Inspection on 01/05/09 for Willowmead

This is the latest available inspection report for this service, carried out on 1st May 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.

Other inspections for this house

Willowmead 07/11/05

Willowmead 17/06/05

Willowmead 10/01/05

Willowmead 30/07/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Willowmead Willowmead Summer Road East Molesey Surrey KT8 9LR     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Patricia Collins     Date: 0 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Willowmead Summer Road Willowmead East Molesey Surrey KT8 9LR 02083988664 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): willowmead@mariondavis.fsnet.co.uk Mrs Marion Davies The registered provider is responsible for running the service care home 12 Name of registered manager (if applicable): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 12 old age, not falling within any other category Additional conditions: 0 The maximum number of service users to be accommodated is 12 The registered person may provide the following category 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 category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Willowmead is a registered care home providing personal care for up to twelve older people. Situated approximately half a mile from Hampton Court Palace and a railway station, the home is on a bus route and within walking distance of East Molesey village shops, post office, library and day centre. The two-storey semi-detached building has been extended to provide spacious ground floor en-suite bedroom accommodation. The wellCare Homes for Older People Page 4 of 30 Brief description of the care home maintained, attractive rear garden backs onto the river and has a furnished patio and summerhouse. Limited parking facilities are available at the front of the property and a mini bus is provided for access to the community. Communal facilities are on the ground floor and comprise of a spacious L shape lounge, separate dining room and homely kitchen. All bedrooms are for single occupancy and in the original building one bedroom has access to a single bathroom and three share access to another bathroom. A stair lift is available to access rooms on the first floor, though three steps have to be negotiated at the top of the stairs, for which handrails have been fitted to aid access. There is a flat comprising of a bedroom, lounge and a bathroom on the second floor accessible by a flight of stairs. This is an owner- managed home and weekly fees range between 750 and 850 pounds. Fees included toiletries, outings, newspapers and in-house social activities. Additional charges apply for hairdressing, chiropody and private physiotherapy. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The homes last key inspection was on 3rd May 2007. This unannounced inspection visit formed part of the key inspection process using the Inspecting for Better Lives (IBL) methodology. The visit was carried out by one inspector in just under eight hours. A senior care assistant who has management and supervisory responsibilities at the home facilitated the visit in the absence of the registered provider/manager. Engaging with people using services is an integral part of the inspection process. On this occasion we used one of our range of stakeholder involvement methodologies, inviting an expert by experience who has been recruited and trained by a support Care Homes for Older People Page 6 of 30 organisation, to be involved in the process. An expert by experience is a person who, because of their shared experience of using services and/or ways of communicating, visit a service with inspectors. On this occasion the expert by experience was present for several hours. A person using the homes services kindly agreed to accompany her on a tour of the ground floor accommodation and garden. She then spent time talking with people who use this service and staff and observing daily life and relationships at the home. Her findings have been incorporated within this report also direct practice observations made by the inspector.The report will say what we found as it is written on behalf of the Care Quality Commission (CQC). It will also hereafter refer to people using the homes services by the term residents, based on the expressed preference of people we consulted in this matter. We have taken all available information into account when forming judgements about how well the home is meeting the national minimum standards for adults. This includes our cumulative assessment, knowledge and experience of the home since its last key inspection. We sampled records, viewed all areas of the building and grounds and consulted the registered provider/manager and her partner during telephone contact with them after the visit. We took into consideration information received during our survey of residents views about the home. Seven survey questionnaires were completed, some with support from relatives and others on residents behalf by their representatives and relatives. The inspection outcomes have been also informed by information received from the provider/manager in the homes Annual Quality Assurance Assessment (AQAA). Each year the provider/manager is obliged to send us the AQAA providing quantitative information about their service. This is a self-assessment of the service against the National Minimum Standards (NMS) outcome areas, demonstrating both areas of strength and where improvement is needed. It also provides some statistical data. We wish to thank all who contributed information and participated in the inspection process. We are grateful to the resident who showed the expert by experience round the home and ensured ramped access to the front door. We also wish to extend appreciation to the senior care assistant who came in on her day off to facilitated the inspection visit. What the care home does well: What has improved since the last inspection? What they could do better: The homes statement of purpose needs to be reviewed and updated to include all statutory information and CQC contact details, also the complaint procedure. A number Care Homes for Older People Page 8 of 30 of policies need to be updated and others produced. Record keeping practices must ensure a clear audit trail of pre-admission assessment processes. It is suggested that care plans and the scope of risk assessments be further developed and records made of monthly evaluations of care plans. The AQAA self assessment needs to be validated by more detailed information, providing a measurable update and evaluation of the quality of services. Quality assurance systems, specifically quality audits need to be more robust to ensure their effectiveness. Some shortfalls in staff recruitment practice need to be rectified. Outstanding electrical remedial work must be carried out to ensure the home has a valid electrical certificate. The provider/manager must ensure compliance with the legal requirement to inform us of all significant events that happen in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, prospective residents and their representatives have the information needed to make an informed choice of home. Whilst a comprehensive pre-admission assessment process was described this is not always evident from record keeping practices. Standard 6 was not assessed on the basis the home does not offer intermediate care. Evidence: The homes statement of purpose was viewed. Attention was drawn to the need to update this document with accurate contact details for the Care Quality Commission; also to include all statutory information specified in Schedule 1 of Regulation 4 of the Care Homes Regulations 2001 (amended). Survey information from residents and their representatives confirmed most had received sufficient information before admission to decide if the home was right for Care Homes for Older People Page 11 of 30 Evidence: them. One resident told us her daughter had made this decision. Some of the comments from relatives include, I knew it was right the minute I walked in and I looked at the home and it seemed much nicer than many others we had looked at. At the time of previous inspections comprehensive pre-admission assessments had been carried out in advance of all admissions to the home. Most of the assessment documentation had been archived and not available at the time of the last inspection and the provider/manager advised to maintain assessments on file in the home. At the time of this inspection these were not on the files sampled. No records were found to evidence the extensive pre-admission assessment process described by the provider/manager for the latest admission to the home. Whilst noting the explanation for this and extenuating circumstances the provider/manager was requested to in future ensure records demonstrate the methodology for satisfying herself before admission that the home can meet prospective residents needs. A template for carrying out pre-admission assessments was viewed. This included a basic health assessment, medical history and current medication, family background and space to record likes and dislikes. Observations of this tool confirmed the need for equality and diversity information to be sought and recorded as part of the pre-admission process to ensure these are considered and can be met. Attention was also drawn to the need to ensure formal assessment relating to the new legal framework under the Mental Capacity Act 2005. An admission checklist was noted to be used in preparing bedrooms and ensuring suitable equipment before admission. Standard 6 was not inspected on the basis that intermediate care is not provided by the home. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Evidence: The care records of four residents were examined. Whilst the pre-admission assessment proforma does not record all equality and diversity information, this information was mostly recorded on residents files after admission. Records include relevant information about residents social and medical history, dietary needs, food preferences and dislikes. Clear life plans had been produced, promoting independence and demonstrating choices in residents lives specific to their daily routines and activities of daily living. Staff respect residents individual wishes for where they spend their time, in their rooms or in the company of others and where they take their meals. Evidence was seen of user involvement in the care planning process. In the past individuals had signed their care plans though short-term memory loss had affected Care Homes for Older People Page 13 of 30 Evidence: the ability of some residents to continue to do so. There is a system for staff to record the date they discussed care plans with residents. A master list kept in the area of the kitchen used for by care staff for office administration, demonstrated a system is in place to monthly review needs. This ensures staff are aware of any change in needs and an individualised approach to care. The need to record the monthly care plan reviews on residents files was discussed. Observations identified a care plan had not been updated to reflect a significant change in needs and provision of pressure relieving equipment. The need to develop the scope of the risk assessments and care plans was also discussed. Pressure sore prevention and falls risk assessments should be carried out as standard and care plans generated from these as necessary. It was positive to note moving and handling risk assessments had been recently undertaken and noted risk of falls had been considered and their prevention. A more in depth falls risk assessment was suggested and for a care plan to clearly detail how this is to be managed. It was positive to note the home is being pro-active in falls prevention with the intention of future implementation of electronic surveillance equipment in bedrooms for some individuals, fitting sensors above beds. This measure will be in addition to the regular night rounds stated to be carried out by waking night staff. The importance of transparency in the use of this equipment was discussed and need to develop a written protocol for its use and to ensure a clear and coherent care plan when used. There should also be policy guidance addressing restraint in its many forms. Care plans should to also address the individual communication needs of people with dementia and short term memory loss and management of mental health needs and behaviours. Whilst good to note effort made to monitor residents weights this is not always possible for individuals unable to use the domestic stand-on scales. It was suggested the home has sit-on weighing scales and implements use of nutritional assessment. All residents are registered with a local large medical practice. The provider confirmed that residents may retain their own general practitioners (GP) from other practices, providing the home is within that practices catchment area. The residents consulted however were unaware there was a choice of medical practice. It is suggested the position is clarified in the homes statement of purpose.The records viewed demonstrated that residents healthcare needs are met with input from various professionals. These includes district nurses, podiatrist, optician, dentist and a private physiotherapist. At the time of the inspection one resident who uses a wheelchair user was present in the home and a second currently in hospital. Residents have the aids and equipment they need. Survey feedback confirmed residents and their representatives are very satisfied with Care Homes for Older People Page 14 of 30 Evidence: standards of care at the home. All said staff are available when needed and listen and act on what they say. They told us they receive the medical support they need. Care staff were observed to treat residents with respect and courtesy during the visit. The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication storage, recording and practice was sampled and is overall satisfactory. The manager and senior carers administer medication and staff designated this responsibility are suitably trained. The training received is through a distance learning course and includes a practice assessment element. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are able to exercise choice and control in their lives within individual levels of capacity. There is a strong commitment in the homes daily operation to the principles of community inclusion. Positive relationships are fostered with the relatives and representatives of residents. A varied and wholesome menu is available using fresh ingredients as much as possible. Evidence: Residents are able to make choices about their lifestyle and routines. Individual preferences are accommodated where possible in the times of getting up and going to bed, where they wish to take their meals and where and how they spend their day. Central to the homes aims and objectives is the promotion of social inclusion for residents. They have opportunity to participate in community outings twice a week, using the homes vehicle. This is driven by the provider/managers partner who is employed at the home, with staff escorts. Sometimes the provider/manager accompanies takes part in outings using her car. Residents enjoy a range of community activities. These include shopping trips, meals out and visits to places of interest, examples include a vineyard, Boxhill, a farm and garden centres. One or two Care Homes for Older People Page 16 of 30 Evidence: trips are arranged in the summer to seaside resorts. A weekly exercise class takes place at the home and since the last inspection musical sessions by a visiting musician have increased. A hairdresser and manicurist also regularly provide a service to residents. The home is within walking distance of shops, a post office, library and day centre in East Molesey high street. Arrangements can be made for residents to attend the day centre if they wish to do so. One individual regularly attends a church service and a local Vicar provides a non-denominational communion service at the home. One resident has capacity to independently access community facilities. The providers partner supports this person in following age-appropriate interests and to integrate in the local community life. A formal social activities programme is not provided. Residents have access to a television in the lounge and in their bedrooms and to radios and music systems. Relatives or friends living locally regularly visit, providing social interaction and newspapers are delivered daily. We received mixed responses to our survey specific to satisfaction levels about social activities. When asked whether social activities are arranged that they can take part in, two residents/relatives told us always, one said usually and four respondents stated sometimes. One survey completed by the representative of a resident with dementia told us how much pleasure this individual derived from the visit by a musician who recently came in to play the piano. This resident was stated to be reluctant to join in the outings and we were told there are no other activities she can engage in. Though provision is made of books and board games, on the morning of the inspection visit staff interaction with residents was mainly task orientated. Four residents spent much of the morning asleep in their chairs. In the afternoon staff were observed to spend time talking with residents in the lounge. The one male resident who is significantly younger that other people living at Willowmead, maintains the garden to a very high standard. This is his pride and joy and other residents derive pleasure from it. The home has a furnished patio and though informed at the time of the visit this is rarely used by residents, the provider stated it is well used in the summer by both residents and visitors. It was noted that two residents sat outside on the afternoon of the inspection, enjoying the spring sunshine. Residents told us that they liked and enjoyed the meals and appreciated that hot food was served hot. Home made food is prepared by three part time cooks. Menus are rotated on a four weekly cycle and a copy displayed in the kitchen for staff to follow. Records demonstrated an individualised approach to breakfast in terms of the time served and content and the option of a cooked breakfast. A two - course cooked lunch and evening meal is prepared daily. Though an alternative option is not routinely Care Homes for Older People Page 17 of 30 Evidence: prepared the daily records demonstrated a choice of meal is offered if residents dont like or wish to have the meal served. Consideration could be given to producing large print or pictorial menus and for these to be prominently displayed so that residents can know in advance of mealtimes what is being prepared. This will enable a choice of meal to be made before the meal is served. Alternatively for staff to ensure they inform residents before each meal of what is being prepared. Food preferences and dislikes are explored on admission and recorded in individual files, though a record of these is not held by catering staff. Observations during the inspection identified the cook was not aware of the particular food dislike of a resident, serving her salad which she has disliked since childhood. A carer asked her what she would like and she requested a ham sandwich with mustard, which was prepared. The provider said the menu is prepared in consultation with residents at their meetings. It is suggested that a list of known food dislikes be available in the kitchen given that not all residents have capacity to to take part in menu planning discussions. Some were unable to recollect these meetings taking place. A list of food likes and dislikes in the kitchen will assist catering and care staff, some of whom are relatively new in post, in accommodating residents preferences. Several residents ate their lunch and evening meal at the dining table. Others had their meals served in the lounge, in their rooms and one person whilst seated in her wheelchair in the kitchen. The dining table and trays were nicely presented with tablecloths, cloth napkins and condiments. Meals were observed to be appetising and consultation with residents confirmed their satisfaction with portion sizes. Observations confirmed fresh food being prepared for lunch and a bowl of fresh fruit available in the sitting room for residents to help themselves, though some would need staff assistance to do so. A bowl of sweets was also available on a side table. The homes statement of purpose promotes a family style environment. Prospective residents are welcome to bring their pets with them and supported by staff in their care. At the time of the inspection the providers had gone away for the weekend and their dogs were staying at the home. Individual residents said they liked having them around. Two residents own cats and one likes to sit near to her, on the kitchen work surface. This surface and area of the kitchen is not used for food preparation but by care staff for office administration. Consultation with the provider confirmed that at the time of the last inspection of the kitchen by the Environmental Health Department this was not an issue. Care Homes for Older People Page 18 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are able to express their concerns through staff and are protected by robust policies and procedures. Evidence: The homes complaint procedure is contained in the statement of purpose and given to each resident on admission. This needs to be updated with the Care Quality Commissions (CQC) contact details. A suggestions and complaints book was viewed next to the visitors book in the kitchen for residents and visitors to write in. Neither the home or CQC had received any formal complaints about the home since the last inspection. Residents surveys told us they and their representatives know how to make a complaint. The homes safeguarding procedure and policy was observed to be in need of updating. We were unable to locate the latest version of Surreys multi-agency safeguarding procedure. New staff told us they were made aware of the homes safeguarding, whistle blowing and harassment policy and procedure during their induction. These are also discussed at team meetings. It was recommended that the whistle blowing procedure includes contact details for the agencies referred to that staff can raise their concerns with. The manager and five staff had attended Surreys safeguarding training workshops and others had received in-house training. Records show an ongoing programme of safeguarding training for the team. Induction Care Homes for Older People Page 19 of 30 Evidence: workbooks were not in use to demonstrate new staff cover the common induction standard recognise and respond to abuse and neglect within the required maximum twelve week period after taking up post. Allegations were investigated earlier this year under Surreys safeguarding procedures. This matter has been concluded and the allegations unsubstantiated. Staff recruitment procedures ensure new staff do not take up post before carrying out a POVA check to ensure they are not on the national register of people unsuitable to work with vulnerable adults. Observations identified an oversight in applying for a CRB disclosure for an employee who is sixteen years of age and has worked at the home for two years in the capacity of general assistant. The provider has since confirmed an application made for a POVA check and CRB disclosure for this worker who does not engage in the delivery of personal care. Care Homes for Older People Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical environment of the home is clean and hygienic and overall meets the needs of people who use the service, ensuring their wellbeing. Work must be carried out to ensure the home has a satisfactory electrical certificate. Evidence: Surveys informed us of a high level of satisfaction within the physical environment of the home. All said the home is always fresh and clean. Comments included, There is a high standard of cleanliness. The home is immaculate. The home is spotless. A full tour of the home was carried out and all areas found to be clean, in excellent condition in terms of furnishings and decor and general maintenance. The home has satisfactory heating, lighting and water systems and odour control was excellent. An oversight in carrying out remedial work to electrical hardwiring was identified at the time of the visit and has since been discussed with the provider/managers partner. Action is in progress to ensure this work is carried out without further delay. The building has been extended to the rear of the home, providing mostly ground floor bedroom accommodation with en suite bathrooms and patio doors opening onto the garden. Discussion took place with the provider regarding the threshold lip on these doors which prevents wheelchair users independent access to the garden by this route. Care Homes for Older People Page 21 of 30 Evidence: Currently there are two wheelchair users one of whom requires staff support when using the wheelchair. The other person, currently in hospital, was stated to not wish to access the garden from her bedroom. The ground floor is wheelchair accessible through a door at the side of the building. A portable ramp is also available for use at the front entrance though the steep gradient would prevent the safe independent use of the ramp. A discussion with the provider regarding the potential risk for the ramp to slip away from the steps confirmed this is not possible. The ramp was purpose made and has fittings securing it to the steps. A number of bedrooms on the first and second floors have views of the garden and river. Accommodation in the original building is arranged on three floors. The second floor provides a bedroom, bathroom and living room for one resident who is fully ambulant. This floor is accessible by a flight of stairs. The first floor bedrooms have shared bathroom facilities and are partly accessible by chairlift. All bedrooms were nicely personalised and comfortable. Observations confirmed safety locks fitted to some bedroom doors for residents who wish to have this facility. The emergency call system was seen working. Individuals at risk of falls or with reduced mobility and flexibility inhibiting access to fixed call bells beside toilets are supplied with call bell pendents. The provider confirmed that a call bell is available in all toilets and bathrooms. The ground floor provides an L shape lounge, separate dining room and domestic style fitted kitchen. The landscaped garden is well maintained. There is a large summerhouse in the garden used by staff for training purposes, with kitchen and bathroom facilities. Outdoor seating is provided for residents to sit and enjoy the river views as well as a furnished patio area. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to meet the needs of residents. Shortfalls in staff recruitment practice need to be addressed and improvements in this area sustained. Evidence: There has been some turnover within the staff team, with three care staff having left and the vacancies filled by staff with relevant experience and skills. A part time cook was also relatively new in post. The files of four staff were examined and shortfalls identified in recruitment practice. A reference had not been sought from the last employer for one care assistant and only one reference obtained for another. A CRB disclosure had not been sought for an existing employee who is aged 16 years and has worked at the home for the past two years. The provider has since confirmed remedial action in progress in these matters. Staff recruitment is underpinned by an equal opportunities policy and the provider advised to maintain a record of staff interviews. The need to ensure gaps in employment histories are probed was discussed. The explanation must be recorded. Discussions with staff and observations of their records confirmed a high level of management commitment to staff training and develop. New staff confirmed they had read key policies and procedures as part of their induction and were undertaking Care Homes for Older People Page 23 of 30 Evidence: statutory training preparing them for entry onto the appropriate Health and Social Care National Vocational Qualification (NVQ). The need to demonstrate the induction covers the six Common Induction Standards developed by Skills for Care, within the prescribed time scale of a twelve week period, was discussed. The introduction of these standards does not alter the pre-existing requirement for statutory training in first aid, moving and handling, food hygiene and health and safety. The provider has a duty to ensure the competence of new staff and must formally sign off the induction as complete. The provider is an NVQ assessor and has attended a train the trainer course in the past. She delivers much of the staff training programme in - house, maintaining individual training records. Seven staff have NVQ Level 2 or above qualifications in Care or Health and Social Care, four have NVQ Level 3 qualifications and the provider has NVQ Level 4 and the Registered Managers Award (RMA). Discussions with staff confirmed positive relationships exist between staff and the provider. Staff feel well supported and described a happy, professional atmosphere and good teamwork. The staff rota confirmed staffing levels of three care staff during the day and two waking night staff. A cook is on duty to prepare and serve lunch and the evening meal and ancillary staff ensure a cleaner on duty. The home employs a staff member specifically to do ironing. At the time of the inspection staffing levels appeared adequate based on all available information. Other areas of discussion included the shift patterns of the senior care assistant with management responsibilities. In addition to working five nights a week her duties include some time spent on day duty, and on these occasions she works between fourteen and eighteen hour shifts totalling approximately seventy hours a week. The provider was advised to refer to the Working Time Regulations to ensure her obligations are being met under this legislation including carrying out health assessments for night workers. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home ensures a good standard of care and satisfaction levels of both residents and their relatives with most aspects of the homes services, shortfalls identified during this inspection indicate the homes quality audit systems needs to be more robust. Evidence: The provider is also the registered manager for the home. She has relevant qualifications and experience to be able to discharge her responsibility fully. These include a professional nursing qualification, management qualifications at NVQ Level 4 and the RMA and is an NVQ assessor. Discussions with staff confirmed the provider works most days at the home and is accessible by phone at all times.A request was made for the provider to record her hours on the staff rota. The provider/managers partner was stated to also work in the home between three and four days a week. Both the provider and her partner have clearly defined management and administrative roles and responsibilities. On the day of the inspection they were out of Care Homes for Older People Page 25 of 30 Evidence: the country having departed that morning for a long weekend break. A senior care assistant in post for eight years with delegated management and administrative responsibilities was contacted by staff. She came in and facilitated the inspection. The provider/manager was in regular telephone contact with her throughout the visit. The provider/manager also had opportunity to contribute to the inspection process in the week following the visit. Observation confirmed records were stored securely in the office. On sampling a range of policies and procedures these were comprehensive but a number found to be in need of review and updating. Discussions included the need for a restraint procedure which should address practice and equipment that can restrain individual liberty and clear policy on restraint. Also the provider was advised to undertake awareness training relating to the requirement to carry out assessments under the Mental Capacity Act 2005. The need to produce related policies and procedures was discussed. Also the need for a risk assessment to be undertaken specific to the practice of the use of a lap strap for the safety of resident sat in a wheelchair without direct staff supervision. It was suggested to the provider that a risk assessment be carried out for the person who uses the stair lift which is not fitted with a safety strap. The inspection revealed there had been a number of incidents not notified to the Care Quality Commission (CQC) as required. These included the recent admission to hospital of a resident, a fire in a neighbours garden which damaged the boundary fence and injuries sustained by a resident in a recent fall. Also discussed was the requirement to notify the CQC of pressure sores of grade 2 and over. The home must ensure all accidents are recorded in an accident book that is compliant with Data Protection legislation. The provider/manager said that routine maintenance checks and audits took place. These had not picked up on the unsatisfactory electricians report received in January 2008 to ensure the essential remedial work was carried out. It has been agreed with the provider/manager that priority will be given to this work. The home does not manage the finances of any residents. Any additional costs incurred are included on fees invoices. The provider/managers partner is responsible for the homes financial management. The home has public and employers liability insurance and the registration certificate is displayed. Quality assurance systems exist and are set out in the statement of purpose. The provider confirmed she is in daily contact with residents, enabling a prompt response to any feedback for improvement and change. She also has regular contact with relatives and other visitors and listens to and responds to their feedback. Care Homes for Older People Page 26 of 30 Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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