Inspection on 03/09/09 for Aspen Lodge

This inspection was carried out on 3rd September 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

Key inspection report Care homes for older people Name: Address: Aspen Lodge Aspen Lodge London Road Sholden Deal Kent CT14 0AD     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: Mary Cochrane     Date: 0 3 0 9 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 33 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 33 Information about the care home Name of care home: Address: Aspen Lodge Aspen Lodge London Road Sholden Deal Kent CT14 0AD 01304367985 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): sharonaspenlodge@talktalk.net Marcus Care Homes Ltd Name of registered manager (if applicable) Miss Sharon Evans Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is: Twenty-five (25) The registered person may provide the following category/ies of service only: Care Home only - 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 Dementia - DE Date of last inspection 25 0 Over 65 0 25 Care Homes for Older People Page 4 of 33 Brief description of the care home Aspen Lodge is registered to provide care for 25 older people or up to 25 older people with dementia. The home is situated on the busy main road from Deal to Sandwich, within the village of Sholden. There is dedicated parking at the rear of the property and a small parking area at the front. Accommodation consists of 21 single and 2 double bedrooms, arranged over two floors with a shaft lift and a stair lift to access the upper floor. Four rooms have ensuite facilities, the rest are fitted with a wash-hand basin. All rooms are fitted with a call bell system. The homes communal areas include a large L-shaped lounge, a conservatory, and a dining room on the ground floor, with a smaller lounge on the first floor. There is a pleasant, accessible, secure garden area at the side of the property and a small garden at the rear. The current fees for the service at the time of the visit range from £380.00 to £450.00 per week. Information on the Homes services and the CQC reports for service users will be detailed in the Statement of Purpose and Service User Guide. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This visit to the service was an unannounced Key Inspection which took place over one day. The inspection started at 9:30a.m and finished at 3:30 p.m. The registered manager and the deputy manager were available during this time. The people living at the home and the staff on duty were helpful and co-operative throughout the visit. Five residents, three staff members and 2 relatives were involved in the inspection. They told us things about the home and the support and care they receive and give. General observations were made during the day of how people are supported. We conducted a Short Observational Framework for Inspection (SOFI) for 1 hour 20 minutes during the visit. This was to look at the daily life and social activities experienced by the residents. We observed how staff supported residents during social activities and when offering care. We looked at interactions and communication Care Homes for Older People Page 6 of 33 between the people living at the home and with staff. We had a look around the home and various records were inspected. We looked at and discussed residents individual support plans and their risk assessments. We looked at medication procedures and records. We also looked at staff files and training records. We saw how the service recruits their staff and the homes quality assurance systems. We also looked at the homes health and safety checks. An annual service assurance assessment (AQAA) was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. Information received from the home since the last inspection was used in the report. We sent six surveys to people who live at the home at the time of writing the report we had received two back. We spoke to professionals who have contact with the home. We also took into account the things that have happened in the service; these are called notifications and are a legal requirement. Care Homes for Older People Page 7 of 33 What the care home does well: People who wish to consider staying at the home have access to information, which tells them about the service and the care they will receive if they decide to live at Aspen Lodge. People will be fully assessed before they come to stay. This makes sure the service can give them the support and care that they need. People said the home had a friendly atmosphere and was comfortable. The majority of people living there were relaxed and content in their environment. Family and friends are welcome at the home and are encouraged to be involved in the care of their relatives. A relative said , I feel my mom is well cared for. She has settled well here. Another said, My husband is safe in here. There can be difficult times but the staff are very good and manage any difficulties. Health professionals and specialist services are contacted promptly if there are any concerns about a person. This means that people are kept as fit and healthy as possible They receive the treatment and care that they need when they need it. Any complaints or concerns are taken seriously and acted on promptly. This means that people are listened to and know something will be done if they are worried or concerned. I have had a few concerns over the years. But I tell the manager and she deals with it immediately. If people want to they can bring their personalised belongings to help them feel more comfortable and at the home. The menu provides residents with a choice of appetising and nutritious meals, which people said they enjoy. One person said the meals are good and there is plenty. They will try and get you whatever you want. The registered manager makes sure that the staff working at the home have been fully vetted before they start. This protects the residents. Staff are provided with the necessary training to assist them in caring and supporting for the residents in the safest way. From using the SOFI tool we saw that people are engaged in activity and with other people. We saw that staff interacted positively and with care and kindness. People are encouraged and supported to be involved in what is going on if they wished. One of the surveys we received said the home does everything well. It is a comfort to Care Homes for Older People Page 8 of 33 know my relative is well looked after. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 9 of 33 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 10 of 33 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 11 of 33 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 cannot be sure they will receive all the necessary information in a suitable format to assist them in making an informed decision about the suitability of the home. Prospective residents can be confident that their needs will be assessed, and that they will not be admitted to the home unless the home can meet these needs. Evidence: The home has a Statement of Purpose and a Service Users Guide. The Statement of Purpose contains a lot of the information needed. It sets out the objectives of the service. But there is some information missing. The Statement of Purpose did not give information about the services and facilities provided. Some of the information in the Statement of Purpose was more relevant to the Service Users Guide. The registered manager told us that everyone receives a Service Users Guide when they are thinking about coming to live at the home. A relative told us that they received information Care Homes for Older People Page 12 of 33 Evidence: about the home and what it has to offer before they made a decision about if it was the right the place. The guide contains information about how to make a complaint and about terms and conditions. The guide is not written in a format that would make it more accessible and understandable for the people who use the service. The registered manager said she would address this. The home has a pre-admission assessment procedure. We looked at three assessments of the most recent people to move to Aspen Lodge. We saw that the registered manager visits prospective residents in their own home, in hospital, or in their existing placement to carry out a pre-admission assessment. This helps the service decide on whether they will be able to offer the person the support and care that they need. The assessment looks at the prospective residents physical and mental health, personal care and social needs. It also looks at cultural and religious needs. The home will not accept any resident unless they are confident that they can give the care and support that they need. The home does not offer intermediate care. Care Homes for Older People Page 13 of 33 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 are provided with the personal and health care they need and are supported by a multi-disciplinary health care team. The ethos of care ensures that residents are treated equally and with kindness and respect. There needs to be improvement in the medication systems and procedures. Evidence: Since the last inspection the home has changed and improved the way it plans care for the residents. Plans are more person centred and individual. Each person has a care plan in which people can say what assistance and support they want and how they want it to be done. We looked at three of these plans in detail and at specific things in another plan. They give a clear account on the support and care people need and who needs to do what and why. They did reflect what people can do for themselves. For example they explained that a person could eat independently but needed to be reminded to eat slowly as there was a risk of him eating too quickly and choking. We saw that the Care Homes for Older People Page 14 of 33 Evidence: person was discreetly reminded to eat slowly and a staff member discreetly observed during a meal time. The plans also gave details on how best to support people with regards their nutrition, personal care, skin and how best to manage some behaviours. Residents skin integrity is monitored. Appropriate aids and equipment are available to prevent skin breakdown. People had special mattresses on their beds and they were sat on cushions that help prevent the skin from breaking down. Some people had cream applied to their pressure areas. We spoke to care workers and they were able to explain about the support and care they give to people and how they do this in a way that best suits that person. We saw evidence that they did this according to the individuals care plan. One person told us, the staff are very good and are always there when you need them. A relative said, the care here is very good. I know my mother is well cared for. She is happy here. She is very settled. Staff keep a daily record of what people do during the day. More information could be put in these so there is a better picture of how people spend their time and what significant events have happened. We saw that care plans are reviewed on a monthly basis. We found that sometimes people have visits from doctors or other specialists. A record of this is kept in a different part of the plan but we found that changes to care are not monitored on a daily basis and plans had not been updated. For example one person had a change to their medication as they were experiencing some pain. There was nothing written to show if this being effective or if it made no difference. The manager said that the plan would be updated at the end of the month. This means there is a risk of things getting missed. The manager told us she would address this issue. Health care needs of people are identified and they are incorporated into each persons plan. We found that in some cases there was no guidance in place to direct staff on what to do if a person experienced a deterioration in their condition. We saw that for diabetes there was no information in place to tell the signs and symptoms experienced by the person if their blood sugars went high or low and what action they had to take. Staff were able to tell explain what they would do. The manager said she would address this and incorporate the information into the plans. This means that any health problems existing or new problems will be quickly identified and the appropriate action can then be taken. Care Homes for Older People Page 15 of 33 Evidence: The home looks at ways in which people can be kept as safe as possible while at Aspen Lodge They have risk assessments in the individual care plans. This means that they have looked at areas which might present a risk and have taken steps to reduce this. The homes have been pro-active in reducing the numbers of falls to residents by having risk assessments and looking at all the reasons why people might fall. They have then taken the steps to prevent this happening. There are guidelines and directions for staff if people have behaviours that might present a risk to themselves or others. Each resident is registered with a local doctor and any area of concern related to health is referred to them. The home has contact with the district nursing team. The home also has contact with the local older peoples mental health team, speech therapists, the home treatment team and other specialists are contacted when they are needed. This means that people at Aspen Lodge are well supported and can easily access the specialist community services when they need them. Visiting professional reported the home offers a good standard of care. One care manager who had recently visited the home to do a review told us, she was happy with the care given to people. The staff contact her if there are any concerns. The care plans are followed and support is given in the way the person has requested. The residents have regular appointments with opticians, a chiropodist and dentists. Medication procedures were looked at. These have improved since the last inspection. All staff who administer medication have received training. We saw no evidence to show that their competencies are checked at regular intervals. The prescription sheets were all signed and no gaps were identified. Medication policies and procedures are in place. The medication being used is stored safely and at the correct temperatures. We did see that excess medication being returned to the pharmacy was not stored according to regulations. A lot of the peoples medication is given by using blister packs which are made- up at the pharmacy. This system reduces the risks of errors when giving out medication. However we also found that some medication which has to be given from the original packing was all stored together in one big container. This means that staff have to go through the whole box to find the medication that they need. Storing medication like this increases the risk of errors and also is not treating Care Homes for Older People Page 16 of 33 Evidence: peoples as individuals and holistically. We saw there was no guidance or direction for staff on when to give medication on when required basis. This means that there is not a consistent approach by staff. People cannot be sure they will receive their medication when they need it and they cannot be sure they will not be given medication when they dont need it. There was no monitoring system when pain relief was given to people. As the resident group have varying communication difficulties, staff would be expected to observe and record the effect of such medication. The registered manager told us she would address these shortfalls. We found that the home did have evidence in place to show that they check the ability of people who self medicate. There was a risk assessment available for one resident who is self medicating. There was evidence in the care plan to show how this was being managed to make sure the person was supported and monitored. All creams that are prescribed by the doctor are now administered and signed for on the prescription sheet. Since the last inspection registered manager has given a lot of attention to how the residents are respected and treated and how their privacy and dignity is upheld. We observed that staff are polite courteous and attentive to the residents. Staff spoke quietly and politely to people. They were discreet when supporting people from the lounge to the bathroom. We saw that they knocked on doors before entering peoples rooms. Residents and relatives told us that the staff are very approachable and obliging. Care Homes for Older People Page 17 of 33 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. The home does provide the residents with opportunities and facilities that enable them to maintain an appropriate and fulfilling lifestyle in and outside the home. Family links are encouraged and maintained wherever possible. The home provides nutritious and varied meals for the residents. Evidence: We conducted a Short Observational Framework for Inspection (SOFI) for 1 hour 20 minutes during the visit. This was to look at the daily life and social activities experienced by the residents. We were looking for the quality of staff interaction with residents and how often people had meaningful contact with staff. We regarded activities not only as those that were laid on by staff, such as arm chair exercises, but being happily occupied, such as speaking with other residents or enjoying listening to music. We found that staff were friendly and attentive. We saw that most of the residents had some opportunity to have quality contact with staff, through support with meals, or conversations. We saw that staff were kind and patient when helping people with personal care. During the observation everyone was included in conversations no-one was ignored or Care Homes for Older People Page 18 of 33 Evidence: left out. During the observation we saw a lot of people smiling and people were engaged with an activity or another person. Some people dozed for short periods but as soon as they woke -up they were included in what was going on around them. People displayed signs of confidence and well-being. Interactions with staff were respectful and marked by warmth and concern for the persons needs and well-being. There was a friendly, relaxed and welcoming atmosphere on the day of our visit. We saw that their was a range of things people could do and records showed that people did different things. On the day of the visit arm- chair exercises took place in the morning. Most people participated and were encouraged and supported to join in. In the afternoon there was a sing-a-long and people said they enjoyed this. One person told us there usually something going on here, you can have a goodtime. We saw that people were offered a choice on whether they joined in or not. Some people preferred to stay in their rooms. Some residents did tell us that they go out at times. Some said they would like to go out more. We spoke to 2 relatives who were visiting people. They said they are made to feel welcome at the home at all reasonable times and no restrictions are imposed. People are able to see their visitors in the privacy of their own rooms or in the communal areas. One relative said this might not be the smartest place but the care is very good. Another said, I feel confident about how they look after my husband. They are so patient and kind. The people we spoke to felt they are able to have some choice in regards to their day to day lifes. Examples given were that they could get up and go to bed when they liked. They could choose what to eat and where to eat their meals. Generally they felt happy with the choices they are offered. The home is demonstrating how it offers more diverse choices to people so they are encouraging them to be as independent and in control of their lifes. The home employs 2 cooks who cover the kitchen 7 days a week. The service told us that they have a 4 weekly menu and an alternative choice of meal is always on offer. Special diets are catered for. Residents said they enjoy their meals and there is always Care Homes for Older People Page 19 of 33 Evidence: enough to eat. A record is kept of food eaten by the residents. This will ensure that any dietary problems are quickly identified and the appropriate action taken. During our observations just prior to lunch, during lunch and for some time after, we saw people be served with hot and well presented food. The cook had a full understanding of each persons nutrition. Those who needed bowls or spoons, rather than knife and fork, had their needs met. Some people chose to sit in the lounge for their meal, and staff were flexible in adjusting their support. Staff supported and observed people throughout the meal. Encouragement was given and peoples choices were respected when they did not want to eat any more. One person decided that they did not want a cooked meal and chose to have sandwiches instead. After lunch, all residents were supported back to the large lounge or to their rooms depending on where they wanted to be. Care Homes for Older People Page 20 of 33 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. The people who use the service are confident complaints will be listened to and dealt with appropriately. People who use the service are protected from abuse. Evidence: The home has a complaints procedure which is available to the people who live at the home and there families. We spoke to a service users who told us If I was worried about anything I would tell Sharon the manager. She sorts things out. A relative told us that she has had a few concerns in the past and has spoke to the manager and they were dealt with immediately. There has been one complaint made to the home in the past 12 months. This was dealt with according to the homes policies and procedures. An outcome was reached and we saw evidence of this at the visit. The AQAA told us Aspen Lodge now provides more support for the families of the service users. There is up to date information available. The home fosters open , honest relationships with relatives so they feel they can talk to us about any worries or concerns they may have. Care Homes for Older People Page 21 of 33 Evidence: The home told us that it has policies and procedures relating to safeguarding adults. The staff have received up to date training in safe guarding adults. Staff were able to tell us about abuse and what they would do if they suspected or evidenced that someone was not being treated as they should be. Staff told us they knew about the whistle blowing policy. The homes recruitment procedure includes undertaking formal checks to ensure that potential employees are suitable to work with vulnerable adults. The home has policies and procedures in place to assist in and support people to manage their finances. The policies and procedures protect people from financial abuse. Care Homes for Older People Page 22 of 33 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 service continues to improve and maintain the environment to provide people with a comfortable, homely and safe place to live. On the whole the residents benefit from a clean and homely environment. Evidence: We looked around parts of the home. The residential accommodation in the home is set on the ground and first floors of the building. There is plenty of communal space to meet the needs of service users with separate dining area, lounge and conservatory on the ground floor and a small lounge on the first floor. The registered manager told us she has plans to develop this into a sensory room as it not used very often. There is a pleasant out door space, which people can enjoy in the better weather. There are 3 assisted bathrooms available in the home plus a shower room, and a total of 11 toilets. 4 of the bedrooms are fitted with en suite toilet facilities, all other rooms are fitted with a wash hand basin. Residents bedrooms are comfortably furnished and are personalised to meet their individual needs. Residents we spoke to said that they like their rooms and they can furnish their rooms however they choose. One lady said, I have everything I need here. I have bought in bits and pieces from my old home. Care Homes for Older People Page 23 of 33 Evidence: The service employs a maintenance person. He does general maintenance around the home when it is needed. The service now has developed a planned maintenance and renewal programme with timescales for the ongoing up- keep and improvements within the home. The service has recently up-graded and refurbished the kitchen. Bedrooms are being redecorated when it is convenient to people. The registered manager has plans to replace carpets and furniture to make the environment more suitable for people with dementia. We did see that the home provides the necessary equipment and aids to meet the needs of the residents. 2 large hoists are stored in the lounge area. This did detract from the homely and conducive atmosphere of the lounge. The home is clean and hygienic with no unpleasant odours. Procedures are in place to control the spread of infection There are the facilities available in all the appropriate areas for hand washing and the home has the appropriate facilities for the disposal of clinical waste. There is a laundry room and soiled laundry is transported correctly in red bags and washed at the appropriate temperatures. Care Homes for Older People Page 24 of 33 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. There are adequate numbers of staff with sufficient training and experience to meet the needs of the residents. The staff have a good understanding of the residents and positive relationships have been formed. Recruitment practises protect residents Evidence: We looked at the duty rotas and spoke to residents, staff and relatives. From this we were able to see that there are enough staff on duty throughout the day and night to look after the people. There are staff shortages at times and the services in the process of recruiting new staff. In the meantime existing staff are covering the gaps. We also saw that a lot of training has been provided by the service. Staff have now completed mandatory and specialist training. The registered manager is also accessing diabetes training from the district nurses. This should provide staff with the skills and knowledge to help them look after and support residents in the best possible way. We did find that staff competencies are not being checked. This means that staff may not be providing care in the way they have been trained. Staff told us that, the home has improved over the past four years. Care Homes for Older People Page 25 of 33 Evidence: There is a good group of staff. We are here for the residents. We get the training we need. We have just had safe guarding training. New staff receive an induction which they first start work at the home this is linked to the Skills for Care programme. The service told us that over 50 of staff are trained to NVQ level 2 or above. During the SOFI observation we saw that staff are caring and kind. They interacted with service users throughout the visit. They supported people to be involved in what was going on. They continually checked if people were alright and if they wanted anything. Staff approaches were seen to be consistent and in line with what was written in peoples plans. At the visit we saw peoples needs being anticipated and promptly met by staff. We noticed that two people who asked to be helped to use the bathroom were assisted straight away. When people asked for a drink they where responded to quickly. We looked at three staff files. These were the files of the most recent people who have started work at the home. One of these had a completed application form but 2 did not. The manager had not been involved in the interview process of the 2 staff members. The registered manager told us this was because the staff had been employed through an agency by the provider. This means the manager was not able to assess the suitability of the staff before they came to work at the home. We did see and were told that the staff had fitted in well within the home and had the skills and knowledge to look after the people living in Aspen Lodge. The registered manager told us she would review this procedure. The files did contain safety checks and references. There was also a record or interview questions and responses. We did find that a full employment history had not been obtained and none of the files had a up- to date picture of staff members. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home needs to be effective to make that the people in the home are safe and receive the care that they need. Residents cannot be sure that their health, safety and welfare is promoted and protected. Evidence: The registered manager of the home has the necessary qualifications, skills and experience to manage the home. Residents, staff and relatives reported that they thought the manager was good. They said that she listened to what they said and acted on it. Since we last visited the home there have been improvements especially in the care planning and medication procedures, staff attitudes and staff training. We did however find shortfalls around fire precautions, safety checks and procedures. This has left people at risk. These shortfalls were identified at the last visit. Some steps had been taken to address this shortfall but they had not been consistent. The manager has not made sure that the necessary tests of fire equipment have been Care Homes for Older People Page 27 of 33 Evidence: done. We found that fire alarms had not been tested at the necessary intervals. Emergency lightening, fire fighting equipment and fire exits had not been checked to make sure they were safe and working. We also found that there was no evidence that the home had done a fire drill. This shortfall has been reported to the local fire office team. A full fire assessment of the building has been completed We also found that the homes were not regularly checking the water temperatures in bathrooms. The manager told us this was because each hot water source is thermostatically controlled. She said that each bath temperature is recorded by staff before people are bathed. This does not make sure that people are safe if they go into the bathroom alone. We received an AQAA from the home when we asked for it. However some of was not sufficient to assist us with parts of the inspection process. The manager had not taken into account the shortfalls identified at the last inspection and did not tell us in the AQAA how these had been addressed. The AQAA did tell us that all the relevant checks and inspection of equipment and gas and electric systems have been done. The manager told us that she plans to circulate quality surveys to residents, families and visiting professionals next month. There was no evidence to show that the results of last years surveys have been collated so the strengths and weaknesses of the home were identified. The homes are not measuring how they are improving the service it provides for the residents. The people who use the service are not being told about the outcomes of the quality assurance and how the home plans to develop and improve. The registered provider of the service visits the home at regular interval to make sure the service is meeting the required standards. None of the shortfalls identified in this outcome area have been identified at the provider visits. The registered manager is not doing regular audits on the systems used within the home to make sure peoples health and safety is being protected. Because this is not being done important things are being missed and overlooked. Financial procedures are in place to safeguard residents monies. There is a staff supervision procedure in place and staff confirm a minimum of six supervisions and an appraisal take place annually. Care Homes for Older People Page 28 of 33 Evidence: Care Homes for Older People Page 29 of 33 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 33 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 33 24 The registered manager 30/11/2009 needs to make sure that there are effective quality assurance and quality monitoring systems in place. The views of residents or representatives, stakeholder need to be taken into consideration to improve and measure success in achieving the aims, objectives and statement of purpose of the home. To make sure the service is improving and run in the best interests of the people who live there. 2 38 23 All fire safety checks and drills need to be done at the required intervals To make sure the people living at the home are safe and staff have know what they have to do in the event of a fire. 30/09/2009 Care Homes for Older People Page 31 of 33 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 Care Homes for Older People Page 32 of 33 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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