Inspection on 28/01/10 for Whitecliff Residential Care Home

This is the latest available inspection report for this service, carried out on 28th January 2010.

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.

Extracts from inspection reports are licensed from CQC, this page was updated on 28/03/2010.

Key inspection report Care homes for older people Name: Address: Whitecliff Residential Care Home Whitecliff Residential Care Home Charles Road St Leonards on Sea East Sussex TN38 0JU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Michele Etherton     Date: 2 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Whitecliff Residential Care Home Whitecliff Residential Care Home Charles Road St Leonards on Sea East Sussex TN38 0JU 01424421081 01424715888 penny@coastcarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Coast Care Homes Ltd Name of registered manager (if applicable) Mrs Penelope Jane Wickens Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: Twenty-eight (28) The registered person may provide the following category/ies of service only: Care home only - PC To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following gategory/ies: Old age, not falling within any other catogory - OP Dementia - DE Date of last inspection Brief description of the care home 28 0 Over 65 0 28 Care Homes for Older People Page 4 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: A first key inspection of this newly registered existing service has been undertaken. This has taken account of information the Commission has received from the home and about the home since its change of registration in September 2009. Information examined has included an Annual Quality Assurance Assessment (AQAA) submitted to us by the service on time. Initially, we found the AQAA to not be completed to the expected standard, and discussed shortfalls in content and detail with the appointed manager. As a consequence the manager revised the AQAA and was able to provide us with a more informative version to aid our inspection of the service. Our assessment of this service has also included an unannounced site visit undertaken on 28th January 2010. During our visit we met and spoke with residents and staff, the registered person, Care Homes for Older People Page 5 of 34 appointed manager and deputy manager. We undertook a tour of the premises to view the progress of the major refurbishment. A range of documentation has also been examined including care plans, medication records,risk and complaint information, accident records and staff recruitment and training information. We acknowledge the short time in which the registered person and registered manager have had to implement the improvements they have identified need doing and this has been taken account of in our judgement of this service. Care Homes for Older People Page 6 of 34 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 7 of 34 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 34 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 34 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. Prospective residents and or their representatives are provided with information about the service and the terms and conditions of their stay, however, proposals to amend or develop this into a range of more accessible formats need progressing. People referred to the home can be assured their needs will be assessed prior to admission to ensure these can be met. Evidence: The Annual Quality Assurance information completed by the home manager informs us that Statement of Purpose and user guide information has been updated since the change of Registration, and we were able to confirm this with the manager during our visit. Whilst this documentation may clearly be appropriate for some residents, their families and representatives, it will not be accessible for others who are no longer able to retain written information. We discussed with the manager the importance of Care Homes for Older People Page 10 of 34 Evidence: developing this information into other formats; the manager informs us that this is currently the subject of discussion within the home, and some consideration is being given to the possibility of providing pictorial or audio versions. We would strongly support the development of a range of more accessible formats, so that prospective and existing residents are made aware of the service offered. The AQAA informs us that the home has re developed assessment and care plan information. To date no new residents have been admitted to the home since the new registration, however the manager is undertaking assessment visits with a view to admission in the near future when the majority of the major refurbishment has been completed. We asked the manager what contractual arrangements have been put in place following the change of ownership. We are advised that the existing residents who remain in residence from the previous service, are sponsored by a local authority and have been issued with new terms and conditions/contracts from the new company owning the home. Copies of these were all available to view; we noted an absence of room numbers on those that have been signed,and have drawn this to the attention of the manager, recommending that these be added to contracts issued to provide security to the resident and their respective relatives and representatives that the room allocated is for their sole use and cannot be changed without discussion and agreement. The service does not have the necessary facilities to provide intermediate care. Care Homes for Older People Page 11 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is progressing the upgrade of care plan formats, residents are being supported to access routine and specialist health care and are better safeguarded by the improvements in medication storage, administration and recording. Evidence: We looked at existing care plans for two people and these evidenced that these are being reviewed and changes recorded. The AQAA informs us that new care plan formats are being established, and are running concurrently with existing care plans. Three have been completed to date. New care plans provide a more comprehensive record of individual residents needs and monitoring systems in place to support these. A review of new completed support plans highlighted that although more comprehensive, they will benefit from greater reflection of individual resident preferences around how support is delivered, this was discussed with the manager and deputy during the visit. During the transition between the old and new care plan systems, some recording Care Homes for Older People Page 12 of 34 Evidence: issues are occurring with staff not fully using one system or the other. Examples of this are a lack of clarity in recording the types of personal care support residents receive, e.g. it is insufficient for staff to record all personal care given in daily logs unless it can be established what this consists of. Examination of records indicates that one resident has refused personal care on a regular basis, but this is not currently reflected as part of their behaviour within the support plan, or how this is to be managed by staff. Whilst staff are managing these issues appropriately with the proposed recruitment of new staff it is important that care plans fully reflect these behaviours and guide staff how to manage such incidents, these should be supported by appropriate risk judgements. Key worker arrangements are yet to be established and staff did not demonstrate a good understanding of what such a role would mean for them, and this will need clarification. Daily logs are generally being well completed by staff and contain good information. Discussion with a staff member who has worked at the home prior to the new ownership indicated an awareness of behaviours for one resident that are not currently recorded in their care plan or risk assessed. It is important that staff who have a fuller understanding of the existing residents are involved in the development of care plans to ensure that the knowledge they have gained about individuals is not overlooked. We are pleased to note that routine monitoring of resident weights is happening and all have gained weight in recent months.The new manager has implemented fluid charts and residents were noted to have glasses of juice or water within reach in addition to coffee and tea they receive at specific times during the day. The new manager has been thorough in undertaking capacity assessments of current residents this has highlighted one resident with full capacity,who is not currently responsible for administering their own medication, documentation indicates some compliance issues with medication and the manager has been asked to contact the Deprivation of liberty assessment team to discuss whether the home should seek an authorisation in this instance. Examination of current resident files provided evidence of residents access to health care professionals through routine and specialist appointments. Equipment to aid staff in supporting the care needs of residents is provided and is serviced at appropriate intervals. Staff have received moving and handling training and moving and handling Care Homes for Older People Page 13 of 34 Evidence: assessments are in place. Falls risk assessment has been implemented for all residents, examination of accident records has highlighted a higher than average rate of falls for one resident, in discussion with the manager we are satisfied that the home is taking appropriate action by seeking input from health professionals in regard to this issue, however, we would also recommend that a system of falls monitoring is implemented to look at patterns of falls which may indicate an underlying problem or cause. The new manager advises that only staff trained to administer Medication are enabled to do so. Plans are in hand to implement routine competency assessments of administering staff and these may be undertaken annually, whilst most staff are being trained with regard to use of the MDS system the manager has assured us that current training also covers the administration of medications outside of this system. The home has identified the need for improved storage of medication and as part of the refurbishment has identified a downstairs room which will provide a secure and sufficiently spacious area for the storage of medications, this will enable staff involved in receipt of medications to do so undisturbed. As the proposed medication room has no natural ventilation we have reminded the manager to ensure that room temperatures are routinely checked. Currently medications in use are stored in a drugs trolley and this is secured to the wall, this was clean and tidy with only current medications in use stored within it, some medications outside of the MDS system are being dated upon opening but this is not done consistently. We have discussed the importance of adding opening dates to prescribed creams, liquid medications,drops and tablets which are not part of the MDS system for medication audit purposes and to ensure life span dates are not exceeded. The manager and deputy have agreed that a consistent procedure needs to be applied and will undertake to implement this with immediate effect. Medication records viewed are being appropriately maintained. The home is developing individual PRN medication guidelines.And the medication procedure has been amended to include the management of PRN medication, there are plans to revise this further at some future date. We noted medication for each resident is listed within care files and consideration should be given to expanding this information into a fuller profile to inform staff what the medication is taken for, likely side effects and any diversity issues that may affect administration. Care Homes for Older People Page 14 of 34 Evidence: The manager has acknowledged the level of refurbishment currently underway in the home and has tried to minimise the impact of this on the existing residents, ensuring that their privacy and dignity are protected. Staff who have known residents for some time prior to the change of ownership reported that despite the works, residents appreciate the improvements and are far happier in themselves. One resident we spoke with was very pleased with changes to their bedroom and looked forward to some of the planned improvements to the garden. The home has a comprehensive range of risk assessments in place to cover the present refurbishment. Care Homes for Older People Page 15 of 34 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. Residents are now being provided with opportunities for stimulation, activity, and personal decision making and for some to take a more active role in the daily household routines. Family contacts are encouraged and supported. Residents nutritional needs have been assessed, a varied menu has been developed that takes account of individual resident preferences, and offers them a choice. Evidence: Since taking over the home in September 2009 the registered person has appointed an activities coordinator with whom we met during our visit. The coordinator expressed enthusiasm about building and developing a suitable activity programme, and demonstrated good insight into the need to establish individual resident preferences and interests. Since appointment the coordinator has begun introducing different types of in-house activities to residents, both he and staff are recording resident responses to these. This information is analysed and enables the coordinator to build a picture of what activity individual residents enjoy and respond to. For those residents with more advanced dementia, more tactile activities are being introduced. Care Homes for Older People Page 16 of 34 Evidence: On the day we visited we observed the coordinator alternately spending one to one time with one resident painting, walking with another resident chatting and talking about things they could see in the home and from the windows of the home to the street outside. With another resident the coordinator spent time sitting with them and talking about a favourite past activity and this discussion was aided by the use of a lap top computer to seek out information the resident enjoyed. When we spoke with staff individually they confirmed that they are also playing games, or trying to engage residents and have been motivated to do so by the improvements in the service. They report that residents are much happier. An innovative programme of activities has also been developed throughout the year that will celebrate cultural events both through activity and menus on those days e,g St Davids day will reflect on welsh poetry, music, activities will centre around craft activities making red dragons and welsh flags, decorate the home with daffodils a theme of red white and green clothes table cloths etc, and food will incorporate leek ad potato soup, welsh rarebit using welsh cheese, welsh cakes etc. When we spoke to staff they expressed enthusiasm for the changes, and have made clear within staff survey information that they wish activities to extend to providing more outings for residents. The registered person has also made clear to us a desire to obtain a suitable vehicle for the use of the home to support such outings in future. The most able resident has taken an interest in the improvements to the rear garden which will provide a paved patio with raised flower beds,pots and water features, he has expressed a keen interest in being involved in up keeping the flower beds etc and this is also seen as an activity in which other residents may be able to have some role also. The manager has noted that more able residents could be encouraged to undertake more tasks e.g laying tables, and have been shown to enjoy these added responsibilities and this is to be extended. All of the present residents have relatives who are involved, some more actively than others. The manager advises that they are made to feel welcome when they visit which for some is regularly. The manager reports that relatives are being kept informed of changes to the home and are welcome to look around when they come, they have generally expressed satisfaction with the improvements that the refurbishment will provide residents with. Care Homes for Older People Page 17 of 34 Evidence: The new manager has initiated a varied menu plan that offers residents a choice at each sitting, the exception being two lunch times each week when a roast dinner is served which all residents enjoy. We discussed the need for the menu plan to be made accessible to those residents who are unable to retain or understand written information to ensure they are still enabled to make an active choice and the manager reports pictorial versions of the menus are being developed and are to be laminated, The manager has also introduced fresh fruit, chocolates and small snacks into the residents diet. Nutritional risk assessments are in place. At present meals are being served on trays in the lounge whilst the dining area is refurbished. Care Homes for Older People Page 18 of 34 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. Systems are in place that protect residents from harm,but these could be improved upon by enabling and supporting less able residents to fully exercise their right to make a complaint or express a concern.Ensuring staff have guidelines to help manage behaviours consistently for the benefit of residents, and that agreed restrictions are more clearly recorded in care plans and thereby subject to review. Evidence: The home records that one complaint has been received since the change of ownership. We have looked at the complaint and noted that the home acted promptly to meet with the complainant and resolve the issue to their satisfaction. Whilst we are satisfied that a copy of the complaints procedure is openly displayed in the entrance to the home, some thought needs to be given to making this information more accessible to residents,both in where it is located and the format in which the information is provided. We have discussed with the registered manager the likelihood that the majority of residents will never actively make a complaint on their own behalf. Being mindful of this, home staff should be actively recording how residents who lack capacity communicate signs of distress and anger and this should be clearly recorded in their files to inform all staff. In the event that a resident is displaying signs of distress or anger staff should be actively recording such incidents and seeking out causes. If it Care Homes for Older People Page 19 of 34 Evidence: can be evidenced as being precipitated by another person or event, staff should consider whether this would in a more able person have generated a complaint and act accordingly. The manager was reminded to ensure that a safe system for the recording and storage of small valuables that residents may lose or leave about in the home is established, possessions inventories are noted in new care plan formats and these now need to be completed for each resident. Some staff have received adult safeguarding training and further training is planned for remaining staff, the manager and another staff member are attending training on safeguarding in order that they are qualified to deliver this training to other staff. In discussion staff spoken with demonstrated a good understanding of safeguarding issues and understood that local protocols exist and must be followed including who the lead agencies might be in investigating allegations of abuse. The manager is keen to ensure staff are provided with regular in house refresher training in addition to external formal safeguarding training. There are currently no safeguarding alerts for this service. Two residents are currently subject to hourly behaviour monitoring at the request of health professionals involved, discussion with care staff also indicated another resident who can display aggressive physical behaviour on occasion, although staff demonstrated confidence in managing behaviours in part due to the length of time they have worked with the residents, we would recommend that behaviour guidelines are established for each resident to ensure all staff respond consistently and in an agreed manner. We are informed that one resident has a sensory mat in place to alert staff when they get out of bed, this has been discussed and agreed with the relevant health professional involved and we would further recommend that any such restrictive practises are fully documented within resident files and their effectiveness subject to regular review. The manager and staff have received mental capacity training , mental capacity assessments have been implemented for current residents. The home has been helpful in making available information leaflets about this important legislation. We have drawn to the homes attention the possible need to seek advice form the Deprivation of liberty assessment team in respect of one resident assessed as having Care Homes for Older People Page 20 of 34 Evidence: full capacity, but who currently is not supported to undertake some everyday tasks i.e. self administration of medication. We are satisfied from our discussion that they will seek to clarify this matter and take any action required. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current programme of major refurbishment means that residents will receive benefit from living in a comfortable, safe and well maintained environment suited to their specific needs, once works are completed. Evidence: The home is currently experiencing a major refurbishment with few rooms having been left untouched by the changes. The majority of bedrooms have been repainted, re carpeted and for the most part refurnished with new beds and bedroom furniture. Seven bedrooms have been provided with en suite facilities. The effect of redecoration has been the home is much brighter and the whole atmosphere lightened. Upstairs a fire escape has been remodelled to provide a wider and brighter space for residents adding more natural light to the area. Downstairs the kitchen has had new shelving, fly screens and a new cooker hood is due to be fitted, the improvements to the kitchen and arrangements for the storage, preparation and recording of food within the home have been assessed and passed by the local environmental health officer. The registered person informs us that outstanding health and safety requirements issued by the Environmental health officer have also now been addressed. Care Homes for Older People Page 22 of 34 Evidence: We are advised that the gas supply has been serviced with pipework to the cooking range improved making this more effective. Electrical installation has been upgraded in various places and a new electrical certificate is to be provided which we would like the home to send us a copy of when completed. Lighting throughout the home has been improved upon. Individual electrical items have not been tested yet but plans are underway as to how this can be achieved for the current and future residents who will be coming in over the course of the next few months and whose electrical items will need to be checked. The dining room is currently out of use being subject to a complete redecoration and refurbishment which will provide improved storage for crockery, glasses and cutlery freeing up space in the kitchen. New carpet is to be laid in corridors and stairs once refurbishment has been completed. A new medication room is being developed to improve security and storage of medications. Ramps have been installed front and rear of the home although work is continuing to reduce the incline of the ramp to the rear of the property before it can be used. A smoking shelter has been built for staff and residents who smoke, no smoking is now allowed in the home at all. The rear garden is being made over to provide a better and more pleasant environment for residents to use in good weather and to participate in garden related activities.The exterior of the front of the home has been repainted and the drive is being upgraded. Examination of the fire log confirmed that fire drills, checks and tests are being conducted although we have reminded the manager of the need to ensure that night staff also actively participate in fire drills a minimum of twice yearly. Extinguishers although serviced are not routinely visually checked and the home should consider implementing monthly checks.A new fire risk assessment has been completed and the registered person informs us they are working with the fire service to ensure any previously identified deficiencies within the fire protection in the home are addressed. Staff report that requests for equipment are now met quickly by the management Care Homes for Older People Page 23 of 34 Evidence: team. Only one hoist is currently needed for the current resident group and this is now serviced at regular intervals. Bathroom and shower rooms are being upgraded meaning that residents are currently making use of one shower room during the period of refurbishment, with so few residents currently this is not causing a problem. Although major works are taking place, the manager informs us that care has been taken to ensure the works intrude on the lives of the residents as little as possible, most are taking interest in what is happening and staff report that residents like the changes and what this will bring for them. Staff report improved availability of protective clothing. The new manager has implemented cleaning schedules for the cook to work to in the kitchen. A cleaner is in place and cleaning schedules have been established. Areas unaffected by refurbishment were seen to be maintained in a good state of cleanliness. Care Homes for Older People Page 24 of 34 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. Residents are better safeguarded by improvements to the availability of staff and strengthening of systems for their recruitment training and supervising. Evidence: When we visited the home we found a deputy manager and two care staff on duty in addition to ancillary staff. The manager was also on duty but was out undertaking an assessment of a prospective resident. When we spoke with staff they commented that this is the usual level of staffing, and is satisfactory for the current numbers and dependency of residents. The home also provides two waking night staff. The home is continuing to recruit and staffing levels will increase to keep pace with additional resident admissions. We spoke with all the care staff on duty who demonstrated a good understanding of the individual needs and preferences of the current resident group. Staff were able to discuss individual resident routines and how they enabled and encouraged residents to make decisions and choices within these. Those staff employed by the previous service expressed enthusiasm for the change of ownership and reported that they have received loads of training since the new owners took over, Im really enjoying it. Staff commented that they valued the Care Homes for Older People Page 25 of 34 Evidence: training because this had given them a much better understanding of people with dementia, staff observed that in their opinion residents are a lot happier. Staff also said they feel much happier under the new management and enjoy their work, they find the home to be definitely better managed and feel well supported by the current management team. Staff also spoke positively about the changes to the environment and availability of equipment commenting Everything has improved, carpets feel safer, there is more equipment, in the past we struggled to get things. Since the change of registration three new care staff have been recruited and we looked at their personnel files, we found these to contain the necessary vetting and checks. Not all had current photographs and this needs to be rolled out across all staff files for the purpose of ID. We noted job offer letters on file detailing staff undergo a 13 week probationary period. The home has also implemented equalities monitoring information. Currently staff application forms only ask for employment history for the last five years, we reminded the manager of the need to obtain a full employment history from applicants and the need to amend the form to allow this. It is important that the home can demonstrate within interview records that gaps in employment histories and verification of reasons for leaving previous care roles have been fully explored with applicants, we have recommended these improvements to the manager and she has agreed to implement them with new staff. The manager demonstrated an understanding of the shortfalls in recruitment information for the staff inherited from the previous service, she is seeking to improve this currently, and we discussed how this might be done during our site visit. Examination of new staff files provided evidence of induction in keeping with Common Induction Standards and skills for care booklets are being completed. The new management have also required that all care staff complete the common induction standards as a means of assessing competency of the existing workforce. More than 50 of the present staff team have completed NVQ2 or 3 or are nearing completion of this qualification. The manager has undertaken an analysis of staff training and individual training profiles have been developed, a training matrix is in place and courses are being booked to ensure staff mandatory and specialist training is updated. Care Homes for Older People Page 26 of 34 Evidence: Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is being managed in the interests of service users who are experiencing improved outcomes and quality of life. Better quality assurance systems are needed to monitor service delivery and maintain standards, and this should seek to include the views of residents in proposed service development Evidence: The present manager has applied for registration with the Commission, she is experienced in managing a care home, and has relevant qualifications. She demonstrates an awareness of the shortfalls within the previous service which with the support of the registered person she is seeking to rectify, and has in addition identified further areas for improvement. There are plans to provide a staffing structure that will comprise a manager, deputy , and two senior care staff, creating opportunities for career progression for care staff. We are informed that as resident numbers begin to increase the home is ready and prepared to recruit new staff to meet the needs and dependencies of the residents. Care Homes for Older People Page 28 of 34 Evidence: Dependency assessments have been completed for each resident to inform this. The Home has an undeveloped quality assurance system. Whilst initially the AQAA we received was not completed to a good standard the manager has revised this and provided much more detailed information about the service to inform us. The Home currently undertakes some stand alone quality assurance checks, but there is a need for these expanded and incorporated into a broader ranging quality assurance system. Such a system once established should enable self audit and review by the service and inform management about the quality of service delivery. This should also enable the production of an overall quality report; the outcome of which should be made public and made available to the Commission and all stakeholders, we have discussed this with the manager and recommend this is progressed. The management team has been proactive in seeking the views of residents and staff about the service, and an analysis of this feedback undertaken. Examination of surveys has led us to make some suggestions for improvement to the range and number of questions asked of stakeholders to obtain a wider ranging response about service quality. We have discussed the need for the home to produce annual reports about service quality that incorporate the views of residents. We are satisfied that regulation 26 registered provider visits are being undertaken. The provider has produced a business and development plan for Coast care ltd that makes clear the planned developments for White cliff over the coming year, consideration will need to be given as to how to evidence within future reporting how stakeholder views have influenced some areas of service development. Appropriate insurance is in place and displayed in the home. We are informed that the home does not manage the personal finances of residents, prefering to invoice family members or representatives for any expenditure incurred on behalf of the resident. Staff confirmed that they are in receipt of regular supervisions and one commented I know where I stand now, Im more informed about things., the staff member also thought that residents health and well being was monitored more and that staff now have a better understanding of managing difficult situations e.g. aggression. All staff have been required to sign up to a supervision agreement and staff files evidenced that regular supervisions are now happening. Care Homes for Older People Page 29 of 34 Evidence: We are informed that one staff meeting has taken place since the change of ownership, Staff tell us that they find the owners and management team approachable and responsive , that staff are listened to and issues acted upon quickly. From information provided in the AQAA,discussion with the manager and examination of documentation during our visit we are satisfied that all health and safety checks have been completed and are up to date. Examination of accident records has highlighted that more than 50 that have occurred since the change of registration have taken place during late shifts, we believe this deserves further analysis and investigation by the manager who has agreed to do so. Care Homes for Older People Page 30 of 34 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 31 of 34 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 2 Terms and conditions/contractual information should record the allocated room which has been agreed will be occupied by the resident. Any changes to this must be by agreement with the resident and or their representatives and recorded in relevant documentation including the terms and conditions/contract. The registered manager should implement a system of falls monitoring to enable fuller understanding and assessment of patterns and causes that may emerge from further analysis, and also to establish triggers for seeking interventions and guidance from other professionals. The communication methods of less able residents should be made clear to staff and where there is evidence of distress or anger linked to a specific incident or person, staff should be proactive in considering whether this should be dealt with under the complaints or safeguarding procedures. Individual behaviour guidelines to be established to inform staff. Restrictive practises agreed by relatives and professionals 2 8 3 16 4 18 Care Homes for Older People Page 32 of 34 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 should be clearly documented within care plan information with the rationale for their implementation, and their effectiveness should be reviewed regularly. 5 29 The registered person should ensure that a full employment history is obtained from applicants, and can evidence within interview records that any gaps in employment and verification of reasons for leaving previous care roles have been explored within the interview process. A current coloured photograph should be added to all staff files for the purpose of identification. Certificates of previous completion of Common Induction Standards skills for care should be retained on staff files. 6 33 The home should expand upon the current quality audits in place and establish a system for the internal audit and review of all aspects of the operation of the home, the programme of quality assurance should include opportunities for consultation with service users and evidence how their views are influential in service development and improvement. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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