Inspection on 11/11/09 for Abbey Care Home

This inspection was carried out on 11th November 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Abbey Care Home 18/05/09

Abbey Care Home 06/05/08

Abbey Care Home 08/11/07

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report Care homes for older people Name: Address: Abbey Care Home 28 North Road Great Clacton Clacton On Sea Essex CO15 4DA     The quality rating for this care home is:   one star adequate 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: Ray Finney     Date: 1 1 1 1 2 0 0 9 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 30 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 30 Information about the care home Name of care home: Address: Abbey Care Home 28 North Road Great Clacton Clacton On Sea Essex CO15 4DA 01255420660 01255420660 info@careone.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care One Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 11 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following categories of service: Care Home - PC to service users of the following gender: Both Whose primary care needs on admisstion to the home are within the following categories: Old age, not falling within any other category - code OP Dementia - code DE Mental disorder, excluding learning disability code MD Physical Disability - code PD Date of last inspection 1 8 0 5 2 0 0 9 11 11 0 11 Over 65 0 0 11 0 Care Homes for Older People Page 4 of 30 Brief description of the care home Since the last inspection the home, previously called Great Clacton Hall, has changed its name to Abbey Care Home. Abbey Care home is an established care home that provides residential care for older people. It is registered to care for eleven elderly people over the age of sixty-five, who may or may not have dementia, mental disorder or physical disability. Abbey Care Home is a detached period property situated in the centre of Great Clacton, close to the seaside town of Clacton-on-Sea. There are local shops, a supermarket, a G.P. surgery, pubs, churches and public transport nearby. Accommodation is in five single rooms and three double rooms; two of the shared bedrooms (with bath or shower) are on the ground floor and all other bedrooms are on the first floor. The bathroom is on the first floor. Access to the first floor is by means of a staircase. The service is currently in the process of installing a passenger lift. The home charges between £375.00 and £450.00 a week for the service they provide. Other services such as hairdressing and chiropody are available at an additional charge. This information was given to us in May 2009. Information about the home is available in the Service User Guide which can be obtained by contacting the home. 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: one star adequate 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 range of evidence was looked at when compiling this report. Documentary evidence was examined, such as care plans, rotas, menus and personnel files. Earlier in the year the manager completed an Annual Quality Assurance Assessment, which is required by law to be completed by the service, with information about the home and sent it to us at the Commission when requested. Information from the AQAA was included in the last inspection report in May 2009; we did not request another AQAA before this inspection. A visit to the home by two inspectors took place on 11th November 2009 and included a tour of the premises, discussions with people living in the home, a visiting relative and members of staff. Completed surveys were received from people living in the home, a relative, members of staff and a healthcare professional. Comments both from people spoken with on the day of the inspection and from completed surveys can be found throughout the report. Care Homes for Older People Page 6 of 30 Observations of how members of staff interact and communicate with people living in the home have also been taken into account. This observation formed a significant part of the inspection and was carried out both informally throughout the day and as a formal process known as SOFI (Short Observational Framework for Inspection). Details of what we observed throughout this process can be found throughout the report. On the day of the inspection we were given every assistance from the manager and staff on duty. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: The service should continue to develop and improve the care plans and risk assessments to ensure all areas of need are covered. The care plans would benefit from being more personalised and person centred. The provider could further improve their processes around the storage of medication by ensuring there is a record of temperatures in the areas where medication is stored. Consideration should be given as to how to provide appropriate outside shelter in poor weather conditions for anyone living in the home who wishes to smoke. The service should continue with the programme of re-decoration and refurbishment, paying particular attention to the kitchen and kitchen equipment. Care Homes for Older People Page 8 of 30 The provider should continue to further develop the homes Quality Assurance process to include an action plan that sets out how the service plans to improve. The provider should continue to develop and improve the staff training programme, with particular attention to ensuring staff have a thorough awareness of safeguarding and the local authoritys role and responsibilities. The provider should ensure that proposed plans for the management of the home are robust and there is a clear structure of who is responsible for managing the home. Also what arrangements are in place for the day to day running of the home when the manager is not available. The provider should continue with the work in progress to install a passenger lift and planned ramped access to ensure people with limited mobility have access to all areas of the home and have safe access to the outside areas. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall people choosing to live at the home can be assured their needs will be met. Evidence: The service User Guide has been updated since the last inspection. At that time we noted that as there were people living in the home with sensory impairments and the information should be available in appropriate formats to meet their needs. The provider explained that other formats were available. We saw evidence that it has been produced in a large print version and is also available in a spoken word recording. There is an information board available in the corridor where people can access information about the home. There have been no new admissions to Abbey Care Home since the last inspection. We examined a sample of two individual care files. There is some background information on the person including identifying likes and dislikes. Each person has a generic assessment of needs that identifies what care plans are required. As there have been Care Homes for Older People Page 11 of 30 Evidence: no new admissions since the last inspection, we are not able to fully assess whether the assessment process has changed or improved. However, it is recognised that there is an assessment process in place. National Minimum Standard 6 relating to intermediate care was not examined at the home does not offer this type of service. 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. People using the service can expect their personal and health care needs to be identified and to be provided with the support to ensure these needs are met as they would wish. Evidence: The proprietor has stated that he has updated the care plans and completes monthly reviews. On the day of the inspection a total of three individual care plans was examined. One persons generic assessment of needs identifies that they have support needs around personal hygiene, smoking, communication, mood swings and aggressive behaviour. There were care plans in place around self neglect with personal care, being unsteady and mobility, maintaining safety and social activities. There was no plan around the persons mood swings and aggressive behaviour. Overall care plans have improved since the last inspection, but this needs needs to continue to ensure there are care plans in place relating to all needs that are identified Care Homes for Older People Page 13 of 30 Evidence: through the risk assessment process. On the day of the inspection we discussed how care plans could be more personalised. There is a Mental Capacity Act Assessment form (MCA 1) in place for one person that records they lack capacity and details the input from relatives. Most of the care plans for this person now no longer apply as their health and abilities have deteriorated due to end stage dementia. There is now only one care plan in place relating to maintaining comfort in the final stages of life. Daily records examined confirm that the person is being offered regular fluids. A member of staff spoken with told us they have read the care plans and know what is in them. People spoken with were complimentary about the way they are cared for, one person said, staff are friendly, kind and caring. One person living in the home who completed a survey told us, I am not disabled, only old. I am getting a bit unsure walking but staff always give me an arm to lean on. There are a range of charts in place relating to peoples healthcare needs, such as weight charts and nutritional intake records. There is a bathing record for a person with needs around maintaining personal hygiene. Records examined contain evidence of visits from doctor, practice nurse and optician. One persons care plan contains body maps documenting broken skin. This person is cared for in bed and is at end life stage. The proprietor explained that district nursing services are visiting regularly and have arranged an appropriate air mattress to relieve pressure. There is a risk assessment in place around the persons moving and handling needs, which requires two members of staff. We observed that staff regularly turned the person during the day. Staff spoken with said at night the person can be turned by one person and if personal care is needed they can wake the sleep-in staff up for additional support. Other care records examined contained a range of risk assessments relating to peoples individual needs. In the past, a safeguarding issue had been raised regarding one persons finances. The person has chosen to manage their own finances. They have had input from an advocate in the past but this service was withdrawn due to aggressive behaviour towards the advocate. There is a MCA 1 form in place for this person stating that the person has capacity to make their own decisions about managing money and about care provided. Care Homes for Older People Page 14 of 30 Evidence: There is a risk assessment in place stating that one person needs support whilst outside smoking to make sure that they extinguish the cigarette appropriately in the ash tray provided. At the time of the last inspection we reported that there had been improvements in the procedures around the storage, administration and recording of medication. There have been some further improvements, including the provision of a Controlled Drugs cabinet for medication that requires a greater level of secure storage. Medication is delivered monthly and staff spoken with explained that they have a good working relationship with the pharmacy that supplies the medication. Overall recording is appropriate, although further improvements could be made, including ensuring records of stock carried forward is documented, the code system for when medication is refused or not given should be added to the reverse of the Medicine Administration Record (MAR) sheet and the room temperature where medication is stored should be recorded. Throughout the course of the inspection we observed that staff treated people with respect and ensured their dignity was maintained when providing care. When asked what the service does well, a member of staff who completed a survey told us, keeping peoples dignity all the time and another member of staff said, everything including care and activities. 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. Overall people living in the home can expect to enjoy a lifestyle that meets their wishes, needs and interests. Evidence: Care plans examined contain activities logs that document how each person spends their time. One person likes to read, watch television or sport and sit in the garden having a cigarette. This is documented in the persons care plan and staff accompany them outside to smoke and ensure that cigarettes are extinguished appropriately. However, there is not a sheltered area available for the person to use in poor weather. There are some activity sessions recorded, including music and movement. Daily records show whether the person chooses to take part in the activities. We observed one person being taken out by a member of staff to the shops. We noted that there is no activity board on display stating plans for the day. This would be helpful to ensure people know what activities are available or to remind people who are becoming more forgetful because of the aging process. On the day of the inspection we had a discussion with a member of staff who is acting Care Homes for Older People Page 16 of 30 Evidence: deputy manager. They told us that one of the improvements in the past six months is the food and explained that there is fresh fruit available all the time and there are now fresh vegetables daily. We observed that people moved into dining room for lunch and there was general sociable chit chat whilst they were waiting for their lunch. There has been new dining furniture purchased and this has made the dining area much more pleasant. Lunch was curry, chicken, rice and salad, which appeared appetising and was well presented. A visitor was able to sit next to their relative and have lunch. Staff members were seen to encourage people to eat and were jolly in their approach. Overall food and the dining experience were noted to be significantly better than at the last inspection. We did observe, however, that there were no condiments on the table or napkins, which would further improve mealtimes. We observed some positive examples of people exercising choices over food, music, discussions etc throughout the day. Also there were very positive interactions seen between staff and service users. One person told us that they choose to stay in their room. They said, We like our room. We have all we need. We dont go out into the lounge really as there isnt anyone we can talk to really, but we are quite happy. When asked what the service does well, a member of staff who completed a survey told us, supports the residents by keeping them motivated by engaging them in different activities of their choice. A relative who completed a survey told us the home, has activities, for example indoor gardening, sing songs and ball games. People spoken with made positive comments about the food. One person said, The food is alright, mostly alright. If we dont like it we get different things usually, another said, its very nice and someone else told us The food on the whole is generally really nice. A visitor told us, I can visit at any time. I was really lucky to get my [relative] in here. Care Homes for Older People Page 17 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service can be assured that their concerns about how they are treated are listened to and acted upon and they will be kept safe. Evidence: The homes complaints procedure, as reported at the last inspection, remains appropriate. on the day of the inspection we observed that staff listen to people and deal with any minor concerns they may have. There was positive praise about the home from people spoken with on the day of the inspection. One person told us they would be able to raise concerns if necessary. They said, If I have any issues I always make sure they know about it. We had discussions with members of staff about their understanding of issues around safeguarding people and recognising signs of abuse or poor practice. Overall staff were able to demonstrate an understanding of their responsibilities around keeping people safe. One member of staff said they would report any issue to the manager but was also aware that social services and the Care Quality Commission should be informed. Another person spoken with was able to demonstrate a knowledge of what constituted abuse or poor practice and would report any suspicions to the manager. However, they were unsure of what external body is responsible for investigating issues around safeguarding. Care Homes for Older People Page 18 of 30 Evidence: Personnel records examined confirm that staff undergo appropriate checks before they are employed, including enhanced Criminal Record Bureau (CRB) checks. Staff have also received training around safeguarding. Care Homes for Older People Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, people are satisfied that the environment suits their lifestyle and is homely, although further improvements are needed in some areas. Evidence: We carried out a tour of the premises and noted that there were a number of improvements to the environment. There has been redecoration in many areas, including the dining room, and overall this had considerably freshened up the home. We also noted that there has been new furniture purchased for the dining room, which has greatly improved the dining experience for people living in the home. We discussed with the proprietor that we noted there were no pictures on individual doors to distinguish one room from another which would assist people who may be confused or forgetful as a result of the aging process. Similarly, better signage on bathroom and toilet doors would assist peoples orientation. Further improvements were noted in the upstairs bathroom, where the taps have been replaced, there is new flooring and the room has been painted. There were paper towels and liquid soap available for hand washing. Other improvements include new carpet in some rooms. The provider told us they have plans to change the carpets in all the communal areas. Overall the environment Care Homes for Older People Page 20 of 30 Evidence: appeared clean and smelled fresh. However, one area where improvements are still necessary is the kitchen. We noted that the area had a shabby, somewhat grubby appearance with some fat stains. There was a domestic flip top bin which could pose a risk to cross infection and would benefit from being replace by a foot operated, pedal type bin. Although we noted that portable electrical appliances had been tested and were in working order, the toaster in the kitchen was old and appeared dirty. Also there was a broken seal to the fridge in the store room. We also noted that the crockery could have been cleaner and the dishwasher was old and was no longer in working order. Consideration should be given as to how to improve these areas. At the time of the last inspection some of the Dorguards in place to hold doors open were not in working order. Since then, the Dorguards in place downstairs were seen to be in working order and doors has new smoke seals in place. However, during a tour of the premises we noted that some upstairs bedroom doors were wedged open. Consideration should be given as to whether Dorguards are necessary in these areas. There was an an area of concern raised at the last inspection around access for people with mobility difficulties. Since then considerable progress has been made on a new extension to the property to house a passenger lift. The provider explained that they had hoped this would have been completed by the end of October, but changes to the original plans were requested by the local authority and this has put things back somewhat. The lift fitters were due to come the week following the inspection. The work on the extension is now in the hands of a contractor, who has fenced the area in securely to reduce the risk of people coming to harm whilst the building work is in progress. Access outside continues to be a problem, but through discussions with the provider and taking the plans for the extension into account, it is evident that these issues should be resolved when the building work is completed. We have taken a proportionate approach to this issue and, in view of the considerable progress that has been made, have agreed to extend the timescale for the requirements relating to access that were made at the last inspection. There have been some improvements made to the appearance of the gardens, including employing a gardener to keep the grass tidy and remove the weeds. One further improvement outside would be the provision of a sheltered area for service users who wish to smoke. Care Homes for Older People Page 21 of 30 Evidence: When asked what the service does well, a member of staff who completed a survey told us, the home is smell free, it has a homely atmosphere and the home is improving by installing a lift and the furniture has been changed. A person living in the home who completed a survey told us, it is small, very comfortable and friendly. 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. People living in the home can be confident they are cared for by a competent staff team who can meet their needs. Evidence: We noted that there has been an improvement in staffing levels since the last inspection. There are now two staff on duty for all shifts during the day and the evening. Through the night there is one awake member of staff and one person on a sleep-in basis who can be called on when a second member of staff is required. In addition the proprietor is managing the home on a day to day basis and one of the care staff who has worked at the home for many years is acting deputy manager in the proprietors absence. The homes process around recruiting staff was examined. Personnel records contained two written references, relevant proofs of identity, CRB checks and PovaFirst checks. Overall staff files contained relevant information as required by regulation. The personnel file of a member of staff who had been in post for a number of years did not have full employment history on their application form and the references were not robust. However, as the recruitment process has improved in the past year and relevant documentation is in place for newer staff, we recognise that after many years in post it would not be proportionate to expect these documents now to be made available. Care Homes for Older People Page 23 of 30 Evidence: Personnel files contained evidence of recent fire training and evidence of in-house staff induction. The proprietor has delivered in-house training on Equality and Diversity. One member of staff spoken with told us, I love being here and another person said, I like the job and Its more pleasant to work here now. Both members of staff spoken with were enthusiastic about training. One person said they wanted to have training around dementia and this is now planned. They told us they have completed NVQ level 2 in the last year and have just completed distance learning around medication. Other training includes Fire Safety, Moving and Handling, First Aid, Infection Control and Deprivation of Liberty Safeguards (DOLS). We examined the proposed training schedule for 6 months to the end of December 2009. This includes training around Moving and Handling, Dementia Awareness, Infection Control and Safeguarding Adults. Training records contain certificates relating to training around Fire Safety and Food Safety in Catering and evidence that there has been in-house training around care planning. Overall training has improved in the past year. However, a health care professional who completed a survey told us, the service would benefit by having training sessions for the staff. On the day of the inspection someone living in the home told us, The girls are caring with us and My key worker is taking me to the bank in her own time at 3 p.m. They do really care about us. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Overall, the home is managed in the best interests of people living there. Evidence: Since the last inspection the home is being managed on a day to day basis by the proprietor, Mr Sivakumar. When he is unavailable a senior member of staff is taking on the role of acting deputy manager. Mr Sivakumar explained that it is his intention to apply for registration as manager of the home. The proprietor further explained that he is in the process of recruiting a deputy on a permanent basis to assist in the running of the home. A member of staff told us that if staff have a problem the manager asks that they write it down. Not all staff think that is the best approach. However, the member of staff said that the manager would acknowledge the issue if he was not busy. Since the last inspection, the proprietor has revised the homes quality assurance process. A new questionnaire has been devised, using a tick box format asking Care Homes for Older People Page 25 of 30 Evidence: people to rate various aspects of the service giving a choice of excellent, good average or poor. The provider has started to collate this information. The process needs to be further developed so that there is a development plan for the home. Personnel records examined contained evidence that there is a supervision process in place that includes a range of methods of supervising staff taking place approximately on a monthly basis. There was evidence that people have one to one supervisions with the manager and staff also have direct observations of their competency around administering medication. A member of staff spoken with told us, I have supervision with the manager every three months. We talk about skills, improvement, development and issues. Another person said, I have a group supervision every two months, notes are taken and I sign them. As reported at the last inspection in May 2009, documents relating to Health and Safety were found to be in order. These included Portable Appliance Testing (PAT) on small electrical appliances, which was carried out in April 2009. a gas installation maintenance check in September 2008 and checks of emergency lighting, smoke alarms and fire equipment in April 2009. The electrical installation maintenance check was carried out in January 2008. A tour of the premises showed that the laundry room contained a domestic washer and dryer, which are adequate for the number of service users living in the home. The COSHH (Control of Substances Hazardous to Health) cupboard containing cleaning substances is situated in the outside laundry room and is not accessible to people living in the home. We also noted that there is a chest freezer and fridge situated in this outside room. In view of the storage of COSHH substances in this area and also that soiled laundry is dealt with here, consideration should be given to whether this is the most appropriate place for food storage appliances as it may pose a cross infection risk. We discussed this with the proprietor on the day of the inspection as something that should be considered when the building work on the extension is finished and the changes to the premises are up and running. A health care professional who completed a survey told us, the service appears to be trying hard to take on board all the advice being given by various departments. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 19 23 Improvements to access 30/09/2009 within the building must be made to ensure people living in the home are able to access all areas they need to. This is necessary to ensure people with deteriorating mobility are to continue to be able to access their bedrooms on the first floor. Since the last inspection considerable progress has been made with work on the extension to house a passenger lift. Completion of the work has been delayed because of changes in planning requirements. In view of this we will take a proportionate view and have agreed to extend the date for compliance. We expect this requirement to be met by 28/02/10. 2 19 23 Arrangements must be put in 30/09/2009 place for safe access to the property. These arrangements include removing or making safe trip hazards and ensuring there is appropriate and unobstructed access for wheelchair users. Care Homes for Older People Page 27 of 30 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 These improvements would ensure that people with mobility problems or sensory impairments would be able to access the home safely. Since the last inspection considerable progress has been made with work on the extension which will include ramped access. Completion of the work has been delayed because of changes in planning requirements. In view of this we will take a proportionate view and have agreed to extend the date for compliance. We expect this requirement to be met by 28/02/10. 3 19 23 Dorguards designed to hold 30/06/2009 doors open and then close them in the event of a fire must be operating appropriately. Other doors that do not have a Dorguard fitted should be addressed in a risk assessment that identifies why a Dorguard is or is not necessary. This would ensure that in the event of a fire risks to people living in the home are reduced. 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 1 19 Signage to assist peoples orientation would improve the environment for people with cognitive impairment and those who are becoming more forgetful as a result of advancing elderley needs. As part of the ongoing programme of improvements to the environment the provider should consider what improvements are necessary to raise the standard of facilities in the kitchen. The provider should consider the appropriateness of siting a fridge and freezer for food storage in the outside laundry room and assess the risk this may pose to good infection control. 2 19 3 38 Care Homes for Older People Page 29 of 30 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). 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