staffing levels with the area manager. During the day time shifts there are 4 members of staff on duty (including a team leader) in addition to either the manager and/or the deputy manager. At night there are 3 members of staff on duty and there is an on call management rota for support in the absence of the manager. There are domestic staff on duty each day for between 5 and 7 hours and there is a cook on duty each day who prepares and serves the midday and the evening meals. A staff rota is kept. When we surveyed members of staff and asked whether there were enough staff to meet the individual needs of all the people who use the service they each ticked Care Homes for Older People Page 23 of 37 Evidence: always. When asked whether they felt that they had enough support, experience and knowledge to meet the different needs of people who live in the home they each ticked always. When we surveyed residents living in the home we asked them if they received the care and support they needed. Three of the 6 residents that completed a survey form ticked always, 2 ticked usually and 1 ticked sometimes. We then asked whether there are staff available when the resident needs them and 5 ticked always and 1 ticked usually. We went on to ask whether the staff listened to what the resident said and acted on this. Four residents ticked always and 2 residents ticked usually. We reviewed the progress made towards achieving the target of a minimum of 50 of carers with an NVQ level 2 or 3 qualification. The area manager confirmed that approximately 10 of the 16 carers hold this qualification and so the home has met the target. When we looked at 4 of the staff files we noted that 2 of the members of staff had achieved a level 3 qualification and 1 member of staff had achieved a level 2 qualification. We examined 4 staff personnel files. We saw that each file contained an application form and that the form included a health questionnaire and a declaration in respect of any cautions or convictions. Files contained 2 satisfactory references although on 1 file the references were open and addressed to whom it may concern. Passport details were held and, where necessary, the right to reside and to work in the UK had been established. Files contained pova first and enhanced CRB disclosures. The provider informed us that the company has now employed a training consultant who facilitates 2 training sessions per month. The training program includes sessions on equalities and diversity, safe working practices, dementia care and medication. We saw the training matrix for the staff team. This records the individual training achievements of each member of staff against a list of mandatory and recommended training. The area manager was in the process of updating the grid so that the need for refresher training can be identified. When we surveyed members of staff we asked whether their induction had covered everything they needed to know to do the job when they started. They each ticked very well. We were informed that the induction training program in use in the care home is to change to the one promoted by the Sector Skills Council. When we surveyed staff we asked whether the training that they have received since their induction is relevant to their role, helps them to understand and meet the individual needs of people, keeps them up to date with new ways of working and gives Care Homes for Older People Page 24 of 37 Evidence: them enough knowledge about health care and medication. They agreed that it did. Care Homes for Older People Page 25 of 37 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. Current arrangements to cover the vacant post of manager ensure the efficient and effective running of the home. Quality assurance systems in place enable the future development of the service to reflect the views and needs of the residents. Support is given to residents who need assistance in managing their day to day finances so that residents financial interests are protected. The testing/servicing of equipment in the home demonstrates that it continues to be safe to use. Evidence: The provider notified the CQC,prior to this inspection, that the registered manager left the home in January 2010. We were informed during the inspection that the post of manager has already been advertised and that interviews have been held. On receipt of a satisfactory CRB disclosure, the successful candidate will begin working in the home. We discussed the qualifications and experience of the proposed new manager. The arrangements in place to cover the managers duties until a new person takes up the post were reviewed and deemed to be satisfactory. The area manager, who has an Care Homes for Older People Page 26 of 37 Evidence: RMA qualification and an NVQ level 4 in care qualification, is working in the home 5 days per week. In her absence the deputy manager is responsible. In order to strengthen the management team in the home the number of team leaders is being increased from 3 to 5. The provider is a regular visitor to the home and is familiar with the needs of the residents. We noted that the home does not benefit from IT systems e.g. a computer and we were told that all administrative work required is faxed over to the central office, where it is dealt with. The care home is part of the companys group of 4 care homes in north London and it is unusual in these circumstances for each site not to be on line. It is recommended that the provider reviews the running of the home so that the benefits of using systems to assist with planning, monitoring and recording are considered and implemented. We noted on our arrival at the care home that a copy of the most recent Quality Assurance Survey results (from the summer of 2009) was on display in the entrance hall. Survey forms had been sent to the next of kin and to representatives of the placing authorities. We looked at the questions asked and at the responses received. The scope of the questionnaire was comprehensive and where responses rated the service as fair we discussed this with the area manager. These scores were in relation to the physical environment and activities within the home. We were told that since the returns the maintenance program has continued and has addressed issues raised. Similarly the activities offered in the home were reviewed and some changes made. There are also opportunities to give feedback during review meetings, residents meetings and staff meetings. However, the recording of the minutes of residents and staff meetings had lapsed prior to the resignation of the registered manager. Informally feedback is sought and given to the provider who visits the home on a regular basis. Internal audits take place e.g. of the building and of its facilities and the area manager has previously carried out Regulation 26 visits, when the registered manager was in post. We checked a sample of the records of monies kept in the home on behalf of residents. Records were up to date and complete and individual residents records included a system for cross checking items of expenditure with the receipts held. After each transaction a balance was recorded. When money was handed directly to a resident the resident, if they were able to, signed to acknowledge receipt. We were informed that no one working for the company acts as an appointee for any resident. Care Homes for Older People Page 27 of 37 Evidence: The area manager informed us that although members of staff are supervised on a day to day basis, individual supervision sessions for members of staff had lapsed prior to the resignation of the registered manager. However, the area manager and the deputy manager of the home are to share the responsibility for implementing a program of supervision that has now been set up. As appraisals are overdue these will take place after a newly appointed manager has had the opportunity to observe the care practice of members of the staff team. A member of staff confirmed to us that they had attended a staff meeting in December but the minutes of this meeting have not been recorded. It is proposed to hold a staff meeting after a new manager is in post. When we surveyed members of staff they agreed that their manager gives them enough support. We noted on our arrival at the care home that a valid certificate for Employers Liability cover was on display in the entrance hall. We checked the health and safety records held in the home and noted that there was valid documentation for the servicing/inspection of the fire alarm and emergency lighting system, the fire blanket and fire extinguishers, the nurse call system, the electrical installation, the lift, the hoists, the portable electrical appliances and the Landlords Gas Safety Record. The fire risk assessment had been reviewed after the last key inspection and this addressed a statutory requirement that had been identified. There was evidence that fire drills are held on a regular basis and that the fire alarm and smoke detectors are tested on a regular basis. We checked the accident book and discussed what follow up action had been taken in relation to specific accidents. We are satisfied that the action was appropriate. Care Homes for Older People Page 28 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 14 The registered person must 01/06/2010 ensure that, where necessary, an assessment of capacity is included in the pre admission assessment procedure and is included in the care plan, if this becomes necessary at any date in the future This will assure residents that their rights are promoted and protected at all times. 2 7 13 The registered person must ensure that care plans include risk assessments, tailored to the individual needs of the resident. This will assure residents that when promoting independence the risks associated with daily living are identified and minimised. 01/06/2010 Care Homes for Older People Page 30 of 37 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 7 13 The registered person must ensure that risk assessments are sufficiently detailed. This will assure residents that members of staff supporting them are able to do so in a safe manner and in accordance with the risk management strategies. 01/06/2010 4 11 15 The registered person must ensure that care plans include information regarding the wishes of the resident in the event of a teminal illness or death. This will assure residents that their wishes are known and respected. 01/06/2010 5 12 16 The registered person must continue to review the content of the activities program with residents. This will assure residents that the program incorporates activities of interest to current residents. 01/05/2010 6 12 16 The registered person must ensure that information on display about activities taking place in the home is current. This assures residents that 01/05/2010 Care Homes for Older People Page 31 of 37 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 they are aware of what activities are on offer that day and can make a choice about whether they wish to participate. 7 12 18 The registered person must ensure that at least 1 member of staff undertakes training in providing activities for residents with dementia. This person (or persons) may then cascade the information to other members of the staff team. This will assure residents that activities are provided that are appropriate for their needs and which will enhance their quality of life. 8 16 22 The registered person must review all documents where a summary of the complaints procedure is included to ensure that the contact details for the regulatory authority are correct. This will assure anyone wishing to make a complaint or to raise concerns that they have the information needed to contact the CQC. 01/05/2010 01/07/2010 Care Homes for Older People Page 32 of 37 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 9 20 23 The registered person must 01/07/2010 ensure that the temperature in the conservatory is suitable for use, throughout the year. This will provide residents with an additional choice of communal space and a pleasant outlook to the garden. 10 24 23 The registered person must review the program of routine maintenance and include and remedy the matters highlighted during the site visit and noted in this report. This will assure residents of a comfortable and smart environment in which to live. 01/07/2010 11 29 19 The registered person must ensure that reference requests are sent to a named person and that to whom it may concern references that have been provided by the applicant are not accepted. This will assure residents that the validity of the reference has been established. 01/05/2010 Care Homes for Older People Page 33 of 37 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 12 30 18 The registered person must ensure that the training profiles of members of staff are kept up to date. This will assure residents that the care provided by members of staff benefits from known best practice and that training has been refreshed according to the recommended frequencies. 01/05/2010 13 33 12 The registered person must 01/05/2010 ensure that minutes of meetings held with residents are kept. This will enable the home to demonstrate that the views of residents are listened to and acted upon. 14 33 21 The registered person must 01/05/2010 ensure that minutes of meetings held with members of staff are kept. This will enable the home to demonstrate that the views of members of staff are listened to and acted upon. 15 36 18 The registered person must ensure that members of staff receive individual supervision sessions at least every 2 months and that a record is kept of these meetings. 01/05/2010 Care Homes for Older People Page 34 of 37 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 This will enable the home to demonstrate that the care practice of members of staff is kept under review and closely monitored. 16 36 18 The registered person must ensure that the overdue staff appraisals are completed. This will enable the home to demonstrate that the training needs of members of staff are identified and then incorporated into the annual development plan for the home. 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 01/06/2010 1 2 9 9 That once a tube of cream or ointment is opened, the date on which it is opened is recorded on the label on the tube. That the assessment of competence for members of staff prior to administering medication is recorded and then kept under review and a record made when the competence is reassessed. That the registered person discusses the complaints procedure at the next residents meeting and explains when and how to use this. That the registered person reviews the need for ceiling blinds in the conservatory by monitoring the temperature in this room throughout the summer months. That the registered person goes ahead with plans to open a Page 35 of 37 3 16 4 19 5 26 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 route to the laundry via a door on the side of the house to avoid laundry being carried through the open plan lounge/dining area. 6 27 That the responses given and comments made in the CQC survey of service users is discussed at a residents meeting and also used as a quality assurance tool. That the provider reviews the running of the home so that the benefits of using on site IT systems to assist with planning, monitoring and recording are considered and implemented. 7 31 Care Homes for Older People Page 36 of 37 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. 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