Inspection on 16/04/09 for Arden House

This inspection was carried out on 16th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Arden House 16/04/07

Arden House 08/06/06

Arden House 16/02/06

Arden House 25/08/05

Arden House 24/11/04

Arden House 12/07/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Arden House 18-20 Clarendon Square Leamington Spa Warwickshire CV32 5QT     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 1 6 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Arden House 18-20 Clarendon Square Leamington Spa Warwickshire CV32 5QT 01926423695 01926315769 arden@greensleeves.org.uk www.greensleeves.org.uk Greensleeves Homes Trust care home 33 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): 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 Additional conditions: The maximum number of service users who can be accommodated is: 33 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 33 Date of last inspection Brief description of the care home Arden House is a Regency property which was originally three terraced houses forming part of a square with a small central park. The home is at the northern edge of the town centre with local shops nearby. Leamington Spas main shopping centre is within walking distance or a five-minute bus journey. A car park is located to the front of the home. It is managed by Greensleeves Homes Trust, a not-for-profit charitable organisation who also manage a further 16 homes in England. Arden House is registered as a care home providing personal care for 33 older people although only 32 places are presently used due to the discontinuation some time ago of double bedrooms. The home is Care Homes for Older People Page 4 of 35 Over 65 33 0 Brief description of the care home constructed on five floors and the first and second floors are also accessible by stair lifts. Each bedroom has a TV point, wash-hand basin and shaving socket. 28 of the rooms have ensuite facilities and there is an assisted bath on all floors and a wet room shower on the third floor. Although a passenger lift is provided as well as chair lifts, some areas of the home are only accessible via a small number of steps. There is level access to the building for wheelchair users and people with mobility difficulties via a separate entrance to the main entrance which has ramp. The dining room is situated on a lower ground floor next to the kitchen. There is a large lounge on the ground floor which has a small conservatory leading off this that overlooks an attractive and well maintained garden. The fees for a room at the time of this inspection were quoted by the manager to be £465 to £635.00 per week. Extra charges are made for hairdressing, chiropody, incontinence pads (if not assessed as needing them in which case they are free of charge). Variable charges are made for newspapers, activities, transport, care assistant escorts to hospital or appointments and social trips. Care Homes for Older People Page 5 of 35 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: The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. The last key inspection took place on 16 April 2007. This inspection took place between 8.25am and 8pm. Three people who were staying at the home were case tracked but specific care issues relating to other residents were also reviewed. The case tracking process involves establishing an individuals experience of staying at the home, meeting or observing them, discussing their care with staff and relatives where possible, looking at their care files and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. A completed Annual Quality Assurance Assessment was received from the service prior Care Homes for Older People Page 6 of 35 to the inspection detailing information about the care and services provided. Questionnaires were also sent out to residents within the home to ascertain their views of the service. Information contained within the AQAA and outcomes of surveys have been included within this report as appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records, quality monitoring records and medication records. Residents were observed in the lounge and dining areas to ascertain what daily life in the home is like. A tour of the home was undertaken to view specific areas and establish the layout and decor of the home. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 35 Records need to clearly indicate any assessments undertaken by the manager prior to each residents admission. This is to demonstrate the needs of each resident have been fully identified and considered and it is clear they can be met. Although detailed information is made available to prospective residents, the Service User Guide should be reviewed to ensure this is a clearly defined document. This should include a clear Statement of Terms and Conditions for the home as well as our summary inspection report. Some improvements are needed in regard to medication management and records to ensure it is clear residents are receiving their medication as prescribed consistently. The procedure for making a complaint needs to be clearly accessible and contain all of the required information. This in particular applies to information required should a resident wish to pursue their complaint beyond the home. The procedures for managing any allegations of abuse and the safeguarding of residents need to be further reviewed. This is to ensure any incidents reported are consistently referred to the safeguarding team to so that appropriate actions can be pursued. Duty rotas need to clearly state ancillary staff roles so it is clear there are sufficient staff to support the home consistently. Staffing arrangements should be reviewed to ensure these remain effective consistently to support the needs of the residents. Training schedules need to clearly demonstrate that care staff have completed all the training required within suitable timescales. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have access to detailed information about the home to help them make a choice on whether to stay but it is not clear their needs are fully assessed prior to their admission to the home to ensure these can be met effectively. Evidence: A Service User Guide was requested for the home. Staff explained that they had a Statement of Purpose document that is included within an Information Pack which was used as their Service User Guide. Staff explained that this is given out to prospective residents once they had made a decision to stay. The pack contains detailed information about the home and the services provided although it was not clear this contains a Statement of Terms and Conditions for the home or our summary inspection report as required. It was however stated that the full inspection report could be accessed via our website or upon request from the home and there were various documents containing some of the information that would usually be included Care Homes for Older People Page 11 of 35 Evidence: in a Statement of Terms and Conditions. Some residents said they knew the home and it was their choice to stay and others said they were helped by their relatives to choose the home. Care files viewed did not contain assessments carried out by the manager prior the residents admission. This process helps the individual needs of residents to be identified and assess whether these can be met effectively by the home. Some files did contain assessments undertaken by hospital staff or social workers prior to the persons admission to the home which contained some information on their needs and the support required. Care Homes for Older People Page 12 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home have care plans in place to ensure these are met by staff. Some attention to the management of medication is needed to ensure this is effective consistently in maintaining the health of the residents. Evidence: People living in the home looked well cared for and were clean, their hair had been groomed and nails were trimmed and clean. The exception was one person was observed to have unkempt hair but their records confirmed that sometimes they were resistive to personal care being given. All residents were well presented and wore clothes reflective of their choices and time of year. The care records were viewed for three people identified for case tracking and other files were viewed to follow up specific information during the inspection process. It was evident that since the last inspection the care planning paperwork has been reviewed, files were standardised and well organised. Care plans were available for most of the identified needs of each person and supplied staff with the information needed to make sure the persons needs were met safely and appropriately. Care Homes for Older People Page 13 of 35 Evidence: For example one person was identified to have poor mobility. A care plan had been devised showing that this was very poor and two carers were needed to assist the resident. A risk assessment had been devised showing in what circumstances two staff should assist the resident. Equipment to support the resident was clearly stated and included a frame, handling belt and sometimes a wheelchair. Care plans were also in place to confirm how each persons continence needs should be addressed and stated how often staff should check with them to see if they needed support. One person was identified to have delicate skin which was prone to pressure ulcers and sores. It was not evident that a specific care plan had been developed in regards to the skin although references were made on how this should be managed in other care plans. Specific care plans should be put in place to ensure it is clear what staff support is required and when without staff having to read several other documents on file which could be time consuming and result in an oversight in care. There was a body map on file confirming the areas where the skin had broken down into blisters or pressure sores and some of the wounds were dated when they had developed. There was information showing that the district nurse regularly visited to put dressings on the wounds. A risk assessment had been completed showing that a pressure relieving mattress and cushion were being used to help relieve the pressure to the skin. There were also instructions as part of a continence care plan for staff to check the resident two hourly during the night. Daily records did not report whether the pressure areas were improving or deteriorating and did not give a clear picture of the persons current skin condition. Another resident with a skin problem also did not have a care plan in place. There was a note written on the district nurse visit sheet to say a dressing had been applied to their skin so it was clear that the sore area had been treated. It was not however clear if this still existed. Daily records made reference the sore area being identified on one day but there were no further references to this so it was not clear if this remained or had healed. Staff spoken to said that the resident no longer had the sore area but confirmed that the resident was prone to developing soreness which was not evident from care plan information in place. Care plan review documents contained a list of needs which staff tick at the end of each month to identify if they have been checked or reviewed. It is not clear from this list what staff have actually reviewed to ensure the resident receives the support they require. For example records of weight are kept on each persons care file and Care Homes for Older People Page 14 of 35 Evidence: had been completed monthly. One resident had lost a signficant amount of weight during a one month period but the review document did not identify this or state that any action was needed as a result. It was however evident that the person had gained some of the weight back the following month. Care plan reviews should identify any changes in the persons health as well as any actions required to ensure the health of the resident is effectively maintained. It was evident from records in place that residents are receiving the professional support of the GP, District Nurse, Chiropodist and Optician when required. Residents spoken to were all positive about the care they receive. One person said its quite a good place and confirmed staff came to help them get up in the morning and get dressed. Another said I am quite happy with everything and another said all good to me. Satisfaction surveys were received by us from nine residents but six of them were assisted by care staff at the home to complete them as opposed to an independent person or advocate which may have generated different responses. Of the three completed independently two have responsed that they usually receive the care and support they need and one person has stated they always do. One person states there can be a problem when agency care has to be called in, some very young recruits can be rather slapdash. A review of medication was undertaken. Of those viewed, the majority were being managed appropriately but there were areas identified where improvements need to be made. One person had been prescribed Warfarin in a 3mg dosage, the way the medication records had been completed it showed that on two days they had received a 1mg dosage as well as a 3mg dosage meaning they could possibly have received 4mg. This medication must be given to the prescribed dosage or it could result in the ill health of the resident. The member of staff who assisted with medication said that the medicaton record had been duplicated in error. The medication record showed that staff had signed to indicate nine tablets had been given of the 3mg tablet but on checking the packet twelve were missing suggesting more had been given than had been prescribed. Cetrizine medication had 23 tablets carried forward from the last prescribing period Care Homes for Older People Page 15 of 35 Evidence: but 25 had been signed for on the medication record before the new box of 56 had been started. This suggests that the resident had not been given the tablets for one or two days when staff had signed for them. Another medication prescribed showed there were more tablets left than there should be again suggesting staff are signing for medication not given. There were no records to confirm that creams prescribed had been applied. Staff responsible for medication had put the code O in a box stating carers apply but there were no records to confirm the carers had actually applied the creams. The person assisting with medication stated that the creams were being applied. Suitable systems were in place for the management of controlled drugs including a controlled drug register and dedicated storage area. Two staff were signing the register to confirm these had been received and given to the resident. It was evident on viewing the medication record and register that on one occasion these had not been managed in accordance with prescribing instructions. Instead of a two day gap, there was a three day gap meaning the resident did not receive their pain control within the prescribed timeframe. This had been identified after the event and the timings of the medication had been changed on the medication record to ensure there was only a two day gap. Signatures were missing on some of the MARS and a O was being used to identify that staff had not signed to say a medication had been given. It was not clear from records whether the resident had actually received the medication or not. Medication records did not consistently show medication available at the beginning of each prescribing period making it difficult to audit that the amount received, given and remaining was correct. Where medications had been indicated to be carried forward it was not clear these amounts were always accurate. Co-codamol for one resident had run out. Records showed the resident had not been given these tablets for pain control for two days. Staff had however made an order for more and these were received the day after it was identified they had run out. Where paracetamol has been prescribed one or two to be given staff were writing on the medication record a 1 or 2. This can result in the medication record becoming ilegible when the information is mixed in with signatures. A protocol needs to be developed so there is a clear system in place for recording this information. There were no concerns during the inspection process in regards to the privacy and dignity of the residents. It was evident that staff were knowledgeable of the residents Care Homes for Older People Page 16 of 35 Evidence: and how they liked their care to be managed. Care records also were clear in detailing this information to ensure staff respected residents wishes when delivering their care. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to take part in social and leisure activities and to maintain contact with their families and friends so that they have a meaningful lifestyle. Residents receive wholesome and appealing meals to maintain their health and are afforded choices in how their care is delivered. Evidence: The care files of people involved in case tracking contained information about their interests and some contained detailed information on their life history to help staff understand more about them and help with their social stimulation. Staff advised that social activities take place with residents. On the day of inspection residents were observed to play a game of Eye Spy in the morning and in the afternoon they sang along to old time songs being played on the piano. They also participated in a reminiscene session with one of the carers who also acts as Activity Co-ordinator. Some residents chose to watch the television or read newspapers and some stayed in their bedrooms. It was evident that social activities are planned on a monthly basis which are detailed in an Activity Schedule on the notice boards in the home. A good range of activities Care Homes for Older People Page 18 of 35 Evidence: were listed on the schedules including, manicures, mobile shop, poetry afternoon, bingo, arts and crafts, reminiscence, watching films, fish and chip supper and armchair athletics. The manager reported in the Annual Quality Assurance Assessment (AQAA) document completed before the inspection that residents and staff are becoming more involved in activities and are giving good suggestions which are being followed up. At tea time residents were observed to have a fish and chip supper in a box which they all seemed to enjoy. The Activity Co-ordinator said this was a good alternative to bringing in fish and chips from the chip shop. Residents spoken to confirmed that social activities take place, one person said they also do things between ourselves. Another said its nice to have someone to talk to. Comment cards received and completed by three residents did not have the boxes ticked on two of them to show if activities are always available. One stated they were usually available and comments made on others included there are many activities arranged for the residents of the home, there is a programme of activities but because of my lack of mobility .... I prefer not to avail myself. The home has an open visiting policy and residents are encouraged to maintain links with their family, friends and the local community. Visitors were observed to arrive during the inspection at various times throughout the day. At lunchtime the residents were escorted down to the dining area which is located in the basement of the home. It is situated in the middle of two kitchens, the far kitchen is where the food is prepared and is referred to as the clean kitchen and the second kitchen is mainly used to wash up dirty items. The dining room is carpeted and is in attractive surroundings with tables set with linen table cloths, condiments, napkins and glasses and a central table decoration giving a restaurant feel to the environment. The menus seen showed clearly all meals for the day including a hot choice of breakfast in addition to the cereals, fruit and juice provided. The menus have changed from the last inspection and although they have more variety, they now do not show all snacks and drinks provided so that all residents know each day what is available to them. On the day of inspection the main meal served was barbque chicken or faggots in gravy or a vegetarian pancake. Vegetables were served in dishes for residents to help themselves and all meals looked appetising. Staff were seen to assist residents where appropriate. Residents spoken to were all satisfied with the food being provided and felt there was enough choice. Comment cards received from three residents Care Homes for Older People Page 19 of 35 Evidence: showed that two usually liked the meals and one always did. One person had responded to the question about liking the food generally, very much, good variety, open to suggestions, splendid cakes for celebrations, no complaints. Another states I think generally the vegetables are overcooked but know that older people are often only able to eat soft food. Care Homes for Older People Page 20 of 35 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 know who to complain to and feel confident any concerns would be acted upon but it is not clear systems for managing allegations of abuse are always followed to ensure the protection of the residents. Evidence: A complaints policy and procedure are in place but these were not seen on display in the home. The copy of the complaints procedure given to the inspector did not state the stages in which a complaint would be investigated and give full details of how the complaint would be handled. The manager said that the complaints procedures should be on display in the reception of the home and also near to the dining area but copies of the procedure could not be located to demonstrate this is openly accessible to residents. On viewing the Service User Guide it was however evident that there was a different complaints procedure which did detail the stages in which a complaint would be handled and which included the providers contact details as well as ours. Information on how to contact the Local Authority were not included and should form part of the complaints process in the event that complainants are not happy with any response from the home. Complaints received by the home had been documented and copies of letters received were on file. Complaints raised included issues relating to a piece of equipment in the Care Homes for Older People Page 21 of 35 Evidence: home, requests for life history information, quality of hairdressing and a resident being isolated due to a medical condition. Some of the complaints had been responded to by letter but others contained a note to say a verbal response had been given. All responses had been made in a timely manner. All residents spoken to knew who to speak to if they had a concern and it was clear they all felt comfortable in doing this if they needed to. We have not received any complaints about this service since the last inspection. The home has an Adult Protection Policy detailing actions that must be taken if abuse of any form is suspected. It was not evident from information recorded regarding safeguarding incidents that the homes procedure had been followed in regards to reporting these to the safeguarding team. This was discussed with the manager who acknowledged the procedure had not been followed. The manager has subsequently advised that she has attended safeguarding networking events and has a good professional working relationship with the safeguarding team to ensure any safeguarding matters are dealt with effectively. Staff were asked about the reporting procedure for allegations of abuse and it was evident that not all senior staff were clear on this process should the manager not be available in the home. The manager has subsequently advised that all staff have completed abuse and Protection of Vulnerable Adult (POVA) training to ensure they know how to identify abuse and know their responsibilities in reporting this. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is fresh, clean and well maintained providing a safe, attractive and homely environment for people to live in and enjoy. Evidence: This home has four floors all of which can be accessed by a passenger lift or stair lifts. The first and second floor also have a stair lift. There are three lounges and a dining room, which were were found to be clean and tidy and decorated to good standards. All bedrooms have an ensuite toilet with the exception of four single rooms. There are also two communal bathrooms with a bath hoist to assist those residents who are less mobile and two wet rooms where residents can have a shower. One of these is based on the top floor and the other is on the second floor. Those viewed were clean, pleasant and well maintained. Since the last inspection there have been some bedrooms that have been redecorated to the individual tastes of the people occupying these rooms and new blinds have been fitted to residents rooms on the ground floor. There has been a new bannister and decoration to the left hand side of the home with new carpets in lounges and to the front entrance. The manager states in the Annual Quality Assurance Assessment (AQAA) completed prior to the inspection that they have also purchased an antique sofa and chairs to compliment the entrance to the home. Care Homes for Older People Page 23 of 35 Evidence: The call bell system in place is new and has a portable facility in that residents can take their call bell into the garden so they can alert staff if they need assistance. The call bells have large buttons so residents can easily locate them and these were available in all rooms viewed. There is a hearing loop available in the home and a notice in reception advertises that this is available to anyone who may need it. The gardens are attractive and well maintained and residents said they enjoy sitting out in finer weather. Since the last inspection a new ramp has been fitted to allow for easier access to the building for people with mobility problems or wheelchairs. All areas of the home viewed were fresh and clean. No unpleasant odours were identified during the tour of the home demonstrating effective cleaning and odour management in the home. Hot taps tested randomly in bedrooms and bathrooms were found to be at safe levels to prevent scalding residents. Both the laundry and kitchen areas were viewed and were clean and well managed. Since the last inspection laundry baskets have been clearly labelled so that dirty and clean items have dedicated baskets. Some residents did state within questionnaires received by the home that items of laundry had gone missing. Staff advised that there had been temporary arrangements in place for a period of time in regards to the management of the laundry but now the regular laundry person was back and laundry management was now getting back to normal. Care Homes for Older People Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are friendly and supportive but it is not clear staffing arrangements are always effective to meet the needs of residents consistently. Staff complete training on an ongoing basis to ensure residents are managed safely and appropriately. Evidence: On the day of inspection both the manager and deputy manager were not in the home and it was established both had good reason for this. This inspection was therefore carried out with the support of the senior carers who were also required to support the care needs of the residents in the home. The senior carer confirmed that the staffing arrangements for the home on a daily basis consisted of three care assistants plus a senior carer from 7am to 9.15pm and two carers during the night. The manager works in a supernumerary capacity and the deputy manager completes some management tasks in the office on some days and on others works as part of the caring rota on the floor. There is a full time cook, part time cook and one kitchen assistant. The duty rota for ancilliary staff which includes cleaning and catering staff did not detail staff designations so that it was clear which duties they were completing. It was not evident that any additional staff had been rostered to work in the absence Care Homes for Older People Page 25 of 35 Evidence: of the manager and deputy manager to allow management tasks to be completed effectively and without impacting on the time needed to care for the residents. During the day staff were observed to be busy supporting the needs of residents and in the morning it was observed to be particularly busy. Residents were looking for staff as were visitors to the home but had to wait until they came down from the upper floors. There were periods of time when the lounge was left for long periods without a member of staff. In the afternoons however this improved with staff visably available in the lounge area. Staff spoken to acknowledged that it tended to be busier during the morning. Residents spoken to were complimentary of the staff one said the staff were very good, very friendly, another said all good to me and another said the staff were quite alright. Comment cards received by us and completed by three residents showed that all felt staff listened and acted upon what they said. Two stated that staff were always available when they needed them and one person said they usually were and commented when short staffed there can be quite long delays. Duty rotas confirmed that these staffing numbers are mostly achieved but on occasions there are three carers instead of four. Duty rotas indicated the need for additional staff where staff are sick and agency staff have been sourced where possible. Training schedules were seen to confirm staff training undertaken although staff designations were not detailed making it difficult to identify which staff were carers. It was evident that staff training is being accessed on an ongoing basis but some staff are due to complete statutory training such as manual handling and food hygiene. It was not clear from schedules in place when this is due to take place. Training schedules indicated that there are over half of the care staff who have attained an National Vocational Qualification (NVQ) II in Care or above which means residents can be confident they are being cared for by competent care staff. Some of the staff have completed training linked to the care needs of the residents including training in dementia awareness but there remains a number of staff who have not completed this training. In view of the numbers of residents in the home with this condition, all staff should be aware of how to manage people with dementia to ensure the residents receive effective care consistently. Care Homes for Older People Page 26 of 35 Evidence: The Administrator for the home assisted with obtaining staff personal files to view. She was able to confirm that the staff turnover for the home was very low and they had therefore only recruited one member of new staff since the last inspection. This file was viewed and it was evident that all of the required information had been collected prior to the person commencing employment at the home. This included two written references, a Criminal Records Bureau (CRB) check and fully completed application form. Another staff members file viewed at random also had all of the required information on file but it was not clear which was the official start date as there were references to three different dates on file. This meant it was not clear if all of the required information had been received prior to them starting. Although it was identified that there is an induction training pack that can be used for new staff, it was not evident from viewing the file of the new member of staff that they had completed this. New staff should complete induction training based on the Skills for Care Common Induction Standards to ensure they are deemed competent to work with the residents. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home which is run in their best interests and which is managed by a suitably experienced and qualified manager. Health and safety checks are regularly carried out to ensure residents live in a safe environment. Evidence: The manager of the home was registered with us in 2008 and has had previous experience of working in a management role within the care sector. She is a National Vocational Qualified (NVQ) Assessor and also has attained NVQ qualification in Care so is suitably qualified to manage the home. The manager was not present during this inspection to obtain details of recent training and qualifications. It was evident that since the last inspection the manager has worked with staff to further improve the standards within the home. Staff reported that they felt well supported by the manager. Care staff said they felt at ease to approach senior carers Care Homes for Older People Page 28 of 35 Evidence: if theyhad any problems and stated they enjoyed working at the home. Quality questionnaires were evidenced for family and friends and comments included:Any problems we have, the staff deal with quickly and efficiently. Food is not to her liking, maybe more traditional English food would be appropriate for this age group. My mother is very happy although she would like more shopping trips if possible. A good varied choice of activities manicures are an excellent provision. Mum has occasionally commented that the food quality has gone down and Yes answers to the questions Do you feel that your relatives care needs are being adequately met. A discussion was held with the manager regarding responses received. It was confirmed that an outcome report had not been completed and made available to friends and relatives or residents showing actions that had been taken to address these comments. The manager did however state that there had been actions taken. The manager agreed to pursue the written report. A review of the systems to manage residents personal monies was undertaken and this was found to be satisfactory. The only exception to this was that receipts/invoices issued did not always contain sufficient information to show they had been received from the person the home said it was from. The Administrator agreed to discuss this matter with the manager to help make the systems for managing money receipts more robust. In regard to health and safety it was evident that systems are in place to ensure these are carried out on a regular basis. Records of checks made are kept and the file viewed confirmed appropriate checks had been carried out in regards to gas, hot water temperatures, the fire alarm, electrical wiring and the lift. The records for the hoists could not be located and will need to be checked. The kitchen area was well organised with good stocks of food which were stored appropriately. Fridge and freezer temperatures were being maintained on a daily basis to show that food is being stored at safe temperatures. Care Homes for Older People Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 35 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 3 14 Prospective residents should have a detailed assessment of their needs completed prior to their admission. This is so needs can be clearly identified and the home can assess if these can be effectively met. 18/05/2009 2 7 12 Care plans must be developed where wounds or pressure areas to the skin are identified. This is to ensure these are managed effectively by staff to promote healing. 18/05/2009 3 7 12 Care plan reviews need to identify changes in health and make clear what aspect of the care need has been reviewed. This is to ensure appropriate staff support is provided to the resident in meeting their needs. 18/05/2009 Care Homes for Older People Page 31 of 35 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 4 9 13 Medication must be managed effectively consistently. Pain killing medications must be available and given as prescribed. This is to ensure residents receive adequate pain control to manage their health. 18/05/2009 5 9 13 The amount of medication available, given and remaining for each resident needs to be clear. This is to ensure residents have received their medication as prescribed to maintain their health. 18/05/2009 6 18 13 Systems for managing 15/05/2009 allegations of abuse must be followed consistently. Staff need to be clear on their responsibilities in regards to reporting any allegations made. This is to ensure residents are sufficiently protected and do not come to harm. 7 27 18 A review of staffing arrangements should be undertaken to ensure these remain effective consistently. 29/05/2009 Care Homes for Older People Page 32 of 35 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 This is to ensure residents receive consistent good care to meet their needs. 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 1 It is recommended that the Service User Guide contains a clear Statement of Terms and Conditions for the home as well as our summary inspection report. This is to ensure prospective residents have all the information they need to make a decision on whether to stay. It is advised that a protocol is developed for indicating whether one or two tablets have been given where these are prescribed one or two by the GP so that the medication records do not become ilegible due to too much information being written in the boxes. It is recommended the menus include full details of all snacks and drinks provided in addition to the meals already stated so that residents know these are available to them each day. The complaints procedure needs to be clearly accessible to residents so that they are clear on how their concerns will be managed Any complaint received in writing from residents should also have a response in writing in accordance with the homes complaints procedure. This also helps to demonstrate that complaints have been responded to. The houskeeping and catering staff rotas should contain staff designations so that it is clear what roles staff have in the home and it can be demonstrated there are sufficient hours allocated to these roles. This issue has been raised in past inspections to the home and should be addressed. Staff start dates on recruitment files need to be clear so it 2 9 3 15 4 16 5 16 6 27 7 29 Care Homes for Older People Page 33 of 35 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 is evident that all of the required checks have been received prior to their start date as required. This is to ensure staff have been deemed safe to work with vulnerable adults. 8 30 Staff induction training needs to be demonstrated so that it is evident that new staff are sufficiently trained and competent to support residents safely. Staff training needs to be completed within the appropriate timescales so that residents receive safe and effective care consistently . Training schedules need to demonstrate this and include staff designations so that it is clear how many care staff are suitably trained. The manager should complete an outcome report from any quality surveys carried out and make this available to residents and their representatives so that it is clear any issues raised are being addressed. This also helps to demonstrate any ongoing improvements being made. Systems for managing receipts for items purchased by residents should be reviewed to ensure it is clear who has provided the receipts and there is a clear evidence trail for auditing that money is being managed accurately and appropriately. 9 30 10 33 11 35 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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