Inspection on 08/04/09 for Ashleigh Manor

This inspection was carried out on 8th April 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashleigh Manor 05/10/09

Ashleigh Manor 13/10/08

Ashleigh Manor 20/11/07

Ashleigh Manor 19/04/07

Ashleigh Manor 19/05/06

Ashleigh Manor 19/10/05

Ashleigh Manor 10/06/05

Ashleigh Manor 15/12/04

Ashleigh Manor 18/06/04

Ashleigh Manor 03/02/04

Similar services:

The Vicarage

Fairfields Country Rest Home

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5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Ashleigh Manor 1 & 3 Vicarage Road Plympton Plymouth Devon PL7 4JU     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: Kim Fowler     Date: 0 8 0 4 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 34 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 34 Information about the care home Name of care home: Address: Ashleigh Manor 1 & 3 Vicarage Road Plympton Plymouth Devon PL7 4JU 01752346662 01752336233 loretta_severn@hotmail.com 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) : Mrs Maureen Lawley,Miss Loretta Maher-Lawley care home 38 Number of places (if applicable): Under 65 Over 65 0 38 0 dementia old age, not falling within any other category physical disability Additional conditions: Five residents Category PD 50yrs Date of last inspection Brief description of the care home 38 0 38 1 7 1 0 2 0 0 8 Ashleigh Manor is a care home for thirty-eight people who may have dementia and/or physical disabilities. Five of the thirty-eight may be admitted under the age of 50. The home does provide a small number of short-term respite care. Mrs Maureen Lawley, who is the Registered Manager, and Ms Loretta Maher-Lawley currently own the home. The home is a large detached house set within its own grounds in the residential area of Plympton. It is close to local shops and amenities and public transport is easily available. Some rooms are en-suite. On the ground floor there are four dining rooms and four lounge rooms. The home has access for wheelchair users including a passenger lift and stair lifts and ramps to the garden. There is parking space available Care Homes for Older People Page 4 of 34 Brief description of the care home at the front of the home and has a large garden to the rear of the property. The current fees range from 333 pounds to 406 pounds. However this may vary depending on individual need. Additional charges are made for personal items should as hairdressing. Care Homes for Older People Page 5 of 34 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 unannounced inspection took place over 1 day and started at 8:00am and finished at 4:30pm on the 8th April 2009. The homes Registered Manager, Mrs Maureen Lawley, was available throughout the inspection. An Expert by Experience was also available for part of the inspection. An Expert by Experience is a person who, because of shared experience of using services and/or ways of communicating, visits the service with an inspector to help them get a picture of what it is like to live in the service. The Expert by Experience spoke with 10 residents and 1 visitor during their time in the home. Also assisting with the inspector was the Commissions Pharmacist Inspector and a Care Homes for Older People Page 6 of 34 second inspector carried out a SOFI observation. This is where during the inspection site visit a period of two hours is spent in the homes lounge looking at how the home manages to interact with people who find it hard to communicate because of problems with memory loss. They also looked at how well the people whom live there are encouraged to engage with the environment around them. The inspector made a tour of the building and spoke to most the people living at the home and two professionals visiting at the time of the inspection. Documentation relating to the care planning process and the management of the home were examined. Prior to the inspection surveys had been sent to the care home to allow people who live there to comment upon their experiences. Six surveys were returned to the Commission. Three staff surveys were also received as well as one professional feedback cards. Any comments are discussed in the relevant section of the report. What the care home does well: What has improved since the last inspection? What they could do better: All Care Plans completed and updated would enable the staff in the home to meet the needs of individuals. The care plans should hold all information about the health care needs and personal care needs of individuals. They should also if possible contain information about the social and personal history of the people being cared for, and communication support needed where appropriate. All people living in the home will benefit from the completed new risk assessment process when this new format is put into practice. Medication procedure need to continue to improved as required to meet this standard. Staff practices in assisting people with eating should be reviewed to ensure people receive the best possible service. The staff should be encouraged not to talk about other people in front of other people living in the home. Care Homes for Older People Page 8 of 34 The environment of the home should continue to be updated and upgraded as stated by the owners. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 34 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 34 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. People who are considering admission to the home can be assured that the new pre admission form will hold information to assist the home to provide individual care to people. Evidence: The last full inspection graded the home a 1 star poor service and due to adult protection issues raised the local authority is currently supporting the home. One person assisting the home has many years experience on managing and running a care home and the second person is a experienced qualified nurse. These people are assisting with updating all files, restructuring the staffing and management team and looking at the medication system. Since the last inspection the home has developed a new pre-admission form and a Client Quick Reference sheet supports this new form. This form is more detailed to Care Homes for Older People Page 11 of 34 Evidence: include full personal details and previous medical history. The next new admission will benefit from this new procedure. One relative visiting at the time of the inspection confirmed that their relative had received a visit from the home before admission and they had been given full details about the home before admission. One survey returned from someone living in the home when asked, did they receive enough information about the home before they moved in, ticked no and wrote, I had no idea I was given no information about the home at all. Fortunately it turned out all right. One of the owners of the home, Loretta Maher-Lawley stated that this person was visited in their own home before admission and information was given to them about Ashleigh Manor. Due to the changes the home is currently undertaking, including the updating of all the files, it was difficult to record that any pre-admission assessments had been completed. However the last inspection did not highlight any areas of concern in these standards. The homes AQAA states, All prospective clients are invited to come for the day, after tea/coffee have a meal, meet other clients and staff. These document are important for prospective new admissions to assured them that not only can their health care needs be met but also their emotional, social, cultural or religious needs. Ashleigh Manor does not offer Intermediate Care. Care Homes for Older People Page 12 of 34 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. People living at Ashleigh Manor receive health and personal care as needed and required. All care plan updated and completed would enable staff to meet the health and welfare needs of people living at the home. Evidence: As previously stated the home is updating all individual files for people living in the home, therefore not all files have been completed. One completed file was examined and showed that the home has recorded details on all aspects of care including health care needs, medication information and personal support needs. The plan for the new files show that they will contain an individual care plan containing information on care needs and how the home would meet these needs. The daily care plans will be made easy assessable for staff on duty and some risk assessments will be held on individual files for the protection of all people living at the home. These risk Care Homes for Older People Page 13 of 34 Evidence: assessments will also be transferred, streamlined and updated to the new filing system. These care plans will give detailed instructions to all staff as well as information to new staff to ensure intimate personal care is being provided in a manner that meets with the approval of people receiving the care. This is particularly important where people are unable to express themselves verbally. The previous inspection showed that one care plan had not been completed; though some files examined during this inspection were near completion many still held the old format and required updating and completing. Evidence was recorded into the old files that people living at the home are referred to the District Nurse team and the Mental Health team after monitoring by the homes care staff. All people living at the home have access to all health care services and some information was recorded into individual files examined. These files recorded that there was input from other professionals including GPs, CPN (Community Psychiatric Nurse), chiropodist and consultants based at the local hospital. One person living in the home confirmed that they had attended a hospital appointment and had also been seen by the GP in the home. The home has produced an A&E admission form; this form will enable staff to update and record the progress each person is making during the stay in hospital. The Expert by Experience asked people living in the home if they had to wait long for assistance when they used the call bell, and the response reported in the Expert by Experience reports states, Call bell response time was said generally to be within 2 to 4 minutes, occasionally 10 minutes and once 30 minutes with the carer advising an acceptable reason for the delay. However the home does have a recorded computerised system in place to show how long people are kept waiting for response from call bells. The owner stated that this system does not show anyone waiting for 30 minutes. The Commissions Inspector Pharmacist undertook an audit of the medication system and reported the following: Medication handling appears to have improved since the previous inspection, and further improvements are still being made. Care Homes for Older People Page 14 of 34 Evidence: Medicines have been sorted out and unwanted or out-of-date medicines have been returned to the pharmacy. We looked at medication records in the home. They are generally well filled in, showing that people receive their medication as prescribed by their doctor. There were a few blank spaces in peoples medication charts where staff have not signed them, but the medication has been taken from the blister packs and so it appears to have been given to people. Staff must be reminded to sign charts at the time of giving medicine to people. We found that the medication charts were generally clear, with dose changes clearly recorded. If varying doses of medication is prescribed, it is recorded how much was given to people. This also helps to show that medication is given as prescribed by the doctor. It should be recorded in care plans for people when varying amounts are prescribed, to help staff to decide how much should be given. We also saw that records are kept of medicines received into the home and those returned to the pharmacy, and these help to show how medicines are handled in the home. We found that the morning medication round was taking a long time for one member of staff, and medication was still being given shortly before the next medication round was due to start. This could lead to problems with doses of some medication being given too close together. The member of staff was well informed on peoples medicines and had given medicines first to those people needing pain relief, antibiotics or medicines with repeat doses due later in the day. Medication is given to people in a safe way. The manager is aware of the need to review the time taken to do the morning round, and it is planned to move the medication room to a more central part of the building which will hopefully decrease the time taken to complete the round. We looked at storage arrangements and found that medicines are stored safely. The home has a controlled drugs cabinet for extra secure storage for these medicines, but it had not yet been attached to the wall, as the medication room is to be moved in the near future. It is a requirement that these controlled drugs are stored correctly in a properly attached controlled drugs cupboard. There is a medicines refrigerator, for storage of items that require refrigeration, and temperatures are sometimes recorded, but it is recommended to monitor the temperature every day to make sure that it is in the correct range. This helps to ensure the medicines will still be effective and safe for people. Policy and procedures for medication are currently being updated and reviewed, and further staff training in medication has been booked. These should provide clear guidance to staff and update their training, which will help to improve handling of medicines and help to minimise the risk to people. Care Homes for Older People Page 15 of 34 Evidence: One incident of missing medication was reported to the Commission. This showed that the home had followed the correct procedure and included contacting the police and appropriate people about the missing medication. The homes AQAA states, We have reviewed and updated our medication policy and goes onto say, We have discussed care plans with clients where appropriate. Many of the people living at the home were spoken with and some confirmed that the staff treat them with respect and protect their privacy and dignity at all times. Observed during the inspection were staff knocking on peoples doors to promote privacy. One relative visiting during the day stated that there relative was well cared for and their visits are held in private. Care Homes for Older People Page 16 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Ashleigh Manor can be confident that the home offers good wholesome meals. The home welcomes and encourages families and friends to visit. Evidence: The home continues to offer a full activities programme. The current activities arranged are displayed on the homes notice board for all to access. One file examined showed a favourite activities list for that individual. The home is currently providing a Quality Moments session, this session will enable staff to find out what activities individuals enjoy. Other activities include trips out, themed nights and takeaway meal nights. One staff member is a trained Art Therapist and this person is organising several activities for people to enjoy. Many of the people spoken with were able to confirm that there is regular activities Care Homes for Older People Page 17 of 34 Evidence: provided and these activities were either organised by the staff or by visitors to the home. The Expert by Experience asked people living in the home about the activities offered and the response recorded into their report stated, Although there is no dedicated Activities Organiser one of the carers is trained in Art Therapy and it is planned that these skills will be deployed in the future. Currently there is a wide range of activities including Sunflower growing, making Easter Bonnets, an impending Easter Egg Hunt, Bingo, Saturday evening film shows, Craft work and visits from entertainers and singers. Some people said they attended all activities, others indicated they were selective and a couple of people said they preferred not to join, one adding, It is not my kind of thing. One staff survey returned under what the service could do better, more outings and entertainment for the clients. A survey returned by someone living in the home said, Many times there are Musical musicians I enjoy. Visitors are welcome at any reasonable time and can visit their friend and family in the privacy of their own room or in one of the lounge areas around the home. One visitor confirmed that they could visit whenever they wished and said that they are always made to feel welcome whatever time they visit. Some of the people living at the home said that they were able to have regular visits from family and friends. During a tour of the building most bedrooms were visited and provided evidence that each contains personal possessions. People were observed moving freely around the home. Some people remained in their individual bedrooms and one person said, I go downstairs sometimes. Staff were seen interacting with people and discussing everyday topics and included assisting individuals when needed showing staff were aware of the needs of people living in the home. During a walk around the premises people were observed undertaking craft sessions or reading and watching TV while interacting with staff. Previous inspection showed that the home does not undertake money management for people living in the home. The manager stated that the families of individuals are sent a bill for any purchases including hairdressing. Care Homes for Older People Page 18 of 34 Evidence: Some of the people spoken with felt that they were able to make individual choices about everyday issues in their lives. These choices also included choosing food from the daily menu on offer. The main kitchen of the home is currently closed and a new kitchen is being fitted in the old office area. Therefore all main meals are being cooked and prepared in a small kitchen normally used for people living in the home to access for snacks and drinks. All people who were able to made positive comments about the food provided. One of the cooks was spoken with during the inspection about the menus and food on offer. The homes 4 weekly menus was displayed for all to see and showed a varied and nutritional diet. A record was also held to ensure that all people received the food they like. It was evident from the food seen served at lunchtime, roast pork, potatoes and fresh vegetables with a second meals available if needed. The home has introduced a dessert trolley and this proved very popular and held a choice of gateaux, cheese and biscuits and other desserts. The cook confirmed that fresh provisions were ordered regularly and there were always plenty of provisions available and everyday items could be obtained locally. The Expert by Experience was requested to talk to people living in the home about the food provided and to observe a meal being served. The report stated, Normally there are two choices of main course selected the previous day with alternatives always available. Currently the main kitchen is being re-vamped and is unusable so a limited food service is being prepared in a domestic sized kitchen in the new wing supplemented by pre-cooked food brought in from outside providers. There were no complaints about the food with residents saying, Pretty good food, Food - nothing to complain about, Food lovely here and I was pleasantly surprised by the food. A visitor praised the food enjoyed by his father. On the day of the visit the main meal was roast pork with apple sauce, roast potatoes, Brussels sprouts and carrots served in attractive heavy bowl type plates with raised edges easy for people to eat from. There was a choice of 4 desserts from a trolley. According to the manager it has been found that by serving main meals and desserts from a trolley at the table people have a greater choice and are enjoying their food more. Consideration is being given to continue with this type of service when the kitchen is completed rather then revert to a plated service. This would require the purchase of a mobile hot cupboard with a Bain Marie top. Noted that several people needed assistance with eating and this was given by carers variously sat on the arm of a reclining chair, kneeling alongside the diner or standing beside/over the resident. A discussion was held with the owner, Mrs Maureen Lawley, on the practice of assisting Care Homes for Older People Page 19 of 34 Evidence: people with eating. It was agreed that some practices carried out that day, including standing over people while assisting them was considered poor practice. Mrs Lawley stated that this was a particular training issue she had raised with the staff and confirmed that she would speak to the staff again about good practices issues when assisting people with eating. During the Inspection a period of two hours was spent in the homes lounge looking at how well people were being supported, the quality of interaction between the people living at the home and staff and how engaged they were with the environment around them. Whilst there was a reasonable amount of staff interactions these were nearly all of a very short duration. Staff would come into the lounge, say hello to someone and be off to do something else. There wasnt much time for sustained contact with people unless it was tasked based for example giving out medication. However the people observed were mainly alert and ready to be interacted with. This could mean these people may benefit from much more stimulation being made available. In particular there were few objects or things to look at or do. The television was on, but the only time people were watching it was when there were animal noises on, which caught peoples attention. Some staff seen communicated with people really well. One person seen spoke to each individual, reminding them of events and information about their lives on each occasion she spoke to them. This was good practice. There was however some evidence of staff talking about people in front of them, and not recognising their individuality. Moving and handling tasks carried out were being done well, and generally people had explanations given to them about why they were being moved. One survey returned to the Commission from someone living in the home said of the food, Very good. Better than expected. The homes AQAA states under the Equality and Diversity heading, Ensure choice of individuals clients is upheld and their preferences in all areas of daily life. Links with local churches, multi-cultural centres. Care Homes for Older People Page 20 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home can be confident that any complaints or concerns raised will be listened to, acted upon and well managed by the home, which protects the welfare of all. Evidence: The local placing authority had received one anonymous complaint. These issues were dealt with via the local authority and many issues looked at during the inspection were found to be unproven. However the local authority had restriction in place on placing people into the home and this restriction was in place for eight weeks. This was due to the last safeguarding issue that raised concerns about the care of one new admission and issues raised at the last inspection. The local authority is still supporting the home in many areas including looking at the reporting process and management accountability for reporting issues of concern that may raise a safeguarding alert. The home has not received any complaints and no further Safeguarding alerts have been raised. Some of the people living in the home stated that they were aware they could complain and they would talk to the owners or one of the staff. Care Homes for Older People Page 21 of 34 Evidence: One relatives spoken with stated that they were aware that the home had a complaints procedure. However they also stated that they have never needed to use it. This person felt that they could talk and approach the management of the home if needed and that any concerns or complaints would be acted upon and listen too. The owner confirmed that she had carried out Safeguarding training for all the staff in the home. However it was recommended that the manager and senior staff receive the local authorities safeguarding training so they are aware of local procedures. The Expert by Experience recorded into there report that, Two ladies volunteered that they felt vulnerable when a male resident came uninvited to their rooms and ignored their requests to leave until a carer was called to take him away. They added that they were aware this person meant them no harm. This issue was discussed with Mrs Lawley and Mrs Lawley gave reassurances that this issue would be looked at and she would talk to the gentleman concerned. Mrs Lawley stated that she would also hold talks with the staff group, and in particular the night staff, about monitoring this gentleman and how best to resolve the problem for all concern and went onto confirm that this gentleman did not wish to harm people. One survey returned by someone living in the home said, I feel very comfortable here and have no complaints. The homes AQAA under plans for the next 12 months state, To log unofficial complaints for Quality Assurances purposes. Care Homes for Older People Page 22 of 34 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. Many of the areas in the home are pleasant and homely. The owners have committed to continue to upgrade and update all other areas. The new extension will provide a suitable environment and an attractive and comfortable home. Evidence: At the last full inspection many areas of concern were raised. Some of these issues have now been dealt with including the cleanliness and hygiene of some of the areas highlighted. The room that held hot equipment to make drinks has had a keypad lock fitted and a notice to ensure that it remains closed at all times. However during the inspection it was noted that this room had been left unlocked and the door open. As previously stated the main kitchen has been closed as it is being moved to a new room were a new updated kitchen will be fitted. The home is currently using a second very small kitchen for meals and during the inspection this was examined and discussed with the staff and catering staff. All agreed it was to small however it was only for a short period and the home is providing some takeaway Care Homes for Older People Page 23 of 34 Evidence: meals and simple menus are currently planned to assist the catering staff. The new kitchen was not available for inspection at this inspection. The previous report highlighted concerns about the laundry area. This included chemicals not secure, the laundry room door wedged open and a large insecure breeze block temporary step in place. The laundry room has now been relocated to the new extension. This new room has been extensively fitted with new industrial washing machines and all other equipment in place to run a large home. The laundry staff were spoken with and confirmed that this room had all the equipment needed and could not be accessed by people living in the home without staff assistance. All previous food storage areas high lighted in the last report have now been closed and these will be relocated into the new extension. The carpet in one of the lounge areas on the ground floor was found to have frayed edges and could place people living in the home at risk of trips mentioned in the last report has now been removed and replaced with suitable flooring. The rear of the home has a large extension fitted and this will cater for an additional 28 beds. This extension is now completed and the owners plan to apply to Register this accommodation with the Commission. Appropriate disability equipment is provided in the home, and these include a passenger lift, hoists, wheelchairs, and a call bell system. This equipment provides the people living at the home with a building that is appropriately adapted to meet their needs. Risk assessments are in place and are currently under review with the home with assistance from the local authority. A tour of the premises showed that all rooms held personal items including furniture, ornaments and pictures that reflect their personality and interests. The process for the removal of clinical waste was discussed and was satisfactory dealt. The owner confirmed that she had carried out Infection control training for all the staff. Several staff members were able to confirm that the home provided disposable aprons and gloves for their protection. Care Homes for Older People Page 24 of 34 Evidence: The home has now employed a Housekeeper to oversee the areas previously highlighted in the last inspection report. The housekeeper was spoken with and was able to provide information and had a clear knowledge of her roll within the home. The home provided the Commission with a development plan to update the home. This showed a clear structure of replacing and upgrading all areas highlighted in the last inspection report. And included replacing vanity units in each bedroom with pedestal sinks, ripping out fitted furniture and replacing beds, chairs, furniture and flooring as necessary. The Expert by Experience observed during their tour of the premises and wrote in their report, All residents seen were clean, tidy and dressed in freshly laundered attire. Although general cleanliness was good, the tablecloth and a place mat on the dining table used for lunch in the conservatory bore evidence of an earlier meal. Residents seemed to appreciate having a choice of a number of comfortable well-furnished, homely lounges to relax in. The homes AQAA under how we have improved in the last 12 months states, We have started a programme of decoration and goes onto say, We have allocated 6 hours pure cleaning time to the kitchen and have updated our cleaning procedures and regimes. Care Homes for Older People Page 25 of 34 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. The homes recruitment procedures protect people living at the home from being placed at risk of harm or abuse. Ongoing staff training is encouraged enabling people who live at the home to receive the best possible service. Evidence: The home has undergone some staff restructuring since the last full inspection. This has included employing new staff to undertake particular duties to ensure the smooth running of the home. This included the employment of a housekeeping post to provide all auxiliary staff with a line manager to oversee the areas of the home that required attention during the last inspection. In particular the general cleanliness of the home and the food preparation and storage areas. The home provided the Commission with a plan of the restructuring of all the staff posts in the home. This showed that the home plan to increase the level of care staff and employ team leaders to oversee the care of people living and receiving care in the home and to manage the care staff. The owner of the home has carried out the restructuring of the care staff to ensure Care Homes for Older People Page 26 of 34 Evidence: that there is sufficient staff on duty and to ensure that some one has responsibility of recording and reporting any Safeguarding concerns that are raised. The homes AQAA states, We have re-structured staffing, that tackles accountability and responsibility. On the day of the inspection there were 6 care staff with a Team Leader overseeing them, a cook, laundry staff and 3 cleaners with a housekeeper in post to ensure all areas of the home remain clean. There was also 2 administration staff as well as the 2 owners on duty therefore providing evidence that the home had sufficient staff to support people currently living in the home. One staff survey returned to the Commission stated when asked if the home had sufficient staff on duty wrote, Usually, because sometimes staff sickness causes shortages of staff. The 2nd inspector who was observing in one of the lounge areas noted on their report that staff in some cases talked about people in front of them without acknowledging their presence. As an example one staff member was heard to say, Ill move another one and then come and get her. This undermines peoples sense of identity and is poor practice. There were several examples of the use of terms such as sweetheart, darling, my love, which tend to undermine people sense of person hood. Other staff however were seen to speak to people well, relating specifically to peoples past experience and life. This helps people with memory problems to retain their individuality and sense of identity. The home has devised a new job description for the Leader post and this shows that people applying for this post must have 2 years experience in a care setting. The Expert by Experience reported in their report sent to the Commission, The staff were seen to display a kindly, caring, patient attitude toward their charges. A visitor said, Cant fault the care here but there have been problems in the past with a lot of changes. One person said, Life is very pleasant here and another said, I like being here. A very recently bereaved person was seen to be comforted at various times by staff and fellow residents. Carers addressed people by their preferred name. The home is currently reviewing and replacing all staff files. The home administration manager has undertaken this task and all files examined showed that this duty now undertaken by the administration manager ensured that all staff had the required recruitment checks in place including CRB (Criminal Record Bureau Disclosure) ensuring as far as possible unsuitable staff are not employed. The home has provided many of the staff with updated and renewed training and have completed a training audit for all staff employed at the home. Care Homes for Older People Page 27 of 34 Evidence: Current training booked included Medication training and Foundation Medication training course for senior staff. Mental Capacity Act training, Dementia training, First Aid and Infection control and other courses planned. The Expert by Experience spoke to several people living in the home and wrote in their report: Respondents indicated that they had confidence in the staff using phrases, The girls are very nice, very kind and gentle, No problems with the staff, We get on alright, The staff are very good, and The staff fascinate me and treat me very well. One person who prefers to stay in his bedroom said, I am content with everything here. A visitor said, I like the way the staff interact with the residents and have bonded with my father who burst into tears on hearing that one particular carer was considering a career change. A resident said, I feel sorry for the staff as they have so much to do for so little pay. The staff spoken to on the visit were proud of the work they did and wanted the home to develop further and provide improved services to people living there. They also wanted to do more training and develop their own skills. One survey returned from someone living in the home wrote of the staff, Very kind and helpful, very pleasant. Care Homes for Older People Page 28 of 34 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. The management of the home is effective, ensuring that peoples needs continue to be met. Evidence: As previously stated the home has under gone staff restructuring and this has included the restructuring of the management team. The owner, Mrs Maureen Lawley and joint owner Miss Loretta Maher-Lawley are both running and managing the care home with one or the other on duty at all times. Were previously their were 2 other managers, both responsible for the care of people living in the home, the restructure now has Team Leader posts in place with the overall responsibility of the care falling to the joint owners to manage. Mrs Lawley has attended the Dignity in Care Homes forum and plans to pass all information and knowledge gained to the staff team. Care Homes for Older People Page 29 of 34 Evidence: Both the owners felt that there had been a marked improvement in the staffing levels and care provided since the restructuring has taken place. The homes AQAA states, We are working very closely with PCC (Plymouth City Council), to improve the services we provide. One staff survey form returned to the Commission wrote under what could the service do better, Organisation of the workforce could be improved. Another staff wrote under what was good about the service, Involvers me in meetings and training so I can fulfill my role. The supervision records showed that the team leader had received supervision and they in turn had started this process with all care staff with the owner confirming that this would be carried out regularly. The manager said quality assurance questionnaires are sent out on a regular bases and includes family, friends, GP and other professionals. Several of these were seen during this inspection and included comments, I came for respite and never went home and another saying Im happy here. Previous inspections showed that the home did not manage or hold any money for individuals living at the home and each person has a lockable cupboard in their rooms for this purpose. The manager said the home has no involvement in any finances and will bill family if any expenditure occurs for example hairdressing. Sampling of records indicated equipment is serviced regularly and maintained in good order. Health and Safety is a priority in the home and records examined showed fire safety training and fire protection is in place and up to date. The accident records were accurate and files examined showed that information is recorded onto accident forms and also written into peoples daily records with appropriate action taken when needed. Care Homes for Older People Page 30 of 34 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 7 15 All care plans must be 31/01/2008 completed to ensure the staff are able to meet the needs of people living at the home in respect of their health and welfare. Care Homes for Older People Page 31 of 34 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 15 All care plans must be completed to hold information on individuals health care and personal needs. Completed care plans would ensure all staff working in the home are aware of individual needs and how they should be met. 24/07/2009 2 9 13 The medication procedure of 24/07/2009 administration, recording, storage and staff training must continue to improve and be audit by the Registered Manager. Safe storage, recording, administration of medication Will protect people who receive medication. 3 19 16 All areas of the home must 28/08/2009 be well maintained and meet peoples individual needs. Care Homes for Older People Page 32 of 34 This will protect the health and safety of all that live in the home. 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 2 7 37 The care plans should hold information about peoples social and personal history. All files, records, policies and procedures must be completed, updated and kept up to date. Care Homes for Older People Page 33 of 34 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. 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. 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