Inspection on 26/01/09 for Anna Victoria Nursing Home

This inspection was carried out on 26th January 2009.

CSCI 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

Anna Victoria Nursing Home 10/08/09

Anna Victoria Nursing Home 22/05/09

Anna Victoria Nursing Home 16/02/07

Anna Victoria Nursing Home 21/02/06

Anna Victoria Nursing Home 07/10/05

Anna Victoria Nursing Home 17/01/05

Anna Victoria Nursing Home 07/09/04

Anna Victoria Nursing Home 11/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Anna Victoria Nursing Home Peace Haven Pole Barn Lane Frinton On Sea Essex CO13 9NH     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Francesca Halliday     Date: 2 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Anna Victoria Nursing Home Pole Barn Lane Peace Haven Frinton On Sea Essex CO13 9NH 01255675609 01255673791 cnunn@annavictorianursinghome.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Anna Victoria Nursing Home Name of registered manager (if applicable) Mrs Carol Nunn Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Persons of either sex, aged 65 years and over, only falling within the category of old age (not to exceed 2 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 28 persons) The total number of service users accommodated in the home must not exceed 28 persons Date of last inspection Brief description of the care home Anna Victoria provides nursing and personal care for up to 28 older people. The home provides palliative care for up to 3 residents with a terminal illness. Anna Victoria is owned by a charitable organisation, named Anna Victoria Nursing Home. The home is founded on Christian principles and there is a Christian ethos in the home. Care Homes for Older People Page 4 of 32 0 0 Over 65 2 28 care home 28 Brief description of the care home The home is a two-storey building that was purpose built when first opened in 1992. There are 28 single en-suite bedrooms on two floors that are accessible by stairs and a lift. The home offers large communal areas. The rear of the home has an enclosed well-maintained garden and is accessible by ramps. The open plan sensory garden to the front of the premises provides a pleasant outlook from the home. The home has a visitors room and overnight accommodation can be arranged. There is a loop system installed at the home for the benefit of those with a hearing impairment. The home is accessible by car and the nearest railway station is nearby. Parking is available for staff and visitors in the large car park located to the front of the home. The home is located within walking distance of the main shops in Frinton-on-Sea. The fees range from £695 to £772 per week and include toiletries, aromatherapy massage and reflexology. There are additional costs for chiropody, hairdressing and newspapers. This information was provided to the CSCI in January 2009 Care Homes for Older People Page 5 of 32 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: This key inspection was carried out on 26th January 2009. The term resident was used throughout this report to describe people living in the home and the term we refers to the Commission for Social Care Inspection. All the key national minimum standards (NMS) for older people were assessed during the inspection. The report was written using evidence accumulated since the last key inspection on 16th February 2007, as well as using evidence found during the site visit. We also looked at the information contained in the annual quality assurance assessment (AQAA) completed by the manager. The assessment is referred to as the AQAA throughout this report. During the inspection time was spent talking to the manager and five staff. We also had chats of various lengths with three residents. We spoke with one relative who contacted us prior to the inspection and one relative who was visiting at the time of Care Homes for Older People Page 6 of 32 inspection. We sent surveys out prior to the inspection and we had received four from residents, three from relatives and four from staff by the time this report was completed. Comments from the surveys have been included in the report where appropriate. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can be confident that their needs will be assessed before admission to the home. Evidence: The home had a range of information for prospective residents and their relatives and representatives. This included a statement of purpose, a service user guide and a web site with details and photographs of the home. The manager had updated the statement of purpose since the last inspection to reflect the fact that the home carried out palliative care. Residents told us that they received enough information about Anna Victoria to help them decide whether it would be the right home for them. Two residents who responded to our survey told us that they had not received a contract. The manager told us that some people had mislaid their contracts and that new contracts had been sent out. She confirmed that all residents had a contract at the time of inspection. Care Homes for Older People Page 10 of 32 Evidence: The manager or deputy carried out the pre-admission assessments. The three assessment we looked at were generally of a good standard. The manager told us that prospective residents were made aware of the Christian ethos of the home when the pre-admission assessment was carried out. The home only admitted residents as an emergency in exceptional circumstances. The manager said that in an emergency situation they would obtain as much information from different sources, for example the persons GP, social services and health professionals to assess the suitability of the placement and carry out a full assessment on admission. Potential residents and their families were encouraged to visit and spend some time at the home before making a decision about accepting a placement. A trial period was offered. One relative said they did an excellent history taking when he first came to the home. Care Homes for Older People Page 11 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents generally receive good care but this is at times put in jeopardy by poor communication within the home. Residents are potentially at risk due to poor medicines management. Evidence: Residents and relatives generally considered that the standard of care from the permanent staff was good but felt that standards dropped when a high proportion of agency care staff were used. When asked whether they received the care and support they needed two residents said always, one said usually and one said sometimes. One relative who responded to our survey considered that the home always met residents needs and two felt that the home usually met their needs. A relative told us that staff were good at preserving residents dignity and privacy. During the inspection we observed staff interacting with residents in a caring and respectful manner. Residents general assessments and their moving and handling assessment were kept in their rooms. However, one assessment we looked at had not been reviewed or updated for ten months and a relative who responded to our survey told Care Homes for Older People Page 12 of 32 Evidence: us that the assessment for the person they visited had not been updated for over a year. This would not give relatives confidence that residents were receiving the care to meet their current needs. Two relatives who responded to our surveys and one relative we spoke with were concerned that the documentation in residents rooms did not reflect their current care needs or abilities. The manager told us in the AQAA that residents and relatives were generally reluctant to become involved in planning and reviewing the care plans. However, she acknowledged that this may have been due to the way in which staff approached the discussions rather than residents or relatives reluctance to discuss their care needs and preferences. We looked at the care documentation for three residents. The care plans were written by the nurses and were not in a format or language that was accessible to residents, relatives or care staff. The care plans were mainly written as tasks for nurses and care staff to carry out rather than being written from the point of view of the individual resident. The care plans frequently did not identify residents priorities, preferences and abilities or their wishes in relation to their care. Three relatives and one resident felt that communication with them needed to be improved. One relative told us that on occasions they felt that their knowledge and understanding of residents needs was not acknowledged and their wish to be involved in the care was resented. Another relative who visited a resident with communication difficulties wanted to see the daily care records when they visited the home to enable them to see how the resident had been in the periods between their visits. A relatives meeting was held at the home, that was independently facilitated but none of the staff were invited and no feedback was given to the manager. This would appear to confirm a breakdown in communication between staff and some relatives, which could potentially be detrimental to the care provided to residents in the home. The home was not using a nutritional risk assessment. However, the manager said that they were hoping to bring in the MUST nutritional assessment tool in the near future and said that six staff had received training in using the tool. Assessments of the risk of developing pressure sores and moving and handling assessments were carried out. The home had a range of equipment to enable them to meet residents nursing and care needs. This included a range of hoists, syringe drivers, electric beds and a range of pressure relieving equipment. The home had the services of GPs from two local practises. The manager said that the home had a good relationship with both practises and said that the GPs visited residents when needed. A GP from one of the practises also visited the home once a week. The home had good links with the specialist nurses, with speech and language therapy and with dietitians in the local NHS. A chiropodist visited the home every six weeks and dental and optical checkups were arranged. A relative told us that staff referred residents to the GP very promptly and said that they were always informed if there were any health concerns. Care Homes for Older People Page 13 of 32 Evidence: There were discrepancies in the controlled drugs (CD) records for two residents. On both occasions the medicine (a sleeping pill) had been signed as given but the dose was still in the container. This was of particular concern as some CDs had gone missing in August 2008 and the manager stated that she had instigated daily CD checks. According to one residents medicine administration record (MAR) they had only received one dose of a medicine, prescribed daily, in two weeks. However, 14 doses had been removed from the blister pack. There were a number of other gaps in the recording of medicines on the MAR and on occasions no explanation was given when an omission code was used. The amounts of tablets left over from previous months (when medicines were being given as required) was not being brought forward and it was often not possible to establish whether residents had been given one or two tablets when a variable dose was prescribed. This made it difficult to establish exactly what doses the residents had been receiving.The home had a number of medicines which staff said were being used as homely remedies. These included some medicines prescribed for individual residents and some topical creams. Medicines prescribed for one resident must not be used for another and there would be a risk of cross infection if topical creams were shared. No record was being made of receipt or balance of the homely remedies so there was no audit trail of these medicines. The date of opening was not always being recorded on medicines with a limited shelf life when opened. This could result in them being used beyond the date by which they were safe to be used. On occasions changes were being made to the prescriptions on the MAR but the changes were not dated or signed and a record was not made of who authorised the changes. A record was not always being made of the application of topical creams. The temperature in the medications room was being recorded daily. It was at times recorded as 28c, which is above the safe limit of 25c for the majority of medicines. This could result in the medicines being given when they were no longer fit for use. The nurses who administered the medicines had not received an assessment of competence or any recent training in the safe administration of medicines. The home specialised in providing palliative nursing care but the manager told us that they would only admit up to three residents with palliative care needs at time. Four of the nurses had completed the ENB 931 care of the dying patient and family and one had a counselling certificate. All nurses and managers had received training in implementing of the Liverpool care pathway for the dying patient and had good links with the local Macmillan nurses. One of the nurses was qualified to provide complimentary therapies such as aromatherapy, reflexology and gentle massage, which were particularly beneficial for relieving the symptoms of residents receiving palliative care. None of the residents had developed pressure sores in the past year despite the fact that the home had a high proportion of residents of high dependency and had cared for a number with palliative care needs. The manager told us that a Care Homes for Older People Page 14 of 32 Evidence: meeting was being set up to discuss one residents wishes for their future care in order to agree an advanced directive for when they were no longer able to express their wishes. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect a range of activities in the home and to be offered a nutritional diet. Evidence: The home had a part time activities co-ordinator. They were responsible for booking entertainments, providing one to one contact with residents and arranging activities in the home. There was an activity programme but the activities co-ordinator said that they generally responded to what residents wanted to do on the day. The activities coordinator said that current residents particularly enjoyed scrabble, quizzes and reminiscence sessions and said that they also tried to see all residents who preferred to remain in their rooms. They also arranged video afternoons. The activities coordinator said that residents thoroughly enjoyed joining in with a range of percussion instruments when musicians visited the home. The activity coordinator kept a record of activities but was not involved in the monthly care plan review of residents social care needs. The manager told us that they had recruited an additional activities coordinator to provide back up and holiday cover and a volunteer also provided some additional support. Care Homes for Older People Page 16 of 32 Evidence: The local library visited the home on a monthly basis to leave a stock of books. They provided large print and talking books when required. A church service was held every Sunday, communion was held on the first Wednesday of every month and a prayer meeting was held on the second Tuesday of every month. The home had no restriction on visiting as long as individual residents were happy with this. Meals for relatives were provided free of charge, or with a voluntary donation. The home had a guest room for use by relatives and friends when needed. The room enabled relatives and friends to remain with the resident, free of charge, in the final stages of their illness if they wished. The manager said that they had links with local schools, cub and scout groups and encouraged them to visit the home. Residents told us that they had the choice of when they got up and went to bed, where they ate their meals and where they spent their day. The menus we looked at showed that residents were offered a choice at each meal. Staff told us that snacks were available on a twenty four hour basis and residents confirmed this. The cook had a list of the dietary needs of all residents, as well as information on their particular likes and dislikes. The cook told us that the majority of food was home cooked. Home made cakes and soups were seen to be available on the day of inspection. The home had daily deliveries of meat, vegetables, fruit and salad. There were good stock levels to enable kitchen staff to meet residents choices and to provide alternatives if they did not like what was on the menu at the time of the meal. The cook visited residents each day to ask what they wanted from the choices on the menu. The manager said that occasionally staff went to the local shops to buy particular ingredients to tempt residents appetites or meet a special need. The kitchen looked clean and well organised and food we saw was stored and labelled appropriately. One resident who responded to our survey told us The food could be served hotter. Supper menu could be more varied. The manager said that she was aware of the problem of cold food being served and said that they now had different sittings for those who needed assistance and those who were more independent. She said that they were also trying to prevent any gaps between the time food was plated up and the time it was served. She said that they were also planning to train some of the support staff to give additional assistance with meals and drinks so that all residents could receive their meals promptly and while they were still hot. Staff had received training in how to support people with swallowing problems. The dining room was an attractive place to eat. It was set out like a restaurant with linen table cloths and place mats. One relative told us that the resident they visited enjoyed the food and said that they also sometimes ate at the home. They said the food is really nice. Care Homes for Older People Page 17 of 32 Care Homes for Older People Page 18 of 32 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. Residents can be confident that they will be protected from abuse but cannot be assured that their concerns will always be promptly addressed. Evidence: A copy of the complaints procedure was held in each residents room. Residents we spoke with and who responded to our survey told us they knew how to make a complaint and said that staff listened and acted on what they said. However, three relatives told us that the management could at times be defensive when concerns were raised. Verbal concerns and complaints were not being recorded as staff told us that they dealt with the concerns and resolved the issues where possible at the time. However, if the same problem was dealt with repeatedly by different staff and this was not recorded and communicated to other staff, small concerns could develop into more major complaints. The home had a policy on safeguarding residents from abuse and a whistle blowing policy (the reporting of poor practice or abuse). There was evidence that staff used the services of advocates to assist residents who had no relatives to act on their behalf. Information on the advocacy services was available in residents rooms and in the entrance hall. The manager told us that staff received safeguarding training and were given a copy of the Essex County Council booklet on safeguarding vulnerable adults. According to the training records we looked at fourteen staff had not received any Care Homes for Older People Page 19 of 32 Evidence: safeguarding refresher training for over two years. However the manager confirmed that four safeguarding training sessions had been booked for 2009. We have not received any complaints or safeguarding alerts concerning residents at Anna Victoria since the last inspection. Care Homes for Older People Page 20 of 32 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. Residents live in a well maintained home but potential risks in the environment have not been eliminated. Evidence: We inspected parts of the premises during the inspection. The home looked well decorated and maintained. Residents bedrooms were personalised and demonstrated their individual tastes and preferences. The home had four baths and two showers, which enabled residents to have a choice of bathing facilities. The two shower rooms did not have a hand basin or any liquid soap or paper hand towels to enable staff to carry out good infection procedures when providing personal care. The home had a large communal lounge on the ground floor, which was divided up into three seating areas. There was also a smaller sitting room on the first floor, which could be used as a quiet room. Residents had portable call bells, which the manager told us could be used in any part of the home and also in the gardens. Digital boxes had been installed in residents rooms, the lounge and dining room to enable them to access a wider range of television and radio programmes. The home was clean and there were no unpleasant odours on the day of this unannounced inspection. One resident told us that the communal areas were kept spotless, smell fresh and look homely and inviting but said that time constraints Care Homes for Older People Page 21 of 32 Evidence: meant that their room was not hoovered regularly enough. A relative who visited the home very regularly said that they were happy with the standard of cleaning in the home and considered that there was a good laundry service. The laundry looked well organised and had washing machines with sluice cycles. Staff followed appropriate procedures for handling soiled linen and had access to a good range of personal protective equipment. The laundry room had a well sealed floor but parts of the walls had peeling paint and could not be kept in a hygienic condition. The door to the laundry was not always locked when staff were not present despite the fact that hazardous chemicals were present in the room. This could pose a potential risk to residents who had a degree of confusion or dementia. An unlabelled chemical was being stored in sports drinking container in the laundry but the manager removed this during the inspection. Care Homes for Older People Page 22 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the benefit of increased levels of staff but the lack of training for some staff may potentially reflect on standards of care. Evidence: The relatives who responded to our survey and one whom we spoke with were very concerned about the number of agency care staff used during the past year. One relative told us There has been a marked increase in the use of agency workers so loosening the bond between staff and residents. Another relative described the lacklustre quality of the agency staff and said that at times the home was staffed by between 20-40 agency carers. This relative was particularly concerned about residents with communication difficulties having problems understanding the agency carers, as a number of them did not speak English as their first language. One relative responding to the question about whether care staff had the skills and experience to look after residents properly said care staff usually, agency staff never. A resident who described themselves as more able said when staff are busy or overstretched I am marginalised and left to fend for myself. This is generally at weekends or when there are a high proportion of agency staff on duty. One relative we spoke with told us that when staff were caring for residents with palliative care needs other residents were not given the attention they needed. One relative told us that they wished staff would wear name badges. The manager told us that staff name badges were being Care Homes for Older People Page 23 of 32 Evidence: ordered. The manager said that the home had gone through a particularly difficult period in the summer and autumn of 2008 when they had a considerable amount of staff sickness as well as annual leave and maternity leave. This had resulted in a very high use of agency care staff. She confirmed that the staffing levels agreed with the health authority in 1999 had still been in place, despite the fact that the dependency of residents had increased considerably in the intervening years. However, she told us that more care staff had now been recruited and an additional carer was now being provided on the morning shift and for a part of the afternoon shift. She confirmed that the number of staff was now one nurse plus seven care staff from 07:00 to 14:30, one nurse plus 5 care staff from 14:30 to 22:00 and one nurse plus two care staff from 22:00 to 07:00. She also said that they would bring in an additional member of care staff if any resident with palliative care needs required 1:1 care. We looked at three staff files. These demonstrated that the home had a good recruitment process. Staff received a criminal records bureau and protection of vulnerable adults list check and nurses registration was checked with the nursing and midwifery council. Two references were obtained and there was proof of identification on file. The manager used set interview questions for each role. New staff were given a probationary contract for three to four months to enable the home to assess their suitability and the member of staff to confirm that they were happy in the role. The home encouraged staff to use the keep in touch scheme when on maternity leave whereby they worked ten days in six months in order to ease their transition back to work.Staff received the staff handbook, safeguarding booklet and the GSCC code of conduct on first day of employment and new employees remained supernumerary for a minimum of one week. The length of time they were supernumerary was varied depending on their experience and confidence. One member of staff said that they had plenty of support when they started and said that they had been supernumerary until they felt confident working in the home. The manager told us that any new care staff who did not hold the national vocational qualification (NVQ) at level 2 were automatically enrolled on to the programme in conjunction with the Skills for Care induction and foundation programme. The manager said that a number of staff who completed NVQ level 2 went on to do nurse training but that this sometimes made it difficult to sustain the 50 target for care staff with NVQ level 2 in the home. The home had links with Anglia Ruskin and Cambridge Universities and provided placements for student nurses. This encouraged staff at the home to keep up to date with current nursing practises. Nursing staff who held the ENB 998 (teaching and assessing certificate) had an update of their mentorship training from the universities every 18 months. One member of staff whom we spoke with told us that the training Care Homes for Older People Page 24 of 32 Evidence: in the home was good. Another said that the training was very helpful. The manager and deputy had received some training in the Mental Capacity Act and were due to attend a further session and the manager had completed some training in deprivation of liberty and safeguarding. The home had links with specialist nurses and accessed training and specialist advice for staff when residents were admitted with more unusual conditions. All nurses had received training on to how to use the Liverpool Care Pathway and how to implement it for residents with palliative care needs. We looked at the training records and they indicated that twelve staff had not received any training for over a year and one for over two years. The manager was aware of this and had sent a letter to staff reminding them of the need to attend mandatory training. The home had a training programme for 2009 and the manager said that she was trying to source additional training relating to the specific care needs of residents in the home. Care Homes for Older People Page 25 of 32 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. The home is generally well managed but potential risks to residents health, safety and wellbeing are not always identified. Evidence: The manager and deputy manager were registered nurses and both had completed NVQ level 4 in management. The manager had been in post since 2001 and had also completed the ENB qualification in care of the dying patient and family and the ENB 998 teaching and assessing in clinical practice. Staff told us that they felt supported by the manager and deputy manager. The manager sent us the annual quality assurance assessment, which was detailed and informative. She also carried out a quality assurance audit in June 2008. The audit covered a wide range of topics. However, it did not identify the serious concerns about medicines management, the issues relating to care documentation, dealing with concerns and communication with relatives and the health and safety risks identified Care Homes for Older People Page 26 of 32 Evidence: during this inspection. Residents in the home were surveyed on a regular basis. The last survey demonstrated that residents were generally very happy with the care, the staff, food and the cleanliness but would like less agency staff used. A small amount of personal money was held securely for residents if they did not wish to keep it in their bedroom. We looked at the balances for two residents and found them to be correct. The majority of services and expenses, such as newspapers, chiropody and hairdressing were invoiced directly. The manager told us that the system for holding the money was audited monthly. The manager was aware that staff supervision and appraisals had not taken place on a regular basis during the last year and said that she was taking steps to address this. There were systems in place for assessing health and safety and fire risk in the home. Equipment such as the hoists, bath hoists and the lift were serviced six monthly to ensure that they were safe for residents to use. The maintenance person told us that they regularly checked the water temperatures in all outlets used by residents and flushed the outlets not currently in use in order to reduce the risk of Legionella. A record of this was not being made but they told us that this would be done in future. Care Homes for Older People Page 27 of 32 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 9 13(2) The registered person must ensure that omissions of prescribed medication are monitored and the reason recorded on the MAR sheet. This is a repeat requirement 31/03/2007 2 38 13(4) The registered person must ensure that the laundry and maintenance cupboards are kept locked when unsupervised. 31/03/2007 Care Homes for Older People Page 28 of 32 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 1 7 14 The manager must ensure that residents assessments are regularly reviewed and updated when their condition changes. In order that they reflect residents current condition and the support and care they need from staff. 01/04/2009 2 7 15 The manager must ensure 01/05/2009 that care plans are drawn up in consultation with residents, relatives and care staff where appropriate. In order that residents priorities, preferences, abilities and wishes are reflected in the plans and they are written in a language that is accessible to residents, relatives and care staff. 3 9 13 The manager must ensure that nurses make accurate records of all medicines that they administer, document 16/03/2009 Care Homes for Older People Page 29 of 32 the reasons why any are omitted and provide a clear audit trail of all medicines in the home. Medicines must be kept below the maximum temperature identified by the manufacturer, which for the majority of medicines is 25c. In order to demonstrate whether residents have received all their prescribed medicines, what dose has been administered and that medcines are not given to residents when they are no longer fit for use. 4 9 13 Nurses must have regular refresher training on the management of medicines and an assessment of competence. In order to ensure that they have up to date knowledge and understanding of the receipt, administration, recording and disposal of medicines. 5 19 13 Risk assessments of the premises must be carried out on a regular basis and action taken whenever needed. In order to ensure that the environment is safe and meets the needs of current residents. 16/03/2009 01/05/2009 Care Homes for Older People Page 30 of 32 6 26 13 Hand washing facilities 20/04/2009 facilities must be available in all areas where staff carry out personal care. Hand washing facilities facilities must be available in all areas where staff carry out personal care. 7 30 18 The manager must ensure 04/05/2009 that a training review is carried out for each member of staff. In order to identify the training needed for staff to undertake their role and provide good support and care to residents. 8 33 24 The manager must ensure that the quality assurance audits are comprehensive. In order to identify and address risks to residents health, safety and welfare. 01/07/2009 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 36 The manager should ensure that staff receive regular supervision and an annual appraisal. Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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