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Inspection on 11/05/09 for Thomas Knight Care Home

Also see our care home review for Thomas Knight Care Home for more information

This is the latest available inspection report for this service, carried out on 11th May 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Makes sure that people who want to move into the home are properly assessed so that everyone is sure their care and support needs can be met, and meets with relatives to talk about expectations and what the home can and cannot provide. Uses the assessment process to inform and prepare care plans and the service user plan so that people get the care and support they need in the way they want, promoting choice, independence, privacy and dignity. Makes sure that people can see a wide range of healthcare professionals as and when they need helping to keep them safe and well. Manages peoples` nursing needs in a way that promotes their health and well being and minimises the risk of pressure area damage. Promotes social events and activities so that people get the chance to go out and about in the community and lead interesting and stimulating lives. Encourages and welcomes the involvement of relatives and friends, welcomes them into the home supporting them at difficult times. Provides and promotes a varied, nutritious diet for residents, fortifying meals where necessary to make sure people get the calories and fluid intake they need. Keeps good records to promote the health and well being of residents. Regularly follows proper recruitment and selection procedures to make sure that only people who are able to work with vulnerable adults are employed. Provides residents with a warm, homely environment where they can spend time privately or with others as they wish and where they can personalise their own room as they wish. A relative said: `This home gets 10 out of 10`.

What has improved since the last inspection?

Redecoration of the corridors and kitchen has taken place and refreshment areas have been provided on each floor for the convenience of relatives and staff when making residents a drink or snack. Policies and procedures have been updated where necessary to promote current best practice. `Staggered` admissions have been introduced so that new residents are able to have extra care and support to help them settle in. Menus and morning routines have been changed to give residents a greater choice of when they get up and what they want to eat.Increased the number of staff who have achieved a National Vocational Qualification at level 3.

What the care home could do better:

Make sure that staff/agency staff always follow the home`s policies, procedures and guidance in the safe handling of medication, helping to keep people who live in the home safe and well. Make sure that application forms are properly checked when they are received and that employment history dates are completed in full.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Thomas Knight Care Home 1 Beaconsfield Street Blyth Northumberland NE24 2DP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anne Brown     Date: 1 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Thomas Knight Care Home 1 Beaconsfield Street Blyth Northumberland NE24 2DP 01670546576 01670546823 noemail Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Sewa Singh Gill care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 54 The registered person may provide the following category of service only: Care Home with Nursing, Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category, Code OP, maximum number of places 17 Dementia, Code DE, maximum number of places 36 Physical Disability, Code PD, maximum number of places 1. Of the following age range: Aged 55 years and above Date of last inspection 36 0 1 Over 65 0 17 0 Care Homes for Older People Page 4 of 32 Brief description of the care home Thomas Knight was opened in 2005, it is situated in the centre of Blyth. The home is close to local shops and amenities. The accommodation is located on three floors and all rooms are single with en-suite facilities. The ground floor of the home accommodates residents with general nursing needs. The first and second floors accommodate residents with nursing and mental health needs. There are sitting areas and a dining room on each floor and a passenger lift connects all floors. Outside there are small gardens to the front and side of the home. The garden at the front is not suitable for use by those residents with any degree of confusion as it leads directly onto the main road. The fees for the home range from £444.60 to £464.60 per week. Further information can be found in the statement of purpose for the home and previous inspection reports. These are available in Thomas Knight. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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 quality rating for this service is 3 star, this means that the people who use this service experience excellent quality outcomes. An unannounced visit was made on the 11 May 2009. A total of 7 1/2 hours were spent in the service. The manager was present throughout the inspection. Before the visit we looked at Information we have received since the last visit on the 16 June 2008. The Annual Quality Assurance Assessment (AQAA) that gives CQC evidence to support what the service says it does well, and gives them an opportunity to say what they feel they could do better and what their future plans are. How the service has dealt with any complaints and concerns since our last visit. The providers view of how well they care Care Homes for Older People Page 6 of 32 for people, and the views of people who use the service, their relatives, staff and other professionals who visit the service. We have also reviewed our practice when making requirements to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. During the visit we Talked with people who use the service, staff and the manager. Looked at information about the people who use the service and how well their needs are met. Other records which must be kept. Checked that staff had the knowledge, skills and training to meet the needs of the people they care for. We looked around the building/parts of the building to make sure it was clean, safe and comfortable. Checked what improvements had been made since our last visit. We told the manager what we found. What the care home does well: What has improved since the last inspection? Redecoration of the corridors and kitchen has taken place and refreshment areas have been provided on each floor for the convenience of relatives and staff when making residents a drink or snack. Policies and procedures have been updated where necessary to promote current best practice. Staggered admissions have been introduced so that new residents are able to have extra care and support to help them settle in. Menus and morning routines have been changed to give residents a greater choice of when they get up and what they want to eat. Care Homes for Older People Page 8 of 32 Increased the number of staff who have achieved a National Vocational Qualification at level 3. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who move into the home have their diverse needs properly assessed so that everyone is sure they can be given the right care and support. Evidence: People who wish to move into the home and/or their relatives are given information to help them decide if it is where they want to live. They can also visit the home, have lunch and spend time with other residents. People are given a welcome pack that includes a copy of the Care Quality Commissions (CQC) latest report, and they are shown the statement of purpose and service user guide. There are plans to increase the way people can access information by improving the brochure and setting up a internet site. Care Homes for Older People Page 11 of 32 Evidence: We saw the records for six people who live in the home. Each of the records include the original assessment by a care manager or health care professional and the homes pre-admission document. The assessment process includes peoples physical and mental well being, nutrition, behaviour, skin care, moving and handling and risk assessments. The home manager also meets with people who are moving into the home and their family to make sure that everyone knows what to expect and what the home can and cannot provide. There is a staggered admission process, where only one person can be admitted to each floor during a week. This is to make sure that the person concerned gets any additional support they need during this period to help them settle in. The home does not provide intermediate care. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home have their care and support needs met in a way they choose and by who they want. They can see a range of health care professionals as and when they need, are supported to make choices and be as independent as possible. Evidence: Local authority and in-house assessments are regularly carried and used to put together service user plans. We looked at the records for residents who were receiving residential, general nursing or emi nursing care. All records are kept in a consistent way, they were up to date and included good information about how people wanted their care and support to be provided, and by who. Privacy, dignity, independence and choice are promoted through care planning. We heard and saw staff knocking on doors before entering, greeting the resident cheerfully and asking if they wanted a drink pouring or the light left on or off, before Care Homes for Older People Page 13 of 32 Evidence: leaving the room. Preferences for when people liked to take a bath, whether they wanted their care provided by a male or female carer are clearly recorded. As well as any behaviours that may challenge daily routines. Residents are provided with equipment to make their daily life and surroundings more comfortable. The provision of equipment such as pressure mattresses, cushions, wheelchairs, walking aids and hip protectors, cot sides and moving and transferring needs are properly assessed and supported, where appropriate, with guidance for staff. A range of professionally recognised assessment documents are used for pressure area care, mental health well being, continence and nutritional needs. Those we saw were properly documented and detailed. Separate recording sheets are in place for each resident to record food and fluid intake, checks on blood sugar levels, blood pressures and weights. There was also clear information about the frequency of making checks when these were not a daily event. Pressure area damage was well documented together with a treatment plan. People have been admitted to the home with skin problems but there have been no breakdowns in residents skin integrity for over twelve months. This is an excellent achievement. Evaluations of care plans and residents reviews were up to date. We saw a capacity assessment that had been carried out by a Registered Mental Nurse to support a resident making their own decisions. They had recorded that the resident was able to make simple decisions but may need help with more complex decisions. Staff take advice from and involve a range of health care professionals as residents needs dictate. For two people who had lost weight between the March and April checks, there was clear information about what staff had done and who they had involved. For one person it was their GP and for the other the Speach and Language Therapy Team (SALT). Staff were seen spending time with residents talking to them, helping them to eat and drink or move around. All these tasks were carried out in a very senstive way and with Care Homes for Older People Page 14 of 32 Evidence: lots of good humour. Care plans included advice such as staff need to maintain good eye contact whilst conversing, for a person who was hard of hearing. Family involvement is promoted and encouraged and one relative told us the home scored 10 out of 10. Handover records are kept separately on each floor. In the general nursing file we saw laminated guidelines about daily routines and expectations. These are used to remind staff and agency staff about what is expected of them. Summary sheets of residents needs were also in place to give any agency staff visiting the home a pen picture of each person. All the documents we saw in these records were consistently completed and detailed. Staff present at the handover are required to sign the handover sheet. We carried out a random check of medication and medication administration systems in the home. The treatment room is on the first floor. It was clean and tidy and contained three separate drugs trolleys, one for each floor. There are also three separate medication cabinets for extra supplies of medicines. Medication is received into the home from Boots the Chemist on a four weekly cycle. Unused medication is also returned to the chemist. From the Medication Administration Records (MAR) we saw it was evident that staff do not always carry forward onto the new MAR medication left over from the previous month and not returned to the chemist. This makes it difficult to audit supplies. We saw a small number of gaps in the initials on the MAR sheets. These were on the same day, and the same shift. The deputy manager was going to follow this up. Controlled medication is kept separately in a secure cabinet. Two staff are required to gain access to the cabinet. We checked all these medicines against the controlled drugs register. There were no discrepanices and all entries were double signed. In the treatment room staff also have access to copies of Medical Devices Alerts (MDAs) and an up to date medication reference guide. Guidance and check sheets are in place to record refrigerator temperatures and the checks and cleaning routines for the suction machine. Equipment such as syringe drivers are not kept in the home but are provided from the community as and when a resident needs. Staff have been working with the Primary Care Team (PCT) to review and improve the Care Homes for Older People Page 15 of 32 Evidence: policy and guidance for the safe handling of medication. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are encouraged to take part in social events and activities, to keep in touch with families and friends and to go out independently into the local area, promoting their independence and choice. Evidence: During the inspection we saw lots of people visiting the home and residents going out. There are strong links with the local community and whilst we were there someone from the library came along and donated a large amount of books for the residents. The home has a full time activities organiser post and interviews were due to take place to fill this appointment by the end of May. Residents are encouraged and helped to stay in touch with family and friends, and family involvement in the home is very welcome. One gentleman who visits his wife and takes her out for lunch most days has been unable to do this whilst another member of the family is unwell. Staff said they would make sure his wife went out with one of them. He was very appreciative of the support. One resident has their own bus pass and goes out independently when they wish. Care Homes for Older People Page 17 of 32 Evidence: The manager has put together an activities pack and there is a copy of this on each floor. The pack gives staff advice about the benefits of activites and social events. Residents go out to theatre, on bus trips and for walks in the local area. Thomas Knight is in the heart of the local community close to the shops, market and harbour, which means people can get out and about quite easily. There is a church opposite the home where people can take part in multi-faith services and join in coffee mornings. A local priest also visits the home for residents of the catholic faith who are unable to get out. The home has its own hairdressing salon, and hairdressers attend twice a week. A barber also visits the home fortnightly for the benefit of the gentleman who want a more traditional service. There are lots of videos and books around the home. Daily events can include todays news, armchair aerobics, arts and crafts, a walk, music, singing, gentle exercise, aromatherapy, or photographs. There is a small, enclosed garden at one end of the home and we were told that it is hoped to provide a sensory garden in this area. Two seats been donated for the residents to use when they sit outside in memory of people who previously lived at Thomas Knight. The activities sheet for May included visits to the market, pamper day, films, park visit, shopping and a quayside walk. The manager holds regular relatives meetings. At a recent meeting she shared with them feedback from the recent survey, information about the Mental Health Capacity Act and Deprivation of Liberty legislation. As we walked around the home a resident who was leaving the dining room said best meal I have had for weeks, presentation and everything. A relative said this home gets 10/10. The manager showed us pictorial menu cards that are being put together to help people with communication difficulties make choices about what they want to eat. Following the results of a questionniare on dietary preferences changes have been Care Homes for Older People Page 18 of 32 Evidence: made to menus. We visited the kitchen and spoke to chef and a kitchen assistant. Chef bakes cakes and/or biscuits everyday. There is also one milk based pudding on the menu daily and pudding is prepared for supper time. Menus follow a six weekly cycle providing residents with two hot choices at lunch time. Alternatives can still be provided if someone does not like the days menu, or needs a different type of diet. Products received into the home are colour coded to identify delivery days. No items over three days old are used. The routines in the kitchen and management systems are excellent. There are refreshment facilities available on each floor for relatives and visitors to use and so that staff can make residents a drink or snack quickly and easily. Relatives are being encouraged to help their family member complete a social history book including a family tree. This is a good initiative, and some of those seen gave a real insight into the persons life, likes and dislikes. Care Homes for Older People Page 19 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are able to raise any concerns and complaints they may have and know they will be listened to. Policies, procedures and staff training in complaints and safeguarding adults help to promote the safety of residents. Evidence: The home has a complaints procedure in place that promotes the receipt, recording and investigation of complaints and concerns. Copies of the procedure are displayed in the entrance hall and on notice boards. There is a complaints register in place, no complaints had been received. The home has a whistle blowing policy, that encourages people to tell someone if they witness any poor practice. The whistle blowing policy has been revised and improved during the last 12 months. Staff are required to have a Criminal Records Bureau check (CRB) at an enhanced level to make sure that they are able to work with vulnerable people. Checks are also carried out to ensure that nurses personal identification numbers (PINs) are up to date and they are registered to work as a nurse. The AQAA told us that all staff have received training in the protection of vulnerable adults (POVA). Care Homes for Older People Page 20 of 32 Evidence: Work is underway to put together an information pack for staff about the Mental Health Capacity Act and Deprivation of Liberty legislation. The home has also been working on a pilot project with the Mental Health Team, and this is to be rolled out throughout the home. Care Homes for Older People Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is clean, tidy and odour free giving them access to a private bedroom and comfortable communal areas that they can move freely between. Evidence: The home provides everyone with a single room and en-suite facilities. People are encouraged to bring personal items into the home with them so that they are comfortable and they have familiar things around them. Areas of the home have been re-decorated since the last inspection and refreshment facilities have been provided on each floor for visitors and so that staff can easily and quickly make someone a drink or snack. There is a dining room and choice of lounges on each floor so people have plenty of room to move around, spend time with each other or privately. On one floor a small lounge was being used for a resident and her husband to have lunch privately. Bath, shower and toilet facilities are also located on each floor. There are problems with providing new shower facilities on the first and second floors because of drainage. It is intended to provide two new assisted baths over the next two financial years, in these areas, for the comfort and safety of residents. Care Homes for Older People Page 22 of 32 Evidence: There is a passenger lift to all floors as well as a stair case. All exists and entrances are secured by a key pad so that people are kept safe. At the entrance to the home and each floor there are also hand gel dispensors to promote infection control. The home has its own hairdressing salon. People who live in the home are provided with, or have access to, aids and adptations to make their daily life easier and more comfortable and to promote their health and well being. The laundry was clean, tidy and well organised. Washing machines can be programmed to provide a range of washes including a sluice wash. There is also a sluice room on each floor, these were also very clean and tidy. Paper towel and soap dispensors are fitted in all communal areas. The home was very clean, tidy and odour free. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are protected by recruitment policies and procedures that are regularly followed and staff training that helps them to do their job. Evidence: The organisation has policies and procedures in place to promote the proper recruitment and selection of staff. The records we saw showed that people wanting to work in the home are required to complete an application form, provide the names of two referees, have a criminal records bureau check at an enhanced level and/or provide evidence that their registration with the Nursing and Midwifery Council is up to date. We looked at three staff files and two supervision records. Two of the staff files for people most recently recruited had not been put in the expected format. The other file contained all the required information, was easy to use and up to date. From staff files we identified two issues. One was that when applicants complete their employment history they are only giving a month and year or year of employment. Unless a full date is given it may be that a gap in employment is missed. On one application form the person had not fully completed the criminal cautions and Care Homes for Older People Page 24 of 32 Evidence: convictions section. Neither had the interview record been dated and signed. We saw clear records to show that identity checks were carried out including with the Home Office to make sure that people had the right to stay and work in the United Kingdom. Returned Criminal Records Bureau checks are kept between inspections. The manager keeps a database so that these can be signed off for destruction by the inspector. We saw two induction training files. Care staff are also issued with a copy of the General Social Care Council (GSCC) code of conduct and a guide to Essential Steps to Clean Safe Care. The manager has her own induction package. New staff usually work for at least two days as an extra to the staffing rota to help them settle in and get to know routines and people. Information has been put together with a view to providing staff with a handbook of policies, procedures and guidance. The organisation is now using an external company who will offer guidance on employment matters and keep them up to date with changes in legislation. Five staff are due to complete Healthcare Associated Infection training by mid-July. It is intended that they will then feedback to other staff. We saw the training matrix which was clear and up to date and provided evidence of training completed and due dates. Refresher training in mandatory areas has been identified and costs have been submitted for approval. Nursing staff attended a conference on tissue viability. An increased number of staff have now completed a National Vocational Qualfiication at level 3. The administrator has also completed an NVQ level 3 in Administration. Over the next 12 months there are plans to introduce psychometric testing into the recruitment and selection procedure, provide staff with equality and diversity training, venipuncture and catheterisataion training/consolidation for qualified staff. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in an open and transparent way and in the best interests of the people who live there. Attention is paid to issues promoting health, safety and well being, keeping residents and staff safe. Evidence: The manager sent us the Annual Quality Assurance Assessment (AQAA) when we asked for it, it was very detailed and gave us lots of information about how the home operates, what has improved over the last twelve months and future plans. The home is run in a relaxed, open but professional way. The manager is interested in what people have to say and is ready and willing to listen. The results of a survey of residents carried out earlier this year were impressive. Some residents completed the questionniares themselves, others did so with the help of relatives or friends. Care Homes for Older People Page 26 of 32 Evidence: People were 100 per cent happy with the management and daily living arrangements. Other areas scored: premises 96.78, catering and food 94.88, and personal care/support 99.12. Feedback was given through the relatives meetings that are regularly held. The manager has also used these meetings to update people on new legislation like the Mental Health Capacity Act and Deprivation of Liberty legislation. Supervision is carried out bi-monthly for care and qualified staff. Ancillary staff will be added to the rota over the coming months. The two supervision records we saw showed that the programme is on target to meet the minimum of six sessions per year. We looked at the accident records and fire log. All entries and checks were up to date and complete. The manager completes a monthly accident monitor sheet that includes information about what actions have been taken, also whether an event has required reporting to CQC or RIDDOR. All maintenance and servicing arrangements were up to date. Repairs and maintenance issues are recorded in a repairs book. They are then signed off when completed and checked. The manager has a comprehensive matrix in place that is used to monitor when premises checks need to be carried out and/or servicing arrangements need to be renewed. We were told that the previous electrical contractor had logged the homes wiring circuit to be re-checked every twelve months, the new contractor has advised, as a recent new build, this should be five yearly. The manager is trying to get the certificate changed. Policies, procedures and systems are in place to promote the safe keeping of residents monies. They also have access to a lockable facility in their bedroom where they can keep person items/valuables. Staff meetings are held and recorded for each group of staff. For example, qualified, care and ancilliary. The manager meets with each group of staff and everyone is required to sign to say the have read the minutes. For a recent meeting the agenda items included whistle blowing, safeguarding adults, managers routines, fire signing in book, sickness procedures and lateness. Care Homes for Older People Page 27 of 32 Evidence: Comprehensive policies and procedures are in place and staff have easy access to them. They include protection of vulnerable adults, advocacy, confidentiality, racial abuse, control of substances hazardous to health (COSHH), violence and aggression, whistle blowing, code of conduct, bullying, disciplinary and grievance. A range of audits are regularly carried out and recorded. These include, assessments and weights, reviews, pressure area care, deaths. Health and safety policies and procedures promote safe working practices and are supported by risk assessments. Staff receive training in health and safety, first aid, fire safety, moving and transferring and food hygiene. The range of records we saw and most of the recordings were of an excellent standard. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Medication held over from a previous month should be carried forward to the MAR so that all medicines can be properly checked. This helps to keep people who live in the home safe and well. Ensure that all employed and agency staff regularly complete the MAR sheets. This will promote good medication control, helping to keep people safe and well and show whether people have had their medication or not taken it for some other reason. Applicants for posts within the home should be encouraged to fill in the complete date of their previous employment (day, month and year), so that any gaps in employment can be identified and followed up. This will help to keep people who live in the home safe and well. Care should be taken to ensure that all parts of the application form are fully completed, including the disclosure of previous cautions or convictions. This will promote the recruitment of honest staff who are not barred from working with vulnerable people. All staff should receive regular, recorded supervision, at Page 30 of 32 2 9 3 29 4 29 5 36 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 least six times per year to help and support them with their work. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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