Inspection on 16/07/09 for Angela Court

This inspection was carried out on 16th July 2009.

CQC found this care home to be providing an Adequate 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

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Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Angela Court Tipton St John Sidmouth Devon EX10 0AG Lead Inspector Ms Rachel Fleet Key Unannounced Inspection 16th July 2009 10:00 DS0000072963.V376241.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Angela Court Address Tipton St John Sidmouth Devon EX10 0AG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 08702 869456 08702 869457 angelacourt@psphealthcare.com www.psphealthcare.com PSP Healthcare Ltd Mrs Emma Jayne Seal Care Home 37 Category(ies) of Dementia (37), Old age, not falling within any registration, with number other category (37) of places Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum of 37 places Dementia (Code DE) - maximum of 37 places The maximum number of service users who may be accommodated is 37. N/A 2. Date of last inspection Brief Description of the Service: This care home was registered as a new service on 19 January 2009, under new ownership, having previously been a registered care home under the same name. The home can now offer accommodation, personal care and nursing care for up to 37 people of either gender, whose primary care needs on admission to the home are due to old age or dementia. The new Registered Provider is PSP Healthcare Ltd. Mr. Shrien Dewani is the Responsible Individual representing the company, the Dewani family having owned the home since the 1990s. There is a lounge in two parts, each with linked dining areas off the ground floor corridor, giving people the opportunity to walk around the ground floor. Bedrooms are on two floors, with passenger lift access as well as stairways between floors. Most bedrooms are suitable for people with high physical care needs, who may need the use of a hoist or other equipment. Two bedrooms are not suitable for people needing such care. The bathing and toilet facilities are to be improved. There is an upstairs assisted bathing facility and a ground floor level-access shower facility. The Company plans to develop the toilets and bathing facilities on the ground floor of the home along with the laundry facilities, once fire safety measures have been improved. The back of the home has pleasant views over the home’s gardens, with access Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 5 from one lounge area to a secure, paved garden area with seating. There are sloping grassed lawns beside the home’s driveway, which is accessed next to the church in the village of Tipton St John. There are parking areas at the front of the home. Fees at the time of our inspection were £391- £800 per week, depending on individuals’ needs and the room to be occupied. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection reported on below took place as part of our usual inspection programme. It was the home’s first key inspection under the new ownership. Louise Delacroix and Rachel Fleet, Regulation Inspectors, carried out an unannounced visit to the home. This lasted 10.5 hours, on a week day, which included time spent with the manager Emma Seal discussing our findings at the end of the day. She and her staff assisted us fully through the day. Prior to this visit, the home had returned a questionnaire (the Annual Quality Assurance Assessment, or AQAA), about the service they offered and any plans for the future. This included general information about the people living at the home and the staff, some assessment of what the home does well, and any plans for improving the service. Before our visit, 10 of our surveys for people who lived at the home and 5 staff surveys were sent to the home. Surveys were returned from 4 people living at the home, all of who were helped by their families to complete them; 2 surveys were returned from staff, one of who was a member of the care staff. Of 12 surveys sent to a range of community-based health or social care professionals, 7 were returned; 5 of them included that the respondent had had limited contact with the home to date. Surveys were generally positive about the home. Some surveys were returned after our visit. No-one indicated in their survey that they wished to speak to us. There were 35 people living at the home at the time of our visit. We met individually with at least 6 of them, around the home. Several people could not give us their views in depth, because of communication difficulties caused by dementia. Because of this, we sat for a while in the lounges, using a particular method for observing activity that helps us get a sense of peoples well-being, how they are able to use their environment, and how staff support them. The inspection also incorporated case-tracking of 4 people living at the home, including new residents, people with nursing needs or more complex physical needs, and people who did not have nursing needs. Case-tracking involved looking into these peoples care in more detail by meeting them, checking their care records and related documentation (pre-admission assessments, etc.), talking with staff, and observation of care or support these people received. We also spoke with 2 visiting relatives, 6 care or ancillary staff, and the manager. We followed up matters from the AQAA, surveys, and the home’s Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 7 registration process. Records seen included those relating to staff, health and safety, and quality assurance. Our tour of the building included the kitchen and laundry, as well as people’s bedrooms. Information from these sources, and from communication with or about the service since it was registered under new ownership, is included in this report. What the service does well: Asked, in surveys for people who lived at the home, what the home does well, people commented ‘Situation is excellent and good use made of this. People are seated…to view the gardens and not in a silent circle’, ‘Always clean, and the staff friendly and helpful. Good with the patients’, ‘A friendly homely atmosphere...The manager and senior staff are always approachable and ready to listen and help with any problem’. A professional surveyed felt that the home was good at supporting people with behaviour that could be challenging. Another included ‘Understands needs of their residents, particularly regarding mental ill health’. They also thought the home was good at liaising with other professionals and people’s relatives and friends. A third, who said they had been to the home frequently, said they were impressed by the cleanliness and provision of care since the new service was registered. The home generally obtains enough information about prospective residents to identify their individual needs and decide if the home can meet those needs, before offering them a place. The home is run in the best interests of the people living there. The safety and welfare of everyone at the home is generally well addressed, with fire safety matters currently being addressed to better protect everyone at the home. The home’s thorough recruitment practices ensure that the people it employs are suitable to work in a care setting. People enjoy the balanced, varied diet offered. The concerns of those who use the service are listened to. People are generally treated with dignity, with their privacy respected. People living at the home benefit from good relationships between the home, people’s relatives or other representatives, and the community around the home. What has improved since the last inspection? This is the first inspection of this service. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 8 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. The home does not provide intermediate care. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally obtains sufficient information about people to identify their individual needs, before offering them a place at the home. But prospective service users do not have enough information about the home to make a properly informed choice about whether it will be a suitable place to live. EVIDENCE: When the home was registered, it was recommended that information for prospective and current residents – the home’s Statement of Purpose – should include additional detail about the service and facilities provided. This was to explain that two bedrooms were too small to accommodate people with certain needs, and more about how the home would provide the care and support needed by people who have dementia. The information we were shown on our visit had not been updated with regard for these matters. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 11 We also noted that the information said lunch was a three course meal, and high tea was served 5-5.30pm. We found during our visit that this was not the case, with two courses served at lunch, and tea served at 4.30pm. Detail about fees was not included either. The manager showed us computerised records, for existing residents, giving a breakdown of what was charged for - which varied according to individuals’ needs. We were told this level of detail was given to each prospective resident, with copies of individuals’ contracts – which contained this information - held at the company’s head office. Three of four surveys from people who lived at the home said they had been given written information about the home’s terms and conditions. One said they had not been given this information. People could visit the home to find out about it. We saw the manager showing relatives of a prospective resident around, answering their questions, etc. All four surveys from people who lived at the home said they were given enough information to decide if it was the right place for them, before they moved in. Information on people’s needs, and associated care or support, had been obtained from Social services care managers for two people we case-tracked, before they were admitted to the home. Pre-admission assessments had also been carried out by Emma Seal, the home’s manager, enabling her to ascertain if the home’s staff and facilities could meet the person’s needs. A social care professional told us that the home had not offered someone a place because the manager felt the home would not be able to meet the person’s needs properly after assessing them. This ensures that individuals are not admitted to a home that is unsuitable for them. Another professional wrote that admissions to the home that they had been involved in had been successful. One of the home’s assessments included equipment the person would need, some information about how they communicated, and how staff might manage situations where the person declined attention. The manager had noted that information was to be sought from the family about the person’s faith needs, which was still to be done, and some other basic information had not been obtained – such as the person’s preferred or usual bedtime / rising times. These were noted for a second person, although where it was included that they had ‘some disturbed nights’ there was no information about what (if anything) was currently done about these. A record had been made of what the person liked to be called, their background and their hobbies, their favourite meal with how to help the person eat their meals, and the fact that they did not practice their given faith. Such detail helps to ensure that people receive person-centred care if they move into the home. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 12 Staff told us that the assessments of prospective resident’s needs were made available to them, or discussed, ahead of the person’s admission. However, staff we spoke with were unaware that someone to be admitted very shortly had nursing needs. This was of relevance to responsibilities for meeting the person’s nursing needs after admission. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7 – 10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning does not yet ensure that each person will get the holistic, individualised care they need. People’s emotional needs are not always met, creating a risk to their wellbeing, and medication systems are not robust enough to ensure people’s health needs will be met appropriately. People are generally treated with dignity, with their privacy respected. EVIDENCE: We looked at four care plans in detail. We saw that where individuals with cognitive impairment had family or close friends, these people had been asked to provide information relating to the individual’s needs, preferences, background, interests, etc. -building a better picture of each person as an individual. A professional surveyed commented ‘The Care plan was thorough and the home certainly appeared to have the best interest of the gentleman at Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 14 heart.’ Surveys from staff indicated they felt they had good information about people’s needs. Of surveys completed for people who lived at the home, 3 said they usually or received the care and support they needed; 1 said this always happened. Three said the staff usually listened and acted on what the person said; one said this occurred sometimes. The visitors we met were happy with the care provided; a professional said that staff were anxious to give good care, and families had been complimentary. We saw staff following someones care plan to provide reassurance to them. The manager explained guidance had been provided to ensure consistency in approach. Care plans for other people stated staff were to ‘use distraction’ in specified circumstances, but without saying what this meant in practice. When we asked staff about this, in relation to a named person, we received various responses. Two of these methods of distraction were reflected in the person’s care information, with one used during our visit, but others were not included. People might therefore receive inconsistent or ineffective support. An ‘Activities assessment’ form for one person identified their previous interests or hobbies, but without guidance on what staff were to do with this information, how the person was to be enabled to continue these interests, etc. Daily notes we saw tended to reflect people’s physical needs better than their social needs, with limited information on how they spent their free time, whether they enjoyed an activity, how they participated, etc. Care plans were reviewed regularly. Sometimes it was not clear what the person’s current needs or care were. One person’s care plan said that they walked independently and tried to leave the home, and elsewhere it indicated that they had been moved to a different bedroom because of their reduced mobility, and needed support from staff. Asked in surveys if the home made sure the individual got the medical care they needed, two people said ‘usually’ and two said ‘always.’ The health professionals surveyed were positive about the way in which the home liaised with them and acted on their advice. A dentist had visited someone about their dentures. Others had been seen by GPs, chiropodists, opticians, and attended audiology appointments. We could see that people with residential care needs had access to the community nursing service. We noted that some people had been assessed as being at risk of pressure damage, and they had pressure relieving cushions and bed-mattresses. Staff used other equipment indicated in individuals’ care plans, such as hoists, to meet their specific needs. We were told that 2 hoists and adjustable, profiling beds had been purchased recently. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 15 ‘Gentle movement’ sessions were part of the home’s activity programme, with relaxation sessions also held. Care plans included assessments of people’s oral health. We saw risk assessments for malnutrition had been completed, with people’s weights monitored from admission. A list in the kitchen showed special diets required by individuals, with their likes or dislikes. We were also told by staff that when people first moved into the home, a record was kept of how much they ate. We noted these records did not routinely include the actual foods offered or eaten. Such detail could help to identify people’s dietary preferences where they couldn’t otherwise tell staff because of a cognitive impairment, etc. We saw people being encouraged to drink. However, we noted one person did not have a mid-morning drink, or the drink given with their lunch. During our time of observation, we saw that some people had little contact from staff and that their mood declined. One person was spoken to twice by staff in 95 minutes, in the last 10 minutes of this observation - once fleetingly and without eye contact, once to confirm that the person could sit as they chose. A staff member did not acknowledge the person as they sat talking nearby. The person’s care plan said keep orientated as much as possible. Another person slept for a large part of the morning, and during lunch, remaining at the table after others had left. Their care plan said Likes to sit and chat, but we did not see staff spend meaningful time with them or converse with them in a 3-hour period, apart from to help them to their table and serve their meal. When people are not acknowledged or communicated with in a meaningful way, they can lose their confidence and sense of self, which can lead to withdrawal from the world around them. The home’s nurses administered everyone’s medication. Where someone was prescribed a variable dose of medication, staff had recorded what dose they had given - enabling proper assessment of the medicine’s effectiveness, etc. Where medication was given hidden in someone’s food, a ‘covert administration’ form had been signed by the person’s GP and staff from the home, after considering the person’s best interests. It would also be good practice to involve other relevant professionals in such decisions. Handwritten directions on medication charts had not always been signed and dated by staff, including where medicines had been crossed out. This should be done to verify the accuracy of the entry or the change made, and for audit purposes. Unwanted tablets had not always been disposed of in line with the home’s policy. There was little guidance for staff regarding medication that was to be used only when required - such as when and how laxatives or tablets for pain should be used. One person’s care plan said ‘Monitor for signs of constipation’ but did not mention the laxative they had been prescribed, which was for ‘Use as directed’ according to their medication chart. Someone’s care plan said they were to be given a medication if a certain health problem occurred, but the medication was not prescribed on their current medication chart. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 16 There was a fridge for medication needing cool storage. Its temperature had not been recorded on a daily basis, so it was less certain that correct temperatures had been maintained over time. Insulin was stored in it, which can be damaged if it freezes. On checking the controlled drugs, there was no indication of when one was first opened, thus staff could not be certain of the expiry of its shelf-life. People looked well cared for, with their glasses and nails looking clean. Staff told us about individuals who preferred to be looked after by female staff only, for personal care. Visitors we spoke with said their relative always had their own clothes on and these looked presentable. Minutes of the last staff meeting showed that privacy and dignity had been discussed, including that staff should speak only English when in the presence of people living at the home. However, we saw some practices that could undermine peoples dignity. People were given biscuits by staff, rather than being given a choice. Someone was wearing their dressing gown until midday, which we were told was because they were having a bath. One person was anxious and needed regular reassurance, which was noted in their care plan and confirmed by staff. However, some staff went by without making eye contact or picking up on their body language; some staff were more directive, and did not take time to listen. But, generally, staff demonstrated knowledge of good dementia care: we saw some staff ensure that they made eye contact, listening and acting upon peoples requests. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from the good relationships the home has developed with their relatives, other representatives and the community around the home. Staff are respectful but people’s choices are not always recognised and people are not always enabled to participate in activities that are meaningful or fulfilling to them, affecting the quality of their lives. They enjoy a balanced, varied diet. EVIDENCE: Surveys from people at the home included positive comments about the atmosphere, family contact, and food. The matter of activities got the least positive response in the surveys, with 3 people saying the home sometimes arranged activities the individual could take part in, and one answering ‘Don’t know.’ When asked generally what the home could do better, both staff surveyed suggested more activities or outings, provided there were enough staff. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 18 They also indicated that they led spontaneous activities, in addition to preplanned events or sessions. One staff member said they sat with one person, showing them pictures and asking them if they were relevant to their experiences or seeing how the person responded. Minutes of the last Relatives’ meeting showed people had requested more activities, although they appreciated the fortnightly musical entertainment at the home, the Easter cooking activity that took place, and the availability of large print books. Raised flower beds were suggested. Staff told us most people enjoyed the music provided, some enjoyed drawing, puzzles or reminiscence, but not many liked Bingo. Table-top games were offered – dominoes, cards, etc. The local library service provided reference books for reminiscence sessions, as well as puzzles and tapes. We saw an outing to a donkey sanctuary was to take place, as was the home’s summer fete. Staff confirmed two church services were held at the home every month. When we first arrived, 24 people were using the main lounges. Music played was changed through the morning, and we saw several people enjoying it. However, other people seemed in a negative mood state - one person was anxious despite their care plan saying they enjoyed music, and other people spent time asleep or just looking around. A staff member painted the nails of someone who had had their head resting on a table. The person seemed to enjoy this occasion, which lasted 10 minutes, and then as the staff member left, the person rested their head on the table again. We did not see anyone look at the fish tank in the room, and there was little else for people to interact with. Some peoples care plans said that they enjoyed looking at books but we did not see these provided, even when the person seemed agitated. One person moved furniture about, which made other people cross, but staff were not always on hand to intervene. Peoples activity records suggested they did not benefit from regular meaningful occupation, with 9 – 11 entries in six months for two people, for example. A visitor later played the organ loudly and sang. Some people, including one person who had been very quiet, visibly brightened; some sang, danced or played an instrument. However, one person, who we were told had difficulty communicating verbally, looking distressed. They were close to the organ. Staff did not pick up on their discomfort. When we raised this concern with the manager, she confirmed that the person did not like loud noises. We were told that the home had tried to recruit a person specifically for activities but that this had been problematic. We saw that staff and the manager had a good rapport with relatives and made them welcome as they visited, demonstrating knowledge of issues that were important to them. Relatives told us that staff kept them informed, and that they were able to visit at the times they wished to. Minutes of the last relatives’ meeting showed a new initiative by the home was appreciated: people living at the home could invite their family for Sunday lunch, creating the family occasions experienced before admission to the home. Ten people Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 19 were expected for a birthday meal soon. The home did not charge anything if two or less people attended. Visitors also told us that local school children come to sing at the home at Christmas. The home’s fete was going to be open to the public, and the church services at the home were led by people from two local churches, helping to maintain links with the community around the home. Care plans included assessments of people’s capacity to make decisions for themselves, which had been reviewed over time. And descriptions here of peoples daily decisions, such as where to sit, were reflected in their behaviour and the support we saw staff give. Of 4 peoples files that we looked at, peoples advance decisions or ‘last wishes’ regarding their end of life care or treatment were recorded for only 2 people. A visiting mobile clothes shop and the home’s ‘trolley shop’ gave people an opportunity to be involved in choosing items they might need or want. Staff told us that people were offered a choice of clothing visually, to help them choose what to wear. When we asked more about how they found out about people’s likes/dislikes or preferences, they said senior carers told them sometimes, they asked people or their families, and they looked in people’s care plans to find their preferred activities. We noted that people were given their choice of hot drink as recorded in their care plan. We saw that some people were offered a choice of drink at lunchtime, but a staff member then served orange juice, despite people’s requests. We were told there were two meal choices at lunchtime. We did not hear staff offer meals to individuals or check in other ways if the person wanted the meal choice taken to them, although once people had started the meal, staff asked some individuals if the meal was satisfactory. Some people were addressed by name as staff served them, and others were not. We also saw people choosing independently where they spent their time, with some walking around within the home. The new, secure, garden area was freely accessible although not used during our visit because of rain. We talked to the manager about the current practice of locking some bedroom doors. She explained that this was to prevent some people going into other peoples rooms without their permission. We discussed considering other environmental changes to deter people from going into the wrong room. The manager told us that people could have a cooked breakfast daily if they wished. Menus for the week of our visit showed a variety of dishes at lunchtime (liver and bacon, roasts, stuffed peppers, shepherds’ pie, etc.), with a buffet tea on Sundays. Scrambled egg, tomatoes, waffles and beans were served for tea during our visit, with sandwiches, cake and milky drinks offered at 7pm. We were told staff could make snacks for people overnight. Visitors we spoke with said meals served looked nice, their relative seemed to enjoy them, and the home had provided a lovely cake on the person’s birthday. Asked if they liked the meals at the home, 3 people surveyed said ‘usually’ and one said ‘always’. We saw that people appeared to enjoy their lunch; one Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 20 person commented Very nice, and a number of people ate all of their meal. Pureed meals had the different components served separately rather than mixed together, so different flavours could be appreciated or experienced. There was much activity in the main dining room where 21 people ate lunch during our visit. Staff were busy fetching people’s meals from the kitchen, and there was no one with an overview of what was going on in the room. Some people who were asked regularly to move their chair, to allow other people through, got up and walked away. Of two people sitting together, one had their meal. The second person tried to obtain a covered meal that was placed on their table. Passing staff asked them several times to leave it alone, as it was for someone else - causing the person to become frustrated. Eventually, the person was served with a meal the same as the covered meal - which therefore could have been given to the individual to prevent their frustration. Some staff told people what the meal was as they served it, although the meal was called ‘pork’, ‘gammon’ and ‘ham’ by different staff. One carer assisted someone with their meal almost in silence, but another explained what the meal was, etc. as they helped them. One staff member sat with someone who was restless, and the person then settled and ate their meal. Discrete assistance was given to others. Once individuals had finished, staff did not stop them leaving the table if they wished to, helping them back to the table when the next course was served. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The concerns of people who use the service are listened to, but not enough is done proactively to protect people living at the home from harm or abuse. EVIDENCE: All four surveys for people who lived at the home said there was someone they could speak to informally if they were not happy. Two said they knew how to make a formal complaint, and two did not. A professional commented that the family of their client at the home visited the person very regularly and had not voiced any concerns at a recent review. The complaints procedure was displayed in the entrance hall. It did not state that people may contact us at any stage if they have a complaint i.e. they did not have to contact the home first, as currently indicated. The manager said she would address this. The home’s self-assessment on this section in the AQAA was not detailed; they had received one complaint. Staff surveyed confirmed they knew what to do if someone had concern about the home, and care records included some people’s concerns, with the action taken to try to address them. A relative told Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 22 us that they could raise concerns, and were kept informed by the home. We have not received any complaints about this new service. One safeguarding concern has been raised in relation to the service since it was registered. This was regarding the action taken by staff in an emergency situation. The responsible individual was asked to investigate and provide a written response, but this report was not provided. A nurse we spoke with during our visit confirmed there had been a meeting as a result of the incident to clarify matters with staff, including the need to get information from or the views of families and GPs on this aspect of care. The safeguarding policy we were shown did not clearly give staff guidance in line with the local authority’s safeguarding procedures. It did not identify the primary contact point external to the service, to who staff could report concerns if they wished. It indicated that the home would investigate allegations, without first seeking advice from Devon County Council safeguarding teams. Some staff could name outside agencies with safeguarding responsibilities, although they did not name the principle ones and they did not know where to find relevant contact details. The manager told us that relevant contact numbers should be in the staff handbook. We found at least five records about one residents behaviour that had negatively impacted on other people living at the home. We also saw an entry where two people living at the home had hit one another. The Commission had not been informed of these incidents. This prevents us from monitoring if people were being appropriately cared for and had implications for how the home addresses potential safeguarding matters. Bedrails had been risk assessed where they were used for people we casetracked, ensuring they did not create unnecessary risks to the person. Use of a lap-belt had not been assessed in the same way. There was no information on how long the belt should be kept in place or when it should or could be released, with respect for the person’s rights as well as their physical and mental wellbeing. Staff we asked were unsure about such aspects of care. Asked what the home did well, one professional commented ‘Secure and safe environment regarding signing in, accompanying me to the client’s room, checking my identity, etc.’ Relatives had requested that staff had some form of identification. The home now displays photographs of staff with their name, (rather than using name badges) for people to identify staff if they wish to. We saw property lists had been completed for individuals. We were told that one person living at the home (who had a cognitive impairment) collected other people’s property, as had occurred for some months. Staff handled this sensitively, but no new action had been taken by the home despite the ongoing situation, and we discussed this with the manager. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable, spacious place to live, with improvements planned to ensure that the accommodation will be safe and homely throughout. Some areas need further attention to provide people with a hygienic and fresh environment. EVIDENCE: Most bedrooms were personalised with people’s possessions, so looked welcoming and individual. Communal areas had been redecorated and refurnished. Staff explained the system for reporting breakages or repairs needed, and felt matters were addressed quickly. There were some adaptations to promote people’s independence. One bath was adapted for people with mobility problems, and there was a level access Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 24 shower, with a chair provided. Handrails were fitted in some places, but sometimes only on one side of toilets. Staff told us the baths downstairs were not used, staff taking people upstairs to the adapted bath, or to the shower. This meant people’s choice or dignity could be affected. The local fire service had required the home to change bedroom door locks for ones suitable for emergency situations such as a fire. The manager said these had been obtained but were still to be fitted. When the home was registered under new ownership, the provider said they intended to improve toilet and bathing/showering facilities, since this was considered necessary. We found some had damaged flooring or walls, and looked institutionalised - a bare light bulb hanging from the ceiling in one, for example. The AQAA said the planned improvement was now on hold as fire safety measures had to be addressed as a greater priority. Signage was also still to be improved, to orientate people to their bedroom, toilets, and communal areas, as discussed when the service was registered. Two occupied bedrooms had the previous occupants’ names on the doors, because the handyman was not available to change the signs, we were told. Hot water temperatures were checked regularly but the manager did not know if window restrictors were checked. We were told we were not able to look at the records of maintenance or safety checks because the handyman who kept them was away. Three relatives commented specifically and positively about the cleanliness of the home. One person told us some staff put dirty laundry, etc. directly onto carpeted floors. Staff we spoke with were clear that they used specific, appropriate procedures when handling such items, to prevent contaminating the environment. We discussed four areas elsewhere in the home that had unpleasant odours during our visit, with the manager. Staff described appropriate hand-washing and use of disposable gloves to reduce cross-infection. When we queried that we had not seen people wearing aprons, they told us that these were only worn in and disposed of in individuals’ bedrooms. The laundry had one washing machine and one tumble drier for the whole home, but staff told us the machines worked well and there had not been any issues due to breakdowns. The area was orderly, and staff there were keen to provide people with fresh, well ironed clothing, recognising this was important for people’s dignity. Wash programmes used during our visit included temperatures appropriate for proper cleaning or disinfection of laundry. We saw bags and skips that staff had described for transporting washing, etc. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 25 Some tiling and paintwork was damaged in both the laundry and kitchen which could affect the levels of hygiene achievable. The laundry was to be part of the refurbishment that was now on hold. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home’s thorough recruitment practices ensure that the people employed are suitable to work in a care setting. Staff are caring and receive training for the work they have to do, although there are not always enough staff, with the right skills, to ensure that people’s diverse care needs can be met and met safely. EVIDENCE: Visitors we met felt that the home ran the same at week-ends as it did during the week (when senior staff and extra ancillary support were available). They said there were always staff around. Someone surveyed reflected this, saying ‘A friendly, homely atmosphere, and always plenty of staff in attendance.’ Two of four surveys completed by relatives for people who lived at the home said staff were usually available when they needed them, and two said they were always available. When we arrived, the manager was on duty, with another nurse, a senior care assistant, and five care assistants looking after 35 people, 6 of who had nursing needs. Care staff were being supported on the day by a laundry staff, Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 27 two domestics, a cook, and gardener. The handyman would usually have been on duty but was on holiday. Rotas showed that for the 35 people living at the home there were usually 7 care staff on duty in the morning, 6 in the afternoon, and 3 on duty overnight from 7.30pm. There was always at least one nurse on duty, some of who had a mental health nursing qualification. Where we met people in their rooms with staff present, individuals looked cheerful and relaxed, and we heard staff using reassuring, respectful and unhurried tones, language and postures. We saw staff and people exchanging banter. One person reached up to a member of staff saying You are my dear, and others joined in with staff when they sang, indicating they were relaxed and at ease. When people needed help to move with the use of equipment, staff were calm, unrushed, explained what they were doing, and offered reassurance. We saw staff using appropriate moving and handling techniques. During our observation, we were concerned that staff spent little one to one time with people, and it was unclear what responsibilities some staff had within the team. During our inspection, apart from when music was played in the afternoon, we saw that care staff were busy, moving constantly in and out of communal areas. Around 6.30pm, we noted 24 people were in the lounges without staff present, and there were other periods when communal areas were left unstaffed, which has the potential to leave people at risk. We saw a verbal altercation between two people when no staff were present. A staff member returned, intervened, but then left immediately without checking the situation had been resolved - which it had not been. The lack of oversight of communal areas led, at times, to a lack of personcentred care. Passing staff did not recognise one person was increasingly anxious, trying to get out of their chair, and we had to ask staff to respond. They listened to the person, helped them to stand, but were then called away. The person, looking uncertain, was directed to a table by another member of staff, who did not hear them mention the toilet. The persons care plan said that they often needed reminding and help to find the toilet. This did not happen during our observation around the lunchtime, or in later observations. Another person asked for soup at a meal. Staff responded but didn’t wait to ensure that the person could understand what had been put in front of them. The person became upset, and a second carer changed what the soup was served in, leaving a spoon in the soup. The person again became upset, thinking that they did not have a spoon as they did not recognise its handle. A third staff member got another spoon, but the person then became agitated on discovering two spoons in their soup. The persons anxiety might have been reduced if the first staff member had stayed with them to ensure that they knew how to interpret their meal and feed themself. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 28 We queried the adequacy of the night staffing levels - 3 staff, from 7.30pm, to care for 35 people - given the size of the home, the needs of the people living there, especially in an emergency, and their preferred bedtimes, etc. A staff member who worked day and night shifts thought the levels were sufficient. The manager said she had carried out night-time visits to the home, to monitor and keep in contact with the night staff, but also told us that staffing levels were under review, following the fire officer’s visit. We looked at 3 files for staff recruited since the homes new registration. We saw they contained the appropriate levels of recruitment checks, such as full police checks and written references from former employers, including peoples last care position. These were in place before the peoples recorded start dates. We advised the manager that other information could have been sought to better confirm one person’s suitability. A newly qualified Registered Mental Nurse told us their first days of employment were spent getting to know the home and shadowing colleagues. They confirmed the home had checked that they were registered to practice as a nurse. Discussion with another new care staff member confirmed they had been given a relevant code of conduct for social care staff. They told us they had one-to-one supervision time every three months, and monthly training days. We looked at the training records for new staff. A staff member told us that training was always kept up to date and could give us specific examples. We saw that someone who was employed in a domestic role had received training linked to their work, such as infection control. The manager told us that, for two senior staff members, it had been identified that training would be provided to raise their awareness of the needs of people with dementia. This was particular relevant for one person who had previously worked with a very different client group. The manager told us that she planned to provide this training herself when she had time. However, one person had been in post for three months and the second person for five months. Of 19 care staff, 4 had achieved a recognised English care qualification (NVQ); others had nursing qualifications from their country of origin. Staff attended training on behaviour that challenges, during our visit; ancillary staff were included in this training. Other monthly training topics covered during the year’s training programme included, death and dying health and safety, dementia care and communication. We were told that safe handling, safeguarding and fire safety updates were given by in-house staff, who had undertaken training for this role. Staff we spoke with indicated they had been able to answer a training questionnaire on the Mental Capacity Act, but were subsequently unable to say how it affected or influenced their daily work. The manager said she knew this was a topic that would have to be re-visited since it was new to staff. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people living there. The safety and welfare of everyone at the home is generally well addressed, with fire safety matters currently being addressed to better protect everyone at the home. EVIDENCE: Mrs Emma Seal is a qualified General Nurse, who has undertaken a Person Centred Dementia Practice module with the Bradford Dementia Group, University of Bradford. She commenced in her post at Angela Court in May 2008, under the previous ownership. She has been the deputy manager at another nursing home for people with dementia. She was registered as Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 30 manager by us when the home was registered as a new service in January 2009. She told us she hoped to start the Leadership and Management for Care Services award in September 2009. She had had recent updating in moving and handling, infection control, and health and safety, and attended training on the Mental Capacity Act and Safeguarding. Surveys were positive about the manager and management of the home. A care professional wrote about the home, ‘Its atmosphere was friendly yet professional’. A relative commented ‘Manager and staff are always approachable and ready to listen and help with any problems.’ Staff we spoke with confirmed the manager was approachable and supportive. Staff told us they had formal supervision, as a meeting with senior staff when they could discuss their work, their own training needs, etc. In the light of some situations we had observed (see especially sections in this report on ‘Health & Personal Care’, ‘Daily Life & Social activities’, and ‘Staffing’), we discussed with the manager the importance of there being strong positive role models at a senior level, for ensuring people receive person centred care. Observation of individuals’ practice is an important part of staff supervision and development. Also, one professional, when asked what the service could do better, suggested that other staff might be more involved in visits by other professionals, since the manager had always assisted them so far, to ensure that the home would run in the same way when she was not there. The home’s self-assessment in the AQAA was lacking in evidence relating to some of the core standards – here, in relation to health and safety matters, and people’s financial interests. We looked at other ways in which the home could monitor it own performance, and how it enables people to influence the service. We saw minutes for a meeting in May 2009, which recorded that people living at the home and their relatives attended. Some requests from the meeting had been actioned. Work had taken place to make a garden area secure, as a result of fund raising by a relative, which we were told has been matched by the provider. A notice advertised the next Relatives’ meeting. The manager said such meetings were part of the home’s quality assurance methods, along with an annual survey. The provider’s representative also carried out monthly unannounced visits, which were recorded, and the outcome discussed with the manager. When we checked the home’s copies of notifications, we found we had not received some notifications that the manager said had been sent to us. We agreed she would, in future, inform us by phone of such occurrences since our guidance states we should be informed ‘without delay’, following this with the written notification. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 31 The manager told us that the home does not keep personal monies for individuals at the home, but an ‘Incidentals account’ was managed by the company’s head office for each person who wished to have one. Their personal monies were sent there, as were receipts from the visiting hairdresser, chiropodist, and the home’s ‘shop’ (which sold sundries such as toiletries). We were thus unable to audit such accounts. We noted that an issue relating to invoices were raised at a relatives/residents’ meeting. The manager told us the person had since spoken with the finance office and the matter was resolved. The Responsible Individual acts as appointee for one person who had lived at the home for some years. The manager confirmed that no-one from the company would become an appointee for anyone else. The AQAA said that a new health and safety system was in preparation. The manager explained that a specialist company was advising the home on health and safety matters. Windows were restricted where we checked at random, and we did not find any unduly hot water. When we asked staff if they had a safe workplace, they spoke about their own responsibility to report anything hazardous. The repairs log showed repairs were usually addressed in 2-3 days. We noted that a hoist had been serviced within the last year, and saw staff moving people carefully, checking that peoples feet were on wheelchair footplates before they were moved, and explaining what they were doing. The training records showed most staff had had first aid training in the last year. Nursing staff undertook a higher course, providing a constant level of cover since there was always a nurse on duty at the home. Staff confirmed that the fire bells were tested, that fire drills took place, and that the in-house training they received included use of fire-fighting equipment. Records showed a fire drill had been carried out in May 2009, which was to be repeated since staff had responded too slowly. Three staff were overdue an update on fire safety matters. The manager agreed this would be completed within the next week. The local fire authority had served a notice for improvement in February 2009. The manager said quotes were still being obtained regarding the required work. Leftovers in the kitchen fridges were covered and dated. Freezer and fridge temperatures records showed these were kept within recommended ranges for promoting the safety of stored food. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement You must ensure that there are effective arrangements for the recording, storage, administration and disposal of medicines, especially regarding: Staff adherence to the home’s medication policies & procedures for correct storage (including refrigerated medicines & systems to monitor the storage life of medicines) and disposal of medicines; Arrangements that ensure that there are clear directions available to members of staff, on how and when medicines prescribed to be used ‘when required’ or ‘Use as directed’ are to be used, and that care plans are kept up to date about the use of such medicines So that people’s medicines are managed safely, and their health needs are met. 2 OP12 16(2)(n) You must provide activities that are flexible and varied to suit DS0000072963.V376241.R01.S.doc Timescale for action 25/09/09 25/11/09 Page 34 Angela Court Version 5.2 individuals’ preferences and capacities, along with appropriate and suitable facilities and opportunities So that people’s diverse or particular social and recreational needs are met. You must make arrangements, through training and other measures, including robust policies and procedures for responding to suspicion or evidence of abuse 3 OP18 13(6) 25/10/09 4 OP27 12(1) To ensure that people living at the home are safeguarded from abuse or harm caused through deliberate intent, negligence or ignorance, in accordance with written policies that reflect Devon County Council’s safeguarding policies. Staffing numbers must be 25/10/09 appropriate to the assessed needs of people living at the home, the size, the layout and purpose of the home, at all times Ensuring that the home can be managed and staff can be deployed so as to make proper provision for the health (- both physical and mental health) and welfare of people who live there, especially with regard for people using any communal areas. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000072963.V376241.R01.S.doc Version 5.2 Page 35 Angela Court 1 Standard OP1 2 OP7 3 OP7 4 5 OP8 OP9 6 7 OP12 OP14 8 OP19 9 10 OP26 OP28 It is recommended that a) You make available, to current and prospective residents, an up to date statement of purpose that includes the aims, objectives, philosophy of care, services, facilities, and terms and conditions of the home, as well as a service users’ guide to the home. b) The statement of purpose clearly sets out the physical environmental standards met by a home in relation to standards 20.1, 20.4, 21.3, 21.4, 22.2, 22.5, 23.3 and 23.10, with a summary of this information in the service user’s guide. It is recommended that you continue to improve the level of person-centred detail in care plans, to especially include individuals’ wishes regarding terminal care people’s social and how people’s emotional & psychological needs are to be met. It is recommended that you review people’s care plans monthly, in such a way that enables you to assess whether or not people’s social, emotional & psychological needs are being met. It is recommended that there is better monitoring of people’s psychological health, with better preventative or restorative care and support provided. It is recommended that handwritten directions on medication charts are signed and dated by accountable staff, including where medicines are discontinued, to verify the accuracy of the entry or the change made and promote a good audit trail for people’s medication. It is recommended that staff ensure that people wish to participate in communal activities, either by asking them or by observing their body language. It is recommended that you further develop the home so as to maximise peoples’ capacity to exercise personal autonomy and choice, regarding their choice of drinks, meals and other aspects raised in this report, through staff development, improved signage, etc., as also discussed in this report. It is recommended that the home is kept safe, well maintained & homely, with action taken in the short-term as well as the longer term to promote this, and with records available to evidence measures taken to manage risks to people’s safety (such as checks of window restrictors, etc.). It is recommended more action is taken to ensure all parts of the home are kept free from offensive odours. It is recommended that at least half of the care staff DS0000072963.V376241.R01.S.doc Version 5.2 Page 36 Angela Court 11 OP36 (excluding the registered manager & staff who practise as registered nurses) have achieved NVQ Level 2 in care (or an equivalent). It is recommended that staff are appropriately supervised, especially regarding all aspects of their practice, to ensure that individual staff are supported to develop the practical skills and competency they need to meet the diverse or changing needs of the people who live there, and so they can fulfil the aims of the home. Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 37 Hi Sally Further to the response sent from Harriet on this matter, I wanted to drop you a line to confirm that all appropriate amendments to CAiRE have now been made. On the spreadsheet you sent us there were a total of 9 reports listed as having been made final (post migration to the NPC), but not updated with dates of finalisation on CAiRE. We have been able to enter finalisation dates for 6 of these and once again apologise that this data was not inputted at the time. There are, however, 3 outstanding reports for which we cannot enter finalisation dates since these are still showing at draft stage in ICAP. It would appear that they have not been finalised in the inspectors’ individual task boxes, as there are no ICAP generated final letters. The reports concerned are: 67354 Amberwood House Random 06/04/09 3937 Fair Haven ASR 28/04/09 70846 The Malthouse ASR 02/05/09 As soon as these reports are completed as final by the inspector concerned, they will automatically come through to the print queue and we will make sure they are actioned as a priority by the team and updated on CAiRE as required. Should you have any further queries then please do not hesitate to get in touch. Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk Angela Court DS0000072963.V376241.R01.S.doc Version 5.2 Page 38 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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