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Inspection on 18/08/09 for Welcome Care Home Ltd

Also see our care home review for Welcome Care Home Ltd for more information

This is the latest available inspection report for this service, carried out on 18th August 2009.

CQC found this care home to be providing an Good 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

The home is small and provides a homely and friendly atmosphere for residents. The registered manager is at the home each day and residents say they can speak with her whenever they want to, and that she is quick to help to sort out any problems they have. Management work well with the Commission and all ten requirements made at the last inspection were dealt with. There is a stable staff team in post who know the residents well and no agency staff are currently being used. Residents are relaxed and comfortable and in their interactions with staff, and relatives and residents say that staff are very kind and caring and they feel that they can ask the for anything they need. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.2 Residents know the manager and said they would speak to her if they had any concerns. Good food and beverages are available and residents consistently said that the food is good and they can ask for food they like. Resident’s Religious needs are being well catered for and the manager often takes residents to church and to coffee gathering afterwards. All residents I spoke with and those who responded to the inspection surveys said that they are happy at the home and that the staff are helpful.

What has improved since the last inspection?

Residents care plans are now reviewed every month and include a review of risk assessments so that residents can be safe. Care plans now include comments about exercise and activities such as puzzles for each individual resident so that residents can be given a full opportunity for a healthy and active life with on the home. The home has been redecorated and repaired in many areas and attention has been given to getting rid of unwanted odours in the home so that now residents feel that they live in a comfortable home. Staff now have current CRB checks done before they are employed, and have a complete record of their induction completed so that resident’s safety is now protected. Training about how to best support residents care needs is now included in the training given to staff, so that they are more skilled in helping residents. The owner of the home now carries out formal monthly monitoring inspections of the care and management provided, and looks at the repairs needed so that the quality of the care and the home itself are maintained to a good standard.

What the care home could do better:

A better description of the activities and exercise for individual residents who have dementia care needs is needed in their care plans to help staff to know the best times to provide this support so that they are at their best to participate. It would be good if some staff could have formal training in providing exercise for older people.Welcome Care Home LtdDS0000025650.V377570.R01.S.docVersion 5.2Medication is well managed but it would be better to have a separate small fridge for some medication. The home should ask residents about what outings they would like and try to meet any requests made for more outings. The home must continue to plan for the ling term repair and refurbishment of the home and always speak to residents about what they think needs improvement. Some training for staff in helping residents with moving and handling care needs has to be updated and all staff need to have had this training. The home needs to carry out full inspections of all aspects of the home every year so that better long term plans for improvement include the right areas.

Key inspection report CARE HOMES FOR OLDER PEOPLE Welcome Care Home Ltd 26-28 Fordel Road Catford London SE6 1XP Lead Inspector Sean Healy Key Unannounced Inspection 18th August 2009 09:00 DS0000025650.V377570.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Welcome Care Home Ltd Address 26-28 Fordel Road Catford London SE6 1XP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8697 5024 020 8698 8287 welcomecarehome@hotmail.co.uk Mrs Margaret Newland Mrs Margaret Newland Care Home 15 Category(ies) of Dementia (15), Old age, not falling within any registration, with number other category (15) of places Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) 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 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 15 23rd July 2008 Date of last inspection Brief Description of the Service: The Welcome Care Home is registered to provide personal care and accommodation to a maximum of 15 older people suffering from dementia. The overall aim of the home is to provide care and support in a homely environment with a relaxed family atmosphere. The underlying philosophy, stated in the home’s brochure, is that of a holistic approach to care. The registered provider is a company belonging to Mrs Margaret Newland, who is also the registered manager for the service. The staff team comprised of a registered manager, a deputy manager, care staff and some domestic hours. The home was opened in 1993 and consists of two semi-detached Victorian houses, which have been joined into one. There is a rear garden with a patio, a fishpond and a lawn area, which is well maintained. Thirteen of the home’s bedrooms are single with en-suite toilet facilities. There is one shared room, which has a wash hand basin only, but exclusive use of a nearby toilet. There is a passenger lift and a short stair lift to ensure access to all parts of the house. The property is situated in a residential road in the Catford area, with some local shops nearby and is close to Catford town, public transport and local amenities and shops. The provider’s email address is: welcomecare@hotmail.com Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.2 Page 5 Information about the service provided is made available to current and potential residents in the homes Statement of Purpose and Service Users Guide, which are given to all service users. The recent Care Quality Commission report is kept in the office area in the home, and on the notice board in the hallway so that all residents and relatives can read it. The current fees ranged from £440 to £470 per week and residents pay privately for items such as toiletries, newspapers and personal purchases. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 2 Star. This means that the people who use this service experience Good quality outcomes. The inspection was unannounced and took place as a visit to the home on 18/8/09. The home provided an Annual Quality Audit Assessment (AQAA), which was also used to inform the inspection. The registered care manager and deputy manager facilitated the visit. Two care staff had discussion with me about their employment and understanding of their job. Five care staff responded to the CQC inspection survey. Four staff employment files were examined to check that they had been properly recruited, trained and supervised. Three relatives of residents contributed their views of the home when speaking to me and three others completed inspection surveys. Three residents discussed their views on the home with me and 12 other residents responded to inspection surveys. Four resident’s files were examined including assessments and care plans. One visiting healthcare professional spoke with me and gave her views about the homes ability to communicate well and provide for general healthcare needs of residents. The inspection involved a tour of the premises and examination of a range of management documentation. The home currently has two resident’s vacancies. What the service does well: The home is small and provides a homely and friendly atmosphere for residents. The registered manager is at the home each day and residents say they can speak with her whenever they want to, and that she is quick to help to sort out any problems they have. Management work well with the Commission and all ten requirements made at the last inspection were dealt with. There is a stable staff team in post who know the residents well and no agency staff are currently being used. Residents are relaxed and comfortable and in their interactions with staff, and relatives and residents say that staff are very kind and caring and they feel that they can ask the for anything they need. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.2 Page 7 Residents know the manager and said they would speak to her if they had any concerns. Good food and beverages are available and residents consistently said that the food is good and they can ask for food they like. Resident’s Religious needs are being well catered for and the manager often takes residents to church and to coffee gathering afterwards. All residents I spoke with and those who responded to the inspection surveys said that they are happy at the home and that the staff are helpful. What has improved since the last inspection? What they could do better: A better description of the activities and exercise for individual residents who have dementia care needs is needed in their care plans to help staff to know the best times to provide this support so that they are at their best to participate. It would be good if some staff could have formal training in providing exercise for older people. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.2 Page 8 Medication is well managed but it would be better to have a separate small fridge for some medication. The home should ask residents about what outings they would like and try to meet any requests made for more outings. The home must continue to plan for the ling term repair and refurbishment of the home and always speak to residents about what they think needs improvement. Some training for staff in helping residents with moving and handling care needs has to be updated and all staff need to have had this training. The home needs to carry out full inspections of all aspects of the home every year so that better long term plans for improvement include the right areas. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a Contract or Statement of Terms and Conditions, and an assessment of need completed prior to admission. Residents have received confirmation that based on assessment the service was suited to meeting their needs. Intermediate care is not provided. EVIDENCE: Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 11 There is an up to date Statement of Purpose and Statement of Terms and Conditions for living at the home and the residents I met said that they had received a copy of these. All residents have full and detailed assessments of need on file. I examined four resident’s files and all were seen to have a detailed assessment of their health and social care needs. The residents at the home have been placed in both three London borough local authorities, with Lewisham as the main contracting agent. Core care assessments have been provided by these local authorities and the show the primary care needs of the residents to be associated with ageing needs, with secondary care needs such as dementia and mental health support being prominent. All residents files examined showed that they had a contract in place, which included the fees paid for their care and showed the service they can expect from the home, and their rights and responsibilities. The home does not provide intermediate care for residents and therefore a standard six does not apply to this home. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal care needs are well set out in care plans and care plans and risk assessments are now consistently reviewed each month. Health care needs are being met and medication is well managed EVIDENCE: There were four requirements made at the last inspection concerned with care planning and review of risk assessments. These were all met and improvements have been made to residents care plans so that they are now of a good quality and reflect the assessed care needs of residents. Dementia care needs of relevant residents are now described better in their care plans and exercise and mentally stimulating activities have improved. Residents interviewed confirmed this and said puzzles and exercise activities are now happening a number of times a week. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 13 Care plans for residents who have high personal care supports needs now have written guidance for staff to follow to protect residents from risk and to also enable them to do things for themselves. Care plans and risk assessments are now being reviewed each month and residents are being asked about important areas so that they can have an effect on the care given. I examined care plans for 4 residents and found that all had a care plan based on their assessment of health and social care needs. All were comprehensive and were reviewed on a monthly basis. Many included high levels of personal care support needs where areas of risk are assessed especially regarding moving and handling. The care plans also showed residents food preferences, preferred activities, health care needs and emotional support needs. More than half of residents have support needs in bathing, dressing and support with the care of dementia. Continence care and physical support are also provided for other residents. I found these areas to be included clearly in care plans and staff spoken to understand their responsibilities. A visiting district nurse said that she and her team feel that the homes management and staff understand how to provide the care residents need and that they understand and cooperate well with care plans they put in place. GP visits happen by request, and the residents and the manager said that the GP is quick to come out when needed. The GP normally visits fortnightly, the Chiropodist this visits three monthly, the Oral Hygienist visits monthly with the Dentist visiting at least once a year, or when a new resident comes to the home. None of the residents have tissue viability issues, as this is very well managed by the home. Seven residents have dementia care needs and their care plans needs to describe more specifically how dementia affects them and when it is best to engage them in activities and exercise. (Refer to Requirements OP7) Medication is well managed by the home and none of the current residents manage their own medication. The home carries out an assessment of the resident’s wishes and abilities to self-medication as part of the referral and moving in process. All residents spoken to said they are very happy for the home to look after their medication. Storage facilities are adequate and temperatures of the storage cupboard are checked maintained at a safe temperature. Insulin is stored in a separate fridge in a sealed plastic container. However other non medical items are also stored in this fridge and it is recommended that a small separate fridge be purchased for sole use for storage of medication that needs to be refrigerated. (Refer to Recommendations OP9) Medication labeling is generally good but one resident’s paracetamol did not have a label showing who it was for or when it should be taken. It is recommended that the home remind the pharmacist to label all medication showing these details. (Refer to Recommendation OP9) Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 14 The allergies section of the medication forms show when residents have allergies but are left blank if they do not have allergies. It is recommended that this section be always completed and show “no allergies” when appropriate. (Refer to Recommendation OP9) Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the 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 are satisfied with their lifestyle and more stimulating in house activities and exercise opportunities are now being provided in a generic manner. They are supported to maintain contact with family and friends. Residents are involved with making decisions about their life and are given a choice of good and wholesome food. EVIDENCE: Resident’s care plans include a list of activities offered a daily basis, which are recorded on a daily activities chart. This chart was examined and was consistently completed by staff. Activities included are: a visiting musician, cinema, hairdressing, manicure, quiz evenings, reminiscence sessions, story reading, dancing, shopping, café, and visits to the Kingdom Hall for one resident’s religious support needs. Other residents said that they are supported to go to church by the manager. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 16 At the last inspection care plans examined did not always reflect the activities for each resident as they appeared in their care assessments. This has now been improved and more activities are being provided in the home including more exercise for residents. Resident now have activities like bingo, board games and musical mornings and these activities are beginning to be included in care plans for individual residents. (See Requirement OP7) Three residents said that activities had improved and two said they would like to have more opportunities to go out on trips. It is recommended that the home survey all resident’s views about this topic and take action as appropriate (Refer to Recommendation OP12) It is recommended that one or more staff undergo some training in exercise routines for older people. (See Recommendation OP30) All the residents I spoke to said they had family who visit and also who take them out on a regular basis. They are able to entertain visitors in their room but mainly prefer to use the front room with their visitors. Three family members I spoke with said that they always receive a welcome when they visit the home, and they feel that they can visit at any time. Residents financial support needs are assessed on admission and support to manage finances is offered when necessary. The support needed is included in their care plans. The home provides a wholesome and nutritious diet for residents and offers a choice of food on a daily basis. Four residents whom I spoke with said that the food is good and they are offered a choice every day. The homes menus reflect resident’s preferred meals, and that the residents now have what they want on each day. Residents are asked the day before about the food that they want to eat the next day, and residents said that on each day they could change their minds and get something else if they really wanted. The kitchen was clean and tidy. I looked at records of food provided and sampled a meal and found that the food was wholesome and well presented. Good records of food eaten are maintained as part of the home’s system for monitoring healthy diets. A record is kept in each resident’s own individual file. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Satisfactory systems are in place to manage complaints and the protection of vulnerable adults. EVIDENCE: The homes complaints policy was last reviewed in March 2007. This policy adequately shows how complaints are to be managed, and residents have been given a copy. Three residents confirmed this. The owner of the home and registered manager is at the home on a daily basis and residents commented that they are available to speak with them whenever they need to. There have been no complaints made since last inspection. The Statement of Purpose includes a summary of complaints policy and all of staff had received training in how to deal with complaints. The homes complaints policy was last reviewed in March 2007. This policy adequately shows how complaints are to be managed, and residents have been given a copy. Three residents confirmed this. The owner of the home and registered manager is at the home on a daily basis and residents commented that they are available to speak with them whenever they need to. There have been no complaints made since last inspection. The Statement of Purpose Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 18 includes a summary of complaints policy and all of staff had received training in how to deal with complaints. There has been one allegations of abuse made since the last inspection. This was properly reported to social services and to the Care Quality Commission. It was investigated by the home under the direction of social services and the outcome was that it was not upheld. The home acted appropriately and have complete records of this event and of the final view of social services. The home has a written policy and procedure in relation to Adult Protection. The procedure states that all suspicions or allegations of abuse must be referred to the local authority for investigation under their procedures. A copy of the local authority’s Adult Protection procedures is available to staff in the home in addition to the home’s own policy. The Adult Protection policy was last reviewed in March 2007 and shows clearly how to report suspicion of allegations of abuse. There is a flow chart showing clearly how to make reports quickly and efficiently. Two staff interviewed had a good awareness of adult protection and how to manage an allegation or suspicion of abuse. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,24 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents live in a safe and well-maintained environment. The home was clean, pleasant and hygienic. EVIDENCE: The home was opened in 1993 and consists of two semi-detached Victorian houses, which have been joined into one. There is a rear garden with a patio, a fishpond and a lawn area, which is well maintained. The garden area is well maintained and is accessible by residents. Thirteen of the home’s bedrooms Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 20 are single with en-suite toilet facilities. There is one shared room, which has a wash hand basin only, but exclusive use of a nearby toilet. There are an adequate number of toilets and bathrooms in the home to meet the resident’s needs. There is a passenger lift and a short stair lift to ensure access to all parts of the house. The property is situated in a residential road in the Catford area, with some local shops nearby and is close to Catford town, public transport and local amenities and shops. I walked around the home with the manager and inspected living room and dining room areas, hallways, and four residents’ bedrooms. The living room and dining room areas are in a good state of repair. At the last inspection there were two requirements made about the state of repair and cleanliness in the home. These requirements have now been met and flooring has been replaced in the hallways and bathrooms and new carpet has been laid in a number of residents bedrooms. There is a schedule being worked on for doing similar work in other resident’s rooms. A new conservatory has been built for residents to socialise in and this is well constructed and a very nice addition to the home. Four residents said that they are very pleased with it especially as they can easily get into the garden from this area when they want to. The home is older in structure and will always need a close eye to repairs and refurbishment and it is important that there is a long term plan for maintenance and renewal of the fabric and decoration of the home which is consistently implemented. Residents and their families must regularly be consulted about the quality of repair of their rooms and communal areas and their views be fully considered in the renewal plans for the home. (Refer to Requirement OP19) I inspected six resident’s bedrooms and all were now better decorated at the last inspection. The majority of the residents who use them said they were very pleased with the improvements. One resident’s bedroom still has wallpaper which is coming away from the wall in some places in spite of the fact that it was recently decorated. The manager said she is in the process of sorting this out and it is recommended that attention be given to the quality of the work before the work is finished so that this resident’s bedroom is comfortable and in good repair. (Refer to Recommendation OP24) The home is now clean and free from unwanted odours which were present at the last inspection. Overall the home is an older one and will always need an eye to upkeep but it is now in acceptably good condition. This view was reflected in comments received from residents and families. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skill mix of the staff meets resident’s needs, and they are in safe hands at all times. Residents are now protected by the homes recruitment and induction practices. Staff are trained and competent to do their jobs but training in some important areas of residents care for a small number of staff needs to be planned. EVIDENCE: The staff team is made up of a registered manager who is an experienced manager and qualified nurse, a deputy manager, 14 care staff on various part time and full time contracts, and contract cleaners who come to the home six days a week. There is now a second deputy manager in place who has developed a good rapport with residents and who has some responsibilities for organising administrative systems in the home. A written staff roster is kept to show which staff were on duty at any time. There are 3 staff on duty between 8am and 2pm and 2 staff on duty from 2pm to 9pm, with additional support provided by the manager. At night one waking and one sleeping member of staff are on duty. No agency staff or others who do not know residents are used which is a good achievement and helps maintain a consistent service. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 22 The homes staff are made up of two male and 13 female staff and a number of other bank staff who are mainly female. They provide support for 7 female and six male residents. The cultural backgrounds of residents are: 9 White English residents, two Caribbean, 1 African and 1 Chinese resident, supported by a staff team who are predominately either Afro-Caribbean or Black British. The manager has in place management of diversity training to try to ensure that the resident’s cultural needs are understood and are being met by staff. The home provides work experience for care students who are completing NVQ training. When on duty the students are supervised by the person in charge of the shift. Volunteers are sometimes used to provide additional support but not as part of the minimum staffing levels. The manager checks that all students and volunteers had up to date CRB and POVA checks before working in the home. Residents and relatives said that they felt there were adequate numbers of staff on duty and that all were quick to provide help when needed. The manager and one deputy manager are both qualified nurses and nine of the 15 care staff had achieved NVQ level 2, which is over 50 of care staff. The deputy manager is undergoing an NVQ level 4 course in care and management. Recruitment policies and procedures are in place. Three employee personnel files were viewed. These were generally well kept and included all of the information required by regulation. At the last inspection one staff member had been employed on the basis of a CRB check that was more than 6 months old, without the owner having requested a new CRB. This was unacceptable and a requirement was made to ensure all new staff undergo a fully enhanced CRB check before being employed. This situation has now been rectified and the home now carries out these checks for all new employees. There is an induction schedule in place for new staff, which is largely in line with the Skills for Care requirements. At the last inspection a number of important areas for induction were not listed in this induction schedule. These areas were: management of complaints, safeguarding and use of wheelchairs. This has now been rectified and the now amended schedule fully includes these areas. The home has a training schedule, which includes; equal opportunities, diversity, health and safety, fire safety, moving and handling, infection control, medication and food hygiene. At the last inspection some important features of the care needs of residents are not fully reflected in the homes training plan for care staff. These were: Dementia, complaints and mental health. The home has now reviewed the training schedule for staff and these areas of training are now included, meeting this requirement. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 23 It is recommended that one or more staff undergo some training in exercise routines for older people. (See Recommendation OP30) Inspection of staff files showed that generally training needs are now being planned. One new staff member has not yet had moving and handling training and a number of others have not had refresher training in this area in more than two years. The new deputy manager needs to have medication training. The home must ensure that this training is planned and implemented. (Refer to Requirement OP30) Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 35, 36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an experienced manager and accountability for resident’s reviews, staff recruitment and induction and training of staff has been improved. The home cannot yet fully show that it is run in the best interests of residents. Resident’s financial interests are safeguarded appropriately. The health, safety and welfare of staff and residents are promoted and protected. EVIDENCE: The home’s manager is registered with the Commission and has the experience and qualifications needed to manage the service. The manager is a registered Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 25 nurse, has achieved NVQ 4 qualification in care and management and is supported by a deputy manager who was also a registered nurse and who has worked in the home over a number of years. There is also a new second deputy manager with responsibilities for maintaining and improving administrative systems in the home. Residents spoken with said they were happy with how the home was run. Three visitors commented that they were very happy with the homes management and that their relative was very happy living there. They said they were fully consulted about the move to the home, and are confident that they can speak with the manager when they need to. Twelve residents responded to the inspection surveys and these also showed confidence in the homes management. At the last inspection a range of important management activities in the home were not being consistently implemented. These included: Monthly review of residents care plans, carrying out appropriate CRB checks on staff, and planning and recording of staff induction and training. A requirement was made to improve these areas. The manager has now addressed these issues and ensured that these tasks are accounted for by anyone to whom these tasks have been delegated. The owner and registered manager of the home must now carries out formal monthly monitoring inspections of the care provided, including care plan reviews, the management of staff, and of the repairs renewals and refurbishments needed so that the quality of the care and the home are now maintained to a good level. This requirement is now met. The home has a system for carrying out resident’s surveys and has a system for carrying out annual quality audits. There is also a current development plan in place. The last resident’s surveys were carried out in June 2009. The manager now does monthly monitoring checks and does a written report showing improvements needed. This is going to continue on a permanent basis. However the annual audit system has only been partially implemented and must be fully implemented so that continuing development needs of the home are planned in an informed manner. (Refer to Requirement OP33) Residents financial support needs are assessed on admission and support to manage finances is offered when necessary. All of the residents or their family are responsible for their bank accounts and DSS benefits. The home only manages small amounts of cash deposited with them for personal spending such as hairdressing, or small shopping. In these cases receipts and records are being maintained. All for staff files examined showed supervision to the generally happening well with good notes being kept. Four staff files examined also showed good records of these supervisions are being kept. These files also showed that an annual appraisal system is in operation for all care staff. All health and safety and fire safety documentation was checked and found to be up to date and in order. Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 26 Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 28 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 12. (1) a Requirement The registered provider and manager must ensure that all relevant residents with dementia have their care needs regarding exercise and mentally stimulating activities described in their care plans. This is to ensure that their physical and mental health is maintained Timescale for action 31/12/09 2. OP19 23 (2) b 30/12/09 The registered provider and manager must ensure that a programme of routine maintenance and renewal of the fabric and decoration of the premises be continuously maintained in consultation with residents as discussed in this report. This is to ensure that the home is safe and well maintained The registered provider and manager must ensure that the relevant care staff and the new deputy manager receive training as described in this report under Standard 30. This is to ensure that staff are adequately able to support resident’s care needs DS0000025650.V377570.R01.S.doc 3. OP30 18 (1) c 31/12/09 Welcome Care Home Ltd Version 5.3 Page 29 4. OP33 24 The registered provider and manager must ensure that as part of the homes quality assurance process an internal audit takes place at least annually. This is to ensure that all appropriate areas for development are included in the homes development plan 31/03/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations The registered provider and manager should consider purchasing a small fridge for sole use for storage of medication which needs to be refrigerated The registered provider and manager should remind the pharmacist that all medication items for residents must be always labelled with their name and administration instructions The registered provider and manager should ask staff to always complete the allergies section of residents medication administration sheets whether these residents have allergies or not, so that they can be sure this area is always fully considered The registered provider and manager should survey residents opinions regarding having more group outings The registered provider and manager should plan for rewallpapering of one residents bedroom to ensure that it is secure to the wall The registered provider and manager should plan for one or more staff to undergo training in provision of exercise for older people 3 OP9 4 5 6 OP12 OP24 OP30 Welcome Care Home Ltd DS0000025650.V377570.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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